Breast Cancer India
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My Sister diagonized Invasive Ductal Carcinoma Grade 3

Recently diagnosed IDC Grade 3

(As per report)

3 weeks back my sister diagnosed with Lump in breast area. she is only 33 years old.

Surgery was done and removed tumor measuring 2.0 cm from her right breast.

Histopathy path reports says - its invasive DCIS cancer and all the lymph nodes are negative.

A) Left Sentinel Lyph node, biopsy(Frozen section):

Three lymph nodes are identified, negative for malignancy(0/3)

B) Left Breast, Left Lumpectomy:

INVASIVE DUCTAL CARCINOMA, Grade 3.

- Modified Bloom Richardson score is 9(3+3+3)

- Tumour measuers 2.0 cm in greatest dimension.

- Lymphovasuclar invasion is not identified.

- Perineural invasion is not identified.

- DCIS component is not identified.

- All the margins of resection including skin are free from tumor.

C) Revised deep margin: Negative for maligancy.

D)Revised medial margin: Negative for maligancy.

Doctor is advising for chemotheraphy and radiology for treatment. Pls advise as chemo is required in this type of case.

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We will surely guide you. Our request would be, first please understand the reasons from your doctor, about why the chemotherapy and radiation have been advised and then get back to us. All you have to do is, request your doctor as to why chemo and radiation are advised, what criteria has he considered; and knowing that, we will help you. We can very well answer this question, but that won't suffice; By asking you to do this, we wish to encourage an active discussion and understanding between you and your Oncologist, which, I feel, is lacking, as you do not know why they have advised the same; the same question which you asked us, I request you to ask your Oncologist, and get back to us.

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Ashok - chemo and radiation will be a must - pl consult your oncologists

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this is always difficult to have a patient of cancer in the family but today with latest technologies things are easy to go over

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Thank You Sumit Shah, Kontak . We will discuss with them in detail.

Thank you Madhu I will also look for 2nd opinion and will discuss again on the issue.

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Your are very thorough on reporting information. However there is some key information missing, which I am sure you are your doctors have: What are the receptor statuses (A and B below):

(A) What is the status regarding hormone receptors, i.e. what is the Estrogen Receptor (ER) level, is it positive (and by which percent)? Called ER positive or ER+. Or ER-, if the percentage is zero.

(B) What is the status about the HER2 ("Human Epidermal Growth Receptor 2" - but the abbreviation is usually used as it is, HER2): Is it positive? It probably isn't, because then the chemo therapy proposed would have been supplemented with a medication called Herceptin (or a substitute for it) which you must be taken for e year (whereas chemo is typically for 4 months or so). Called HER2 positive or HER2+. Or HER2-.

Chemo therapy is probably advised for these reasons (1 and 2 below):

(1) Since she got it young, it is probably aggressive (otherwise it normally comes later in life; but breast cancer strikes 1 in 8 women in the US and in the west in their lifetime)

(2) The Bloom Richardson score was maximum on all parameters, and this suggests the cancer is aggressive

If it is also ER+ or HER2+, extra medicines come on top of (some overlapping, some after) the chemo. Presumably this is not the case, since your doctors seem not to have mentioned it.

Medicine is required for all invasive cases - because since the cancer has "invaded" beyond its local site, there are cancerous cells all over the body but hidden and not yet dangerous, but they must be killed. It's called "systemic therapy" - a doctor speak for something that targets the whole body.

Please report the status of ER and HER2 - it is key to understand the situation (together with all the other information you have supplied).

Radio therapy always comes into question when a Lumpectomy is performed (a breast conserving surgery) - because the tissue that is not removed is likely to have cancerous cells that will be killed by the radiation (and are not sufficiently killed by medication). This brings the overall risk down to the same level as if they had removed the whole breast. It's called "local therapy".

Kind regards and best of luck

- Kaare (from Denmark)

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Thank you Kaare for taking your valuable time and briefing it so aptly.

The other details as sought are as follows:

Antibodies to clone Result.

Estrogen Receptor (ER) EP1 Not Detected

Progesterone Receptor(PR) SP2 Not Detected

ER : Negative

PR : Negative

HER-2/Neu ONCOPROTEIN

The Doctor told that cancer was aggressive and suggested 8 Chemos and radiation.

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Impression: for HER2

Test Negative for Her 2 / Neu oncoprotien over expression

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Hi again,

Given that it is ER and PR negative (i.e. hormone receptor negative) as well as HER2 negative, then no other medication than chemo therapy will work on killing the cancer cells that may have spread to the body. And that medication is necessary.

This kind of cancer is called "triple negative breast cancer" - in that the 3 receptors, ER, PR, and HER2, are negative.

Furthermore, as you say, it is aggressive. You can also see that from points (1) and (2) in my previous comment.

So chemo therapy is absolutely required. But all the parameters are good, and the cancer is small, hasn't spread etc. So there is a good outlook.

You can see much more, if you Google "triple negative breast cancer", e.g. breastcancer.org/symptoms/d...

Kind regards,

Kaare

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By the way, please be aware that you have specified a confusion of LEFT and RIGHT - hopefully these are just in your words...

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Thank You Kaare sir, Now I understood the treatment and will go for chemo therapy as suggested doctors and clarified by you. I am very comfortable and able to confidently explain the treatment to my sister. I am indebted to Kaare sir for clarifying my doubts in very lucidly to me. I am also thankful to each one of you who work for this wonderful forum, which has made us confident to fight against cancer. My Thanks with folded hands... Ashok

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I was just going through the communications between ashok99999 and Dr.Karenorgaard while looking for some online help/advice through this forum for some help for a relative whose case is more or less similar with the difference being ER is positive 10% ,PR : negative HER2 Neu is 3+. Before posting my queries in detail I would like to convey to Mr.Kaarenorgaard , I am absolutely impressed by the way he clarified things and in the easiest way possible to understand for a layman. I am also absolutely impressed by the fact that he had brought out the left right difference , which even many of the readers on this forum would have missed , indicating clearly that how thoroughly he studied the query and then advised. Hats off to you Sir.

Now my report says the following sir, if you can help please.

Patient: female Age: 49 yrs Weight : 53.2 kgs

Diagnosis : CARCINOMA LEFT BREAST ( T2N1M0 ) ER - POSITIVE :

PR- NEGATIVE : Her2- 3 POSITIVE

NOTE : History : no family H/o malignancy

Underwent Left MRM on 20.04.2018

HPR- Invasive Duct Carcinoma ( IDC ) Grade 3

: ( 2.8 x 1.6 x 1,5 cms ) : No LVE/PNI : 3/13 LN +ve

ER : Positive 10% : PR - Negative : Her2 - 3+ ( T2N1M0 )

2D eCHO - Normal : LVEF - 65%

Clinical Exam :

Wt - 53.2 KGS : Ht - 141 CMS : BSA - 1.44m2

Advice :

1) FEC x 3 cycles followed by Taxanes x 3 cycles

2) TCH x 6 cycles followed by Maintenance therapy with Herceptin for 1 Year.

The reasons for seeking advice:

The surgery was done by a doctor , different from this adviser above , who suggested the advisers name for cutting cost of chemo which was high in the hospital he works. Since the operating doctor did not advise as above but only 4 ~ 6 chemo cycles , the close family members knee jerk reaction is assuming that the suggested doctor is adding to the cost of the treatment by advising to follow additional treatments which is further adding to the already high cost of treatment.

Seeking your kind advise whether the treatments are additional ( I am already almost decided that it is mandatory from the previous advise you gave to ashok99999 ) which can be done away with or curtailed or all the treatments are mandatory and have to be followed , immaterial of any circumstances.

Thanks Sir

Lalith1971

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Dear Lalith,

Yes as suggested by Dr.Karenorgaard and the treating doctors Chemo is must in our case and we had given 8 Chemos with gap of 15 days for each. Later the doctor has given 16 days radio-therapy and 5 Days some electrons treatment. She is absolutely fine and back to normal.

Tell your sister Nothing much to worry about chemos, the effect will be temporary like loosing hair and weakness. Now her hair is back and very normal. Wish your sister a speedy recovery. I am always indebted to Dr. Karenorgaard for his useful guidance. Hope you also get soon.

Regards,

Ashok

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