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Q: 

IDC breast carcinoma

A: That is too early to tell yet. If the pathology report of his lumpectomy shows only a small cancer that has been completely removed then all I would suggest would be postsurgical radiation therapy. Please let me read his pathology report when available. You can copy it here. You can also reach me on: http://www.lifestylerescue.com/expert/health-fitness-advice/dr-claes-gustaf/128     There is no restriction to the number of questions there.  ...


Q: 

My 87-yr-old mother (non-smoker, non-drinker, has HBP and osteoarthritis) recently found a lump at 10:00 o''clock on her left breast and just had a partial mastectomy to remove it. As of this writing, she has not seen an oncologist - only her primary care physicianm (who is also a surgeon, and performed the surgery), who is now referring her to an oncologist. Following is the Surgical Pathology Report diagnosis. I did not include the Surgical Path Consult or Gross Deion sections of the report.Based on the following report, what does it all mean, and what would be the recommended course of treatment for someone her age?DIAGNOSIS1. Left Partial Mastectomy:- Invasive ductal carcinoma, Modified Scarff-Bloom-Richardson Grade 3/3AJCC PATHOLOGIC STAGE: pT2 Nx Mx. breast carcinoma Synopsis (Invasive)Specimen Source: Left breast massProcedure: Partial mastectomyHistologic Type: DuctalNottingham Grade: 3/3Size of Invasive Tumor: 2.6 cmDuctal carcinoma in-situ Component: Ductal carcinoma in-situ (less than 5% of the tumor mass), high grade, cribiform type (EIC negative)Margins of Invasive Tumor: Tumor is present at less an 0.02 cm from anterior and medial marginsAngiolymphatic Invasion: Angiolymphatic invasion is presentSkin: No dermal invasion identifiedMicrocalcifications: Not identifiedAdditional Pathologic Findings: Columnar cell change/hyperplasiaEstrogen Receptor: NegativeProgesterone Receptor: NegativeHER2: Positive by FISH Analysis (HER2/CEP17:2.6)2. Left breast Tissue- breast tissue with columnar cell change- Skin with dermal fibrosis- No carcinoma seenMany thanks for your opinion.

A: please consider her seeing a breast surgical oncologist. she is dealing with cancer... having a primary care doctor who does some surgery usually isn''t how this is taken care of. that said, she has stage 2 breast cancer. her pathology implies that there still may be some residual cancer there and that re-excision may be needed. no sentinel node biopsy was done either so that should be probably performed. the pathologist will check to see if the tumor is hormone receptor positive. if so then the medical oncologist may give her hormonal therapy (think of it as anti-estrogen therapy-- an aromatase inhibitor) for treatment. there was evidence in the tumor that it has blood vessels and lymphatic vessels enabling it to possibly travel elsewhere....
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I am from india .This is my mothers case historySurgical Pathological CentrePatients Name : Munawar BloorSex: FemaleAge 74 YRS Date reported 07/11/2005 Date Recieved 07/08/2005Specimen : SH 2-7-05Left quadrant matechtomy with axillary clearanceGross:The entire specimen measures 22*12*6.5 cm and shows a 9*3 cm skin ellipse.Serial sections reveal a 4.5*3.8*3.5 cm firm well defined yellow white nodule which is 0.5 cm - 0.8 cm away from surgical margins.From the axillary fatty 31 lymph nodes are dissected.Microscopic:INVASIVE DUCT carcinoma OF LEFT breast[Bloom-Richardson score :3+3+2=8]*cords and tubules of round to oval cells bearing hyperchromatic mitotically active nuclie*dense desmoplastic stroma*vascular invasion is identified*surgical margins FREE of tumour*metastatic deposits in 13 out of 31 left axillary lymph nodes.pT3 pN2 pMx [Stage 111a].IMMUNOHISTOCHEMISTRYbreast PANELESTROGEN RECEPTOR :++POSITIVE[80% TUMOUR CELLS]PROGESTERONE RECEPTOR : ++POSITIVE[80% TUMOUR CELLS]HER 2/neu [C erb -2] :++ POSITIVE [ 96% TUMOUR CELLS]CONTROLS SATISFACTORYCommentThe estrogen and progesterone receptor positivity is seen in nuclie.Intensity is graded from + to ++++.The proportion of positive cells is expressed as percentage.Measurement of ER[ESTROGEN RECEPTOR] and PR [PROGESTERONE RECEPTOR] is very useful to select patients, who are most likely to benifit from hormonal therapy.It is relevant for predicting relapse free survival.C-erb [HER 2/neu ] staining is essentially a memebranous staining and is graded in semiquantitative manner [0&1+ is negative and 2+3+ positive] Cerb 2 [HER 2/NEU] is an oncoprotien which is over expressed in about 25-30% case of breast carcinoma.In such cases monoclonal antibodies which block c-erb 2 activation [hercepten] is found to be effective.Discharge card reportAge 74 years. Diagnosis: L lateral quadrantech ductal CA lat upper lobe off lt breast.Date of admission 07/08/2005 date of discharge 07/15/2005Clinical Notes:A female patient came with h/o lump over outer quadrant of the left breast since 1 month.Associated with swelling all over the body .Pain in both hip joints ,bodyache.tablet propress x4.5 (prazosin hydrochloride ops tat) 1-0-0tablet nikoran 5 (nikorandil 5) 1-0-1tablet imnit 30 1-0-0tablet trivedon mr (trimetazidine dihydrochloride mod) 1-0-1Pi40/0 DM ; 25 Yrs, HT 4-5 Yrs AnginaP/M/O Anul abcess operatedO/E T-Afebrile RS - few crepts over left side of chestBP 150/90 Cus-SISR (N). CNS -Conscion oriented obeying car??Investigations and Findings:GA (L) lat quandrantectomy with axillary dissection done for ductal CA lat upper lobe.One radiva drain fixed in position .Specimen sent to JHT patho CENTRE for HP E AND ER/PR.Operation done by Dr A.R. Fakih Dr P.D KAMATH Dr Sonal Shah on 07/08/0507/19/2005 All stiches removed . no collectionPath report :13/31 node +ve ER PR positive Placed on tamoxifen 10MG ( 2 TABLETS)Treatment Given in hospitalInjection human mixtard 30 units morn 25 units night (BF)T TAXIMO 200 1-0-1T RANITIDINE 150 1 -0 -1T PRAZOSIN HYDROCHLORIDE OPS TAT 1 0 0T NIKORANDIL 5 1 0 1T IMNIT 30 1 0 0T BISOPROPOL FUMARATE 5 1 0 0T TRIMETAZIDINE DIHYDROCHLORIDE MOD 1 0 0T FRUSEMIDE 40 1 0 0T ASTORVASTATIN 20 0 0 1T ALPROZAM 0.5 0 0 1T ASPIRIN DELAYED 150 0 1 0CAP A TO Z MULTI VITAMIN+MINERALfOLLOW UP ADVISED ON DISCHARGEInjection human mixtard 30 units morn 25 units night (BF)T TAXIMO 200MG 1-0-1 FOR 2 DAYST RANITIDINE 150MG 1 -0 -1T PRAZOSIN HYDROCHLORIDE OPS TAT 1 0 0T NIKORANDIL 5MG 1 0 1T IMNIT 30MG 1 0 0T BISOPROPOL FUMARATE 5MG 1 0 0T TRIMETAZIDINE DIHYDROCHLORIDE MOD 1 0 0T FRUSEMIDE 40MG 1 0 0T ASTORVASTATIN 20MG 0 0 1T ALPROZAM 0.5MG 0 0 1T ASPIRIN DELAYED 150MG 0 1 0CAP A TO Z MULTI VITAMIN+MINERALT LOSARTAN POTASSIUM 0 0 1T GLIMEPIRIDE 2MG BEFORE BREAFAST

A: a bit complicated to read some of this. that said, she has stage 3 breast cancer. locally advanced disease. hormone receptor positive so usually hormonal therapy given. Herceptin sometimes also given. her health status in general would determine if she gets chemo and how much benefit it provides. radiation as well....
Q: 

My sister had a lumpectomy 02/2004 and was found to have a 1.1cm moderately differentiated, infiltrating ductal carcinoma of the rt breast. Tumor extended to one inked surgical margin, so a second surgery removed more tissue and at least 5 lymph nodes, with one having metastatic breast carcinoma. (T1c,N1,MX,G2)Chemotherapy and Radiation Therapy were performed.In May 2005, a follow up MRI found enlarged lymph nodes and abnormal enhancement in the inferolateral rt breast.Her Oncologist and Surgeon wish to remove all lymph nodes and perform a mastectomy.Why would enlarged lymph nodes be appearing post Radiation Therapy, and does this course of follow-up seem appropriate.How can my family best support her?Thank you for your time.

A: cancer can still return after it has been treated. nothing is 100%. it is was there there would be zero mortality and zero recurrence rate for breast cancer. not sure what the rationale is in doing mastectomy though if the question of cancer returning is nodal only. For support, someone should accompany her to appointments and be her record keeper/note taker so she can concentrate on listening and not having to write everything down. get email addresses of friends and family and send out notifications to everyone all at once how she is doing/updates rather than her spending hours on the phone repeating the same information. bake casseroles and stick in her freezer. babysit. ask her how you can help....
Q: 

I have invasive breast carcinoma, ductal with some lobular features,.9 cm, grade 1of 3, well differentiated, er postive. Sentinel node contained mircoscopic foci of metastatic carcinoma on cytokeratin stain only.Chemotherapy? Axiliary node biopsy? Other?Thank you.

A: Your situation is the type that is ideal for presentation at a breast cancer case conference. So ask your surgeon to present you! breast centers hold case conferences (sometimes called tumor boards) where cases that are considered borderline and controversial are presented so that a group of surgeons, medical oncologists and radiation oncologists can render their opinions and advice for presentation back to the patient. The pathology slides are reviewed as well as your clinical history and your mammograms/breast images.This way you get the advantage of a multidisciplinary team approach to plan your treatment regarding chemo, radiation and hormonal therapy....
Q: 

Hi, I''m 38 years old woman, one year ago I was diagnosted with right breast carcinoma.The stadification risult from sonogarfy and mammogary T1NoMo, with 2 massa dimens, 8and 5 mm, in quadratin infero medial.The biopsy results Lobular Invasive carcinoma, no nodal involvement to the axilla.I was underwant to definite treatment-radical Mastectomy with axillary disection with imediately riconstruction with silicon protesis.Post operator stadification pT1NoMo. The hormonal status ER+75% PR+ 45 HER2 ''1+'' .My doctors recomends me to not follow with chemotherapy regime, because of the early stage of breast cancer, and I was for one year with Tamoxifen, 20 mg a day.During this year after intervention I was in periodically control of mammogarfy and ultrasound, blood analyses and every thing was ok.But unfornately 2 months ago I was with some strange pain in my muscles and articular pain, not exactely bone pain.My pain were only when I moved.I thought was by Tamoxifen because I have''heard that it may cause that kind of pain, beacuse I was in premenstrual age.I made DEXA and I resulted with Ostopenia T -2 garde.But I made Chintigraphy and than CT bone scan, and doctors told me that there were mets, in bone,hips,right rib,and chest. All of us were scary, beacuse all the doctors told me that my diagnose was with good perspective, at first.They did not make bone biopsy, but I started imediately chemotherapy regime TAC(with taxotere) and now I''m in the last six cycle.Now I m free of pain and the doctors told me that this is a good sign, after twoo weeks Im going to have another CT to see what''s happen.I''m sorry for this long message bu my questions are:1. How it is possible with my diagnose that cancer spreed so fast, even I was with early stage of br.canc one eyar ago?2. The cause of recurrence could be that I should made the chemotherapy when I was diagnosticated? 3.Could be the doctors were wrong and my spots were from arthrits(as I have in my family story)4.Could be the internial mammary the cause of transmited disease?5.If the ''spots'' are there again, do you think that I need to make other chemotherapy cycle? Thank you very mutch

A: no doublt shocking and disappointing to get such news. though you clearly had stage 1 breast cancer with favorable prognostic factors, there are no guarantees that women with such pathology will do well and not need chemo. some doctors would have given you chemo solely based on your young age. others might have done oncotypeDX to see what your recurrence score would be. we can''t look backwards though and rewind the video of your life. we must press forward now. good that the bone pain is subsiding. if some lesions remain they may treat them with radiation or even putting you on a different chemo drug or possibly a different hormonal therapy. even getting ovaries out is possible....
Q: 

Hi, there. My wife, 34-year-old, was just diagnosed breast cancer (Pathology: invasive breast carcinoma, poorly differentiated, Bloom Richardson Elston Mod. Grade III; DCIS, high grade, with focal comedonecrosis; Ultrasound detcted size could be 4-5 cm). She''s in the 12th week of her first prangnancy. My questions are: considering the size and the bad type of BC, should we terminate the pregnancy asap to start the treatment? One doctor suggested that. If she keeps pragnant, how much less chances of surviving the cancer compare to those a non-pregnant woman with the same type of BC? Do the hormones of pregnancy make it harder to successfully treat breast cancer? Is it difficult or impossible to do surgery on the pregnant woman in her 4th month of pregnancy? If she continues pregnancy, will it worsen her chances of recovering from breast cancer? Can breast cancer treatment during pregnancy harm the baby? We want to hear from you, the expert, rather than from some unreliable Web pages. Thanks.

A: There are windows of opportunity to provide the baby safety and your wife treatment during the pregnancy. she needs to be in the hands of a comprehensive NCI designated cancer center though where they will have experts very familiar with dealing with pregnancy simultaneous to breast cancer treatment. if you are within a few hours of us please consider bringing her to us. just call 443-287-2778. Her breast cancer at this point is stage 2 and possibly 3. an ultrasound of her lymph nodes needs to be done to see how they look at this point too. hormone receptors needs to be done to see if the cancer is stimulated to grow by estrogen or not. many things to consider... so don''t hastily do anything based on just one opinion. you need a surgical...
 
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