Need a suggestion

[Simone1422000]

One of my relative had a lupectomy few weeks back and her histo pathalogical report is as follows

Mixed infiltrating carcinoma of no special type and infiltrating lobular carcinoma with lobular carcinoma insitu and atypical ductual hyperplysia grade I

Maximum tumour dimension 1.5 cm

Lymphovascular and pernueral invasion not identified

Mild lymphophytic response

All resected surgical margins and skin are free of tumour

ER and PR positive

HEr2 neg score 0

All lymph nodes are free of tumour

So with this impression my question is

Does she has to go for chemo or just radio therapy will do?

We are going to talk to the ongologist . This is just a question

Thank you

[Hidden]

Hi,seeing this report, I think the patient will be given only hormone therapy. Lucky. Caught it early. I'm sure , everything will be fine.

[Simone1422000 in reply to Hidden]

Thank you for your reply.

[Simone1422000 in reply to Hidden]

Thank you for your reply. Much appreciated.

[sumeet_shah Administrator]

The report is good. It would not be possible for us to comment whether she will or will not need chemo as a few other factors need to be considered. I suggest that you consult your Oncologist in detail and follow whatever he / she says.

[Simone1422000 in reply to sumeet_shah]

Thanks we did consulted our 1st oncologist. He recomended us to perform biopsy again and also gene 21 test then we will decide whether she need chemo or not?. We however will also go to another oncologist for second opinion. How reliable is gene 21 for reoccurence?

[kaarenorgaard in reply to Simone1422000]

Hi Simone,

This looks good, the data you have supplied.

Your relative will have to take an anti-hormone medicine for at least 5 years. Whether chemo therapy here in the beginning is also recommendable is what the test can say (The question is whether the cancer is (1) sufficiently hormone sensitive and (2) the cell division is sufficiently low that the anti-hormone medicine can do the job of killing any small cancer cells that are most probably in the body remote from the original cancer, that is now removed and where any residual cancer cells locally will be killed by the radio therapy). The anti-hormone medicine will always be there. If chemo therapy is also the be had, it will most likely come before the radio therapy.

That 21 gene test is called Oncotype DX and it is the world leader - it is a product delivered by Genomic Health (USA), and the biopsy is sent to their labs for analysis. It is generally considered the best and most reliable test to determine whether chemo therapy is necessary.

That test is probably the single most information giving thing you can do now. But it is expensive (USD 4,000, maybe more). The things to further know besides the test result are whether the person is (1) post- or premenopausal [which determines the kind of anti-hormone medicine], (2) the age, (3) any family history, and if you don't perform the test, (4) what are the % scores of ER and PR positive (is it by more than 10%)?

Feel free to post that information. Also I have the algorithm by which Oncotype DX works and a lot of information about gene testing if you are interested...

Kind regards,

Kaare (from Denmark)

[Simone1422000 in reply to kaarenorgaard]

Thank you for the detailed information. This is so kind of you. I have a question what is your interpretation if ki67 score is 10?

[kaarenorgaard in reply to Simone1422000]

Hi Simone,

Ki67 score of 10 is right at the border between low and intermediate, so rather good.

But the 21 gene test makes a more precise evaluation taking into account the gene behind the (apparent) Ki67 score.

What are the ER (and PR) scores, if you have them?

- Kaare