Stage 2 Breast Cancer with Lymphovascular Invasion.

[cec4111]

Dear all, After a routine check up we found out that my mother aged 57 has been diagnosed with Stage 2 Breast Cancer. This news comes with great pain to our entire family.

Her PET Scans reveal no other locations infected.

She had a surgery lumpectomy and we received the pathology reports.

These are the findings in the report:

Invasive Carcinoma: Ductal

Grade: II NBR Score (2+3+2 = 7)

In Citu Carcinoma: Present

Type: Ductal, of Comedo, cribriform, solid type, intermediate grade

Lymphovascular Invasion: Present

Perineural Invasion: Not seen

Infiltrating Borders: Present

Lymphocyte Response: moderate

Desmoplasia: Intense

Elastosis: Present

Necrosis: Present with in Comedo duct

Excision Margins: Does not reach margins

ER Receptor: AllRed 5+3=8

Progesterone Receptor 0+0 = 0

HER2: Tumor cells are negative

Ki67= 15%

The recommended fixative is 10% NBF.

Doctors suggested 4-6 rounds of Chemo and radiation.

Please let me know how bad is Lymphovascular Invasion and if we are having the right treatment. Also I hear lot of stories about Chemo side effects. Please suggest how to cope up and prepare for that, our family is definitely going through tough time right now.

[tiger72]

Dear cec4111:

Please wait for the doctors reply. Please stay positive & strong. Regarding side effects of chemo, there is a separate section on Chemotherapy , please go through the various posts in the section which will help you with all details.

If you still have questions, we all are always here for you. If you feel like talking please feel free to do so. Your mother will be fine.

Take care,

Regards,

Tiger72.

[roxboxfox RadiationOncologist]

There ia no mention of the size of the cancer

Has your mother had an axillary clearance or sentinel lymph node biopsy ???

If nodes are positive, she may need ct scan staging before jumping to chemo

She would need 2D ECHO to determine which is the ideal chemo for her.

Dr Rohit Malde. MD, DNB, FRCR (UK)

Consultant Clinical Oncologist

[Deval]

Dear Cec4111,

Oncologist can guide you on type of treatment your mom needs. I have gone through chemotherapy myself recently, I have posted in this form how to avoid side effects in chemotherapy, may that will be little helpful. Also I am sure if you google it there are so many web sites which can guide you with side effects of chemotherapy.

What I can tell you from my personal experience is yes with chemotherapy you loose hair, but with nausea and vomiting is not as bad as I was scared. First 24 to 48 hours after Adriyamycin dose I did feel some nausea but it was very well controlled with anti nausea medication. With second phase, taxol there is no nausea, you also start getting hair back once adrimyacin is done. I am sure everyone reacts differently with medication , but it's not as bad as I thought. Good nutrition, rest avoiding infection , positive attitude, faith fiends and family makes a huge difference.

I hope this helps.

[cec4111]

Thanks Deval,

Dear Rohit Malde sir,

Here is the Biopsy report.

Clinical Diagnosis: Left Breast, Birads Lesion

Specimen: TRU Cut Biopsy of Breast Lesion, Left

Macro: Four Cores measuring 1.5*0.1, 1*0.1, 1*0.1 and 0.5*0.1cm

All embedded in one block

Micro: Section shows four linear cores of tissue with tumor tissue arranged in nests, cords. cribriform pattern with extensive desmoplasia. Individual tunor cells, show moderate pleomorphism, hyperchromatic signet ring cell features.

Impression: Invasive ductal carcinoma (NOS) Left Breast.

Advised: ER, PR, HER 2 neu

Above is her biopsy report.

Doctor at HCG Oncology in Bangalore suggested 6 rounds of Chemo and radiation. Chemo starts Oct 5th with 21 days gap between cycles and radiation after that.

She had a Lumpectomy surgery on Sep10th.

This is the hispathology Report after surgery:

Level I axillary node

No.of lymph nodes examined-2

No.of lymph nodes involved-1 without extracapsular extension

Level I & II axillary nodes

No.of lymph nodes examined-6

no.of lymph nodes involved-nil

Extra posterior margin - free of tumor

Extra medial margin - free of tumor

IMPRESSION: Invasive ductal carcinoma, NOS type grade II of left breast with free margins and involved regional lymph nodes without extra capsular extension.

Pathologic stage: pT1N1a

Left breast lumpectomy for FS + Level I axillary node + Level I & II axillary node.

Extra posterior margin + Extra medial margin.

[sumeet_shah Administrator]

To add to Dr. Rohit Malde above, now that you have given us the full report, the answer is clear:

Chemotherapy is needed since one node is positive. Number of cycles and type will be decided by your medical oncologist as it needs detailed assessment of patient and her status as well as receptor status and ki 67 report.

Radiation therapy is also needed since this was a breast conservation surgery. I am sure your doctor will have told you before surgery only since for all lumpectomies, radiation is compulsory.

After chemo and radiation, she will be started on hormonal therapy tablets.

Most people tolerate chemotherapy quite well, so don't worry. Just follow your oncologist and all will be fine.

[cec4111]

Thanks Dr Sumeet Shah,

I appreciate your time and help. Its always convincing to have a second opinion about the treatment procedure followed. Hope my mom recovers and be healthy soon.

Thanks.

[kontak TeamBCI]

Yes we all pray for your Mother to recover soon

[roxboxfox RadiationOncologist]

Agree with Dr Sumeet

You re on the right track.

Chemotherapy

Radiotherapy

Hormone Therapy

All are needed. Follow your oncologists advice and if you need more info, scroll through the search engine of this website and you ll find loads of useful tips, resources and help from our lovely members on this group.

Wish u all the best in your long oncology journey.... Which dont worry will pass away and you ll be a cancer survivor.

Dr Rohit Malde

[cec4111]

Thanks Dr Rohit Malde and Sumeet Shah,

I was also informed about CTC test and Chemosensitivity test. I couldnt find much information about it online. Are these necessary to determine what type of chemo needs to be given? Are they available in India? I know Oncotype DX test is not valid for us as one node tested positive. Please suggest if we need to have a CTC and Chemosensitivity tests if they are required.

Thanks,

CEC4111