My wife underwent Right Mastectomy, His to pathology report is as under:

pTNM -m

pT: pT2

pN :pN -

E Cadherin -Negative

a)Estrogen Receptor (Dako-1D5):Positive(7/8);(Allred)score

b)Progesterone Receptor (Dako-PgR636):(4/8);Positive (Allred)Score

c)Hercept (Her-2)Score (Dako-K5204)-Negative

Nottingham's Prognosis Index -3.70

Impressions:Right Mastectomy

-Invasive lobular carcinoma, grade 2.


-Maximum invasive size of tumor -35mm

-3 Sentinal nodes are free of tumor; (0/3)

Could Dr guide me the future course? Is camotherapy required in this case..!We are based in Gurgaon & age of patient is 52.With lot of hopes from the community especially Dr Smith. Rgds.

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15 Replies

  • Just based on the reports, it's difficult to say, since we always prefer to assess the patient and then take any decisions.

    Anyways, your wife's report is definitely very good, that's why this confusion whether to give chemo or not. The sentinel nodes are negative, the ER is positive, HER2 is negative. The point which favours chemotherapy is the size (3.5 cm). In young patients (such as your wife), sometimes cancer behaves unpredictably. Hence, in these situations, we assess many other factors and the other points in the histopathology report, we do a Ki 67 test and then consider whether to give chemo or not.

    I can understand the apprehension you and your family members must be having, but I can tell you, don't worry, your wife will do very well. Such early stages have good outcomes.

    All I can tell you is, sit with your Medical Oncologist and understand the whole situation and then take the call. If there is some confusion, you can always take another opinion at your place.

  • Thx Dr for your valued response, will follow your advice & will bother you after meeting Medical Oncologists.


  • Dear Mr Mittal,

    You wife has indeed very bravely been through the first step- surgery and based on the information you ve provided, pT2NoM0 Gr 2 ILC , ER/PR +ve, Her2-ve, here are my few thoughts

    Your wife, has a 44% chance of relapse in the next 10 years, with no additional treatment.

    Chemotherapy on its own may benefit by reducing this risk by 14%, whilst Hormone Therapy on its own may help by 21% (Combining these two, the anticipated benefit = 30%). This means, despite having chemotherapy + Hormones, her risk of relapse will be ( 44% - 30% = 14%). This is the best we can achieve.

    In terms of mortality, there is a 24% chance your wife may die due to breast cancer in the next 10 years, with no additional treatment at this stage.

    With chemotherapy on its own , there is a 7 % survival benefit. With Hormone therapy on its own, there is a 6.5% benefit. If we combine both, the anticipated benefit = 12%. This means, despite having both chemotherapy + Hormone therapy, her risk of dying due to breast cancer will be (24% - 12% = 12%). This is the best we can achieve.

    Your wife will need ongoing follow up with your oncologists for at least 5 years, possibly these days for upto 10 years.

    You need to consult a qualified Medical Oncologist, who will explain these statistics in more detail and discuss the pros and cons of undergoing chemotherapy and Hormone therapy. There are a variety of chemotherapy regimens which oncologists prefer, but the bottom line would be, your wife may be offered 6-8 cycles of chemotherapy.

    She would need Hormone therapy for 5 years thereafter, assuming she is post-menopausal.

    She does not need any Radiotherapy.

    I wish you and your wife, all the very best in your Oncology journey

    Dr Rohit Malde

    Consultant Clinical + Radiation Oncologist

    BNH HCG Cancer Centre

    Nanavati Hospital


  • Thx so much Dr. Rohit for your enlightened response,my wife underwent Hysterectomy also in year 2000(Age 38 years) & one of the overy too was removed.No other complications at all.Can this be the cause or added cause for being caught...? Could you pl. further advise in view of this factor.Rgds.

  • No problems. There is no concern.

    She may need to have S. Estradiol Test to confirm the levels are < 50 mcg / ml, only then Hormone Therapy tablet called Letrozole will be added.

  • Today met the Medical Oncologists & he suggested to go for RT-PCR gene Assay,we are bit confused about the utility of this test...!Any guidance Dr Sumit/Malde pl.Rgds.

  • Dear Mr Mittal,

    Yes, your oncologist is one step certainly ahead and has very appropriately recommended and offered this test.

    There are basically two such tests, Mammaprint (70 gene assay) and Oncotype Dx (21 gene assay). These tests check the genetic make up of the cancer, and predict the likelihood of relapse, and help further refine the call whether to have chemotherapy or not.

    If you can afford that test, and /or your wife is keen to to know whether chemo could be avoided or not, this test will certainly help you make that decision easier.

    Pls go thru these links of our forum to get more information on this test.

  • Thx Dr Sirs so much for your kind & valuable advice..!

    But as Dr Sumeet suggested,can Ki67 give some indication & this can be relied.Pl guide.Rgds.Ram Mittal

  • Today consulted the medical oncologists again & Dr recommended Chemo -AC-6 cycles thro' PICC Line,Pl guide

    1)Any side effect's of PICC Line & would the patient be able to function normally with that arm in which Line is inserted..? Any word on its cost pl.

    2)Should we prefer Chemo-Port over PICC Line & why ?

    3)Would all sessions of AC are preferable or mix of AC &EC...

    Kindly respond.Rgds.

  • For node negative Breast cancer, AC Chemotherapy regime or EC Chemotherapy regimen seem perfectly reasonable and acceptable.

    PICC Line or ChemoPORT both are options for easy chemotherapy delivery.

    Just type PORT in the box titled Search healthUnlocked on this forum, and you will find nearly 28 useful blogs, and can get valuable patient experience.

    PICC Line is inserted into the arm AND more or less has same risks of infection, misplacement, clots etc. But Biggest advantage of PORT over PICC is that PORT is under your skin and not visible, whilst the PICC line is hanging from the arm (of course its strapped) and one needs to take slight care. This of course comes at a substantial cost, which may or may not be covered by Mediclaim (please correct me, if any one has got their claim approved for PORT).

    PICC line may cost a few thousand bucks, whilst PORT would be 40K - 90K, based on what device, which surgeon and which hospital does it.

    Every cancer centre is different, some are more comfortable using PICC, whilst some are more comfortable using PORT. If cost is a concern, PICC is perfectly acceptable. Whilst if money is not an issue, go for the PORT.

    All sessions of AC or All sessions of EC are preferable, and there has been no trial till date anywhere in the world which has ever combined or mixed these two regimens.

    I wish your wife all the very best for her treatment, and feel free to seek help from our members should she need any support- emotional , wig support, or support in managing side-effects should you be struggling with this.

    Good Day !

    Dr Rohit Malde

  • Greatful Dr Malde for a elaborate response & this forum has given lot of guidance n emotional support, Sir.Seek the blessings of you all.

    May God bless the patient;

    May God bless the Doctor..!

  • My wife underwent Mastectomy on 25th July & advised 6 sessions of AC chemotherapy,what's the ideal time to start Chemo..?Would it be OK if the 1st session is taken on 28th Aug or so...!Rgds.Ram Mittal

  • Dear Ram,

    As such there is no predefined time frame for starting the chemo after mastectomy but the recommendation says better to start within one month...there is so many factor need to be consider before starting the its ok to start the chemo on 28th aug.



  • Thx Dr.Rgds.Ram

  • Shashi(Wife) underwent 1st Chemo on 24th Aug (Advised 4EC)(Epirubicin:75mg/m2 IV & Cyclo phosphatase:600mg/m2 IV) thro' PICC ,lot of weakness despite taking Peg Grafeel 6 mg on 25th Aug,not able to eat any food(very poor appetite) though taking 1000-1500 ml of fluids.

    Can any medicine help in restoration of her appetite??

    2)What's the role of Peg Grafeel?Very costly and We understand, it is to be taken after every Chemo..!

    Pl guide.Rgds.Ram

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