New "Support Person" for my cousin
New here, but not new to the cancer thing. I lost my mom about 15 yrs ago to this horrid disease. Anyway, I am not the one diagnosed but trying to help my young cousin, 35 y/o, whom I used to babysit... who has now been diagnosed. She is healty otherwise. I am not familiar with the terminology even though I'm an RN or how the grading works, but this is what her report says. It appears that they upgraded the DCIS to IDC...am I correct?
INVASIVE DUCTAL CARCINOMA, MODIFIED NOTTINGHAM GRADE 3 (Tubal formation: 3, Nuclear Grade: 3 Mitotic count: 2 Total score: ) Largest focus at least 5mm
Left Breast mass: 11:00 9cmfn
DCIS, high grade, cribriform patterns with comedo necrosis and microcalcifications.
Addendum Discussion:
ER: Positive - Tumor stained: 
% - Intensity: 2+ - Internal control: Present, Positive
PgR: Negative - Tumor stained: 0% - Intensity: 0+ - Internal control: Present, Positive
Her2 Breast: Negative, - Score: 0+ - Percentage of cells w/ uniform intense complete membrane staining: 0%
Ki-67: High, - Tumor stained: > 90%, - Intensity: 3+
She is scheduled to go in for her port next week and I'm assuming will start the chemo immediately afterward. She's been told that it is curable, yet aggressive and will need both radiation and chemo, as well as oral chemo x 5 years!! We're all extremely worried, but most importantly, she is kind of alone where she lives as most of us are hundreds of miles away and she has a toddler aged 2 and a couple of older kids, and a husband that works out of town. So although she has a strong support system, we are all just kind of scattered around the state...
I'd appreciate any help with deciphering these codes, as well as any advice to help her.
Comments
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Hi - sorry to hear about your mom, and now your cousin - but great that you want to support - I am sure that will be helpful. Based on what you wrote, it appears that this is a combination of both IDC and DCIS - which is very common. Much of IDC grows from initial DCIS so it is not uncommon to find both at diagnosis. Important to note that the IDC will be what drives treatment decisions for the most part. At the moment the measurement in the biopsy sample is 5mm, is there an imaging measurement that indicates the suspected size in total? The area of suspicion is located in the 11 o'clock position, 9cm from the nipple. This report indicates that a small percentage of tumor cells stained for estrogen receptors - which is likely causing the decision to do neoadjuvent chemo when combined with the negative progesterone and negative Her2+, which can be interpreted as a triple negative, or so weakly positive on the ER receptors that it will be treated as such. Low estrogen receptor percentage, and negative PR is likely what is driving the high Ki67 score and grade, which are indicators of aggressiveness. The good news is that chemo is typically effective for this arrangement of receptors, sometimes more so than if the ER percentage was higher. I have a very good friend who was diagnosed with triple negative breast cancer at 37 - she is BRCA 1+, and was very successfully treated and is doing great. I would think genetic testing would be a good idea for your cousin since she has been diagnosed at such a young age. Is she on the same side of the family as your mom? Here is a link that explains grading for breast cancer. Is the medication mentioned for five years after surgery an anti-hormonal?
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Thank you very much!! She does not know the names of meds yet as she has not seen the oncologist, as far as I know, all that is scheduled this week. But thank you very much for helping to interpret these. I plan on talking to her later this evening. I just don't want to give her misinformation while I'm trying to be a solid rock for her, you know. Yes, she is on the same side as my mom. However, her grandmother, my mom's sister also passed from cancer but it was some type of stomach cancer to my recollection. In all, 5 siblings of my mom's have been diagnosed with cancer, but each one was in a different place and a very peculiar type. I should have done more investigating at the time but I didn't. My Brac came back negative so I had washed my hands of the whole thing. Now my whole family has been hit hard by this. My brother was also recently diagnosed w/ colon cancer St III and has completed his treatment.
I'm glad your friend recovered well. We know this will be a hard road.
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We're so sorry to hear about your cousin and mom, purplegirl25. What a difficult thing your family has endured! It sounds like your cousin does have plenty of support from her family, but we know how difficult it can be to be so far away during such a time. When she's ready, this community can be a wonderful source of support for her - for you both! We also have regular zoom meet-ups that she can join, to talk to other members and people going through breast cancer. The schedule for meet-ups can be found here: https://www.breastcancer.org/community/virtual-meetups
The Mods
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I would encourage a full panel of genetic testing in light of the amount of cancer in your family - there are other genetic markers that indicate a propensity for cancer, including breast, other than just the BRAC 1&2. I wanted to add that my friend is now 44, so 7 years past her treatment - which is awesome! I am sorry to hear that your brother was diagnosed with colon cancer, but glad his treatment is done. I hope he is doing well. My brother was also diagnosed with cancer - bile duct - GI cancers are tough. Let us know what happens at your cousin's appt., wishing you both the best.
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