Not sure what all of this means
I was just diagnosed with Invasive Ductal carcinoma. The diagnosis reads as follows:
Left breast, core biopsy:
-Invasive ductal carcinoma, modified Bloom-Richardson grade 2 of 3 (score 7 of 9).
-Invasive carcinoma measures at least 6 mm in maximum dimension.
-Focal associated ductal carcinoma in situ (DCIS), high nuclear grade, cribriform type
-Receptor studies are pending.
I am waiting to get appointments setup but I really don't understand what all of this means or what I should expect. I have no one to help or talk to about this, can anyone help me understand. Thanks
Comments
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Hi @july31, I’m sorry that you have to join us here. Grade tells how closely the cancer cells resemble normal cells. Grade 1 is closest to normal, grade 2 is intermediate and grade 3 is most abnormal. IDC (invasive ductal carcinoma) has invaded the breast tissue; 6 mm is pretty small. DCIS is still in the milk ducts, not invasive, but will also be removed by surgery.
Your treatment depends very much on the hormone receptors, ER (estrogen), PR (progesterone) and HER2 (human epidermal growth factor receptor 2). You’ll have to wait for those to consider what the treatment might be. It’s a steep learning curve (I didn’t know there were so many variations) but you will learn like the rest of us did. Feel free to ask further questions as they come up. All the best.
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Thanks
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I got an updated report with the Receptor information.
Breast Biomarkers
Test(s) Performed
Estrogen Receptor (ER) Status: Positive (greater than 10% of cells demonstrate nuclear positivity)
Percentage of Cells with Nuclear Positivity: 71-80%
Average Intensity of Staining: Strong
Test Type: Food and Drug Administration (FDA) cleared (test / vendor) - Ventana
Primary Antibody: SP1Scoring System: No separate scoring system used
Progesterone Receptor (PgR) Status: Positive
Percentage of Cells with Nuclear Positivity: 11-20%
Average Intensity of Staining: Strong
Test Type: Food and Drug Administration (FDA) cleared (test / vendor) - Ventana
Primary Antibody: 1E2
Scoring System: No separate scoring system used
HER2 by Immunohistochemistry: Negative (Score 0)
Test Type: Food and Drug Administration (FDA) cleared (test / vendor) - Ventana
Primary Antibody: 4B5
HER2 by in situ Hybridization: Negative (not amplified)
Number of Observers: 2
Number of Invasive Tumor Cells Counted: 20 cells
Method: Dual probe assay
Average Number of HER2 Signals per Cell: 2.4
Average Number of CEP17 Signals per Cell: 1.9
HER2 / CEP17 Ratio: 1.26
Test Type: Food and Drug Administration (FDA) cleared (test / vendor) - Ventana
Cold Ischemia and Fixation Times: Meet requirements specified in latest version of the ASCO / CAP
Guidelines
Testing Performed on Block Number(s): A1
Methods
Fixative: Formalin0 -
Hi @july31, The additional information shows that the tumor is ER+/PR+/HER2-, a common diagnosis. You will most likely start with surgery, either a lumpectomy or mastectomy. If you have a lumpectomy radiation will probably follow. If you are over 50 there are shortened courses of radiation (FAST, FAST FORWARD) which can be done in 5 days, once a week for 5 weeks for the first and 5 consecutive days for the second. If you are younger you'll have to go for a couple of weeks or so. If you have a mastectomy radiation won't be needed but the surgery would be more complex and require a longer recovery. You would also have to consider if you wanted reconstruction with an implant or with a tissue flap taken from elsewhere on your body (a harder recovery but many find it worthwhile.) A third choice is mastectomy without reconstruction (flat aesthetic closure.) Usually it is your choice but occasionally a surgeon prefers one method based on the size and location of what is being removed. Lumpectomy with radiation and mastectomy are equally effective at preventing recurrence.
After this you will be prescribed an estrogen blocker, an aromatase inhibitor (AI - there are 3 different types of these drugs) if you are post menopausal or tamoxifen if you are pre menopausal. These are taken for about 5 years to try to prevent the cancer from coming back. Something I initially didn't know is that breast cancer can recur. It's quite unlikely with a small tumor but this ongoing medication reduces the chance.
It might be a good idea to read up on the different surgeries so that you have an idea of what is entailed before you meet with the breast surgeon. If you go to the "about breast cancer" tab on this site and type the topic in the search bar you can find helpful information. This will enable you have an informed discussion with the surgeon. It's also a good idea to have someone (relative, friend) with you to take notes since you are hit with so much information at that first appointment.
Good luck preparing for your appointment. Ask away if you have specific questions that aren't answered.
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Thank you very much for this information. I have no family close and am not the sort to impose on friends unless I become too ill to do something for myself so any information I can receive before is a great help.
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Thinking of you @july31 ! The time period between diagnosis and having your team / plan together is a uniquely sucky time, and all feelings are valid.
I do want to suggest asking someone you trust to come to the first appointments with you, if possible, mostly to act as a notetaker. Maybe you could video call a family member if that's more comfortable. It's a ton of info and can be very helpful to have written notes to look back on as you're making treatment decisions.
There's a great "in treatment" virtual support group hosted by this site that would welcome you with open arms. It's a great option especially to connect with people who really get what you're going through. I have chemo brain at the moment, maybe the @moderators can help provide info about how to sign up.
One day at a time, friend đŸ«‚
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You can take your own notes; just ask the doctor to slow down if necessary. I was by myself since it was during Covid and managed fine on my own. Some people ask the doctor if they can record what is said so they can review it later. Going in with some prior knowledge does help.
The one time I needed someone was going home after surgery. Since you have recently been under anesthesia they need to release you to a responsible adult. I had a lumpectomy with a pretty easy recovery. I was back teaching online four days later.
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Thank all of you. I was thinking I would see if I could record it, my app will transcribe it. Been reading about lumpectomy & radiation treatment vs. having a mastectomy.
I will look into the virtual support group. Thank you again. I'm not a social person so knowing I have people to "talk" to means a lot
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You might ask your doc if it's okay to record your visit—sometimes we can't write fast enough to get everything down and the "notes" portion of your portal's "After-Visit-Summary" may not contain enough info to answer your questions. It's a good idea to make a list in advance of your questions & concerns.
You definitely need someone to drive you home (even if you take a taxi or Uber, someone should accompany you). You will have been given general anesthesia. My lumpectomy was done about noon and I was home in time for dinner. Went out to dinner the next night, grocery shopping two days later. A week later I drove 90 mles to Rockford & back to do a concert—and for two glorious hours I didn't even think about cancer.
Before scheduling my surgery, I was shown a graphic illustrating that lumpectomy had the same overall survival and ipsilateral (same breast) recurrence stats as mastectomy.
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@july31 - Here’s the link with more information about the virtual group that @kks_rd mentioned:
Virtual Support Groups: In Treatment for Breast Cancer
We’d love to see you there!
The Mods
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