Confused about histopathology report

jw

Hi All

my mom had breast cancer diagnosis on 4/12/23 after which she underwent a unilateral mastectomy. At first she was reluctant to undergo mastectomy but with support from you all she finally did. Throughout this journey I could not have done without support from the posts here as it helped me learn so much the diagnosis and the treatments available. I dont think the Doctors had so much time to explain all this to me.

Again I am getting medical advice from 2-3 specialists but need your insights as you all have been through this.

I got 2 pathology reports done on the tumour in the right breast which was 3.5 cm.

First says it is a TRIPLE NEGATIVE low grade adenosquamous carcinoma which is a very rare cancer. The tumour grade NBR is 2+2+2. I showed it to the specialist who said take Xeloda and it would prevent recurrence for 2-3 years.

I was not convinced as it is TNBC then why would it not recur..

Second report says it is TNBC again. It does hightlight some more cellular stuff as below:

Within the mass is a large abnormal squamous island with squamous cells that are discohesive, with the observed cellular discohesion likely artifactual. This large squamous island merges with smaller irregular anastomosed tumour trabeculae extending into desmoplastic stroma, consistent with invasive carcinoma with squamous differentiation.The fibrosclerotic stroma that forms the mass harbours many scattered tubules of variable sizes containing luminal mucin as well as pink colloid-like material.Cystically dilated tubules with calcifications are present. Some of the tubules appear to be accompanied by myoepithelial cells while others seem to be devoid of obvious myoepithelial cells.

Lot of DCIS is seen. Histological type: Ductal with squamous differentiation.

My mom is refusing chemotherapy as says she is old and will die of chemotherapy. I read the posts here and do encourage her to go ahead with it but she says she would not abe able to handle the side effects.

Doctor says okay to no chemotherapy and says if we do not do anything the cancer would not return for 2-3 years.

However my research shows TNBC can come back anytime.

I asked Doctor about Natera and Guardant 360 to check if any targeted therapy can work but he said no.

Is the Doctor too conservative and just giving up on my mother.

Is it true that a 80 plus diabetic cannot survive chemotherapy and will have a poor quality of life after that.

Is it true that low grade adenosquamous carcinoma which is triple negative does not need any treatment.

I seek your advice as despite medical advice from 3-4 specialists noone is giving me a clear answer and casually rejecting chemotherapy.

I do not want her to get mets and die a painful death. I want her to fight this cancer but seems like the Doctors are not to keen either.

Any advice or insight is Godsent.

Thank you all.

exbrnxgrl

jagdish,

I am so sorry that your mom is going through this. Let me start by saying that none of us are doctors and more importantly, none of us are your mothers doctor. Please keep that in mind as you read.

Your mothers age and co-morbidities do create a situation where the doctors likely evaluated her differently than a 50 year old. They are not casually rejecting chemo nor are they trying to give you unclear answers. They have absolutely no way of predicting how chemo will effect your mother and taking her overall health situation into account, they may feel that she could go either way. Chemo, despite advances in keeping side effects to a minimum, is still not a picnic for most and can be downright debilitating for some. Could she survive chemo? Probably, but at what possible cost? Remember, there is no way to predict how her body will react to chemo and her age and co-morbidities are concerning factors.

As far as recurrence goes, that is also an unknown. The doctors guess of 2-3 years is based on historical data but is not predictive. Even with chemo, folks can and do experience recurrences. I wish I could give you something more definitive but much of what goes along with bc and its treatments is far from definite.

My son in law’s grandmother, 83, was recently dx’ed with liver cancer. After surgery she started oral chemo. She developed a bad case of hand foot syndrome and was beyond miserable. After discussing it with her oncologist, they agreed she should stop. At 83 she had no desire to waste the better part of a year in misery. She has decided to enjoy her life and when/if she progresses she will seek palliative and hospice care so pain won’t be an issue. While her family is sad, they respect her too much to watch her suffer through a treatment that might keep her alive a bit longer but makes her life miserable. I hope that once your mother knows all of the facts about her current situation that she will make a decision that you will respect. I also wanted to say that bc has so many unknowns and each person is very different that there is simply no one right way to go and no guarantees no matter what choices are made.

I apologize if this upsets you in any way. It certainly is a very stressful time but I hope that you will allow your mother to maintain her autonomous decision making powers and respect and support her whatever she chooses. TBH, in your mothers situation, I would likely forgo chemo too. Take care

kaynotrealname

None of us are doctors and it is impossible to say for certain with anything. Chemo on an 80 year old can indeed be tough and diabetes is certainly a significant complication. Can it be done? If the doctors say so and you think they are well studied then I'd trust them. But it doesn't read like they're pushing the issue. And the reason is probably because this is considered an "indolent" tumor. What that means is that it is slow growing so they may have questions even whether chemo will be effective. After all it targets fast growing cells and these types of cells don't usually fall into that category. So my guess is that they are letting your mother decide how she wants to live the rest of her life and since her decision does make sense considering the nature of the disease they're fine with that and see no reason to argue. I know it is very difficult to think of losing your mother but I would encourage you to try and separate your needs from her's. What does she want to do with the remainder of her life? It is her's after all. Does she want to go through the horror of chemo and then not even know if it stands a chance of being effective or does she just want to coast for whatever years she has left? I have had breast cancer, done chemo and if I was 80 in your mother's shoes, I'd probably do exactly what she seems to want to do.

jw

Thanks for your responses. I also think that besides chemotherapy being tough for an elderly lady the Doctors are not reading the pathology report closely. Once they see triple negative they all say chemotherapy is usually done and then reject the idea. It seems to me that this is a very rare cancer and they probably have not seen this kind of tumor before. When I put the whole report on Chat GPT it said:

The histopathology report indicates that the patient has been diagnosed with invasive ductal carcinoma with squamous differentiation (metaplastic carcinoma), as well as extensive ductal carcinoma in situ (DCIS). Invasive ductal carcinoma is the most common type of breast cancer, accounting for about 80% of cases.

Metaplastic carcinoma is a rare subtype of invasive ductal carcinoma that contains both glandular (ductal) and squamous cell components. This type of breast cancer is also known as adenosquamous carcinoma. Metaplastic carcinoma tends to be more aggressive than other types of breast cancer and is associated with a poorer prognosis.

Ductal carcinoma in situ (DCIS) is a non-invasive condition in which abnormal cells are found in the lining of the breast ducts. DCIS is considered a pre-cancerous condition, as it has the potential to develop into invasive breast cancer if left untreated.

I was hoping that some Doctor might offer a different line of treatment that might defer the recurrence by sometime but I am yet to find that right Doctor.

Also the surgeon is still the one giving the advice as my mom had a seroma and he is treating it. Am i making a mistake and should I be seeing an oncologist now as he might have seen this kind of rare cancer.

I find it hard to give up on my mom although she has given up totally and left it to God. She is happy to let go and prepare for her final journey but I am hoping for a miracle that I find some specialist who throws some light on this diagnosis and gives some less invasive treatment options.

Every insight I get gives me a better perspective of the situation. Also the entire forum is very encouraging and clears small little doubts that one might have. My family would not even have done the mastectomy or the biopsy if I did not come across this forum. It was only after i read your stories that i encouraged her to go and get tested. Thanks so much to this forum and all of you..

exbrnxgrl

jagdish,

You are a wonderful son! Yes, metaplastic bc is a rare molecular subtype of bc. There are a few threads dealing with it on bco, but they are not active. As I said, I have no medical knowledge beyond being a patient but my understanding is that it is usually treated as triple negative. I am unaware of any less invasive treatments.
You mention a miracle. That is something we all wish for as there is no cure for bc (yes, lower stages are often treated and never recur but that doesn’t hold true for about 30% ) . Your love for your mother is very clear so I hope that in your search for a miracle that you take your mothers feelings into account as well and respect her wishes. At her age, please understand that quality of life often trumps quantity. This is not giving up but simply weighing all of the factors and making decisions based on her specific circumstances and wishes.