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Topic: Extensive DCIS with scattered multifocal IDC

Forum: Mixed Type Breast Cancer — Meet others who have mixed type breast cancer.

Posted on: Jan 3, 2018 11:24PM

Axolotl wrote:

Hi, I'm new here and trying to make sense of my pathology reports.

I had a unilateral mastectomy with clear nodes. Er+/pr+/her2- (FISH). The pathology report says: "The lesion is formed of extensive multifocal high-grade DCIS. Within this there are multiple infiltrative foci of a grade 3 IDC (grade scores T3, P3, M2). These infiltrate between the DCIS, and this carcinoma is not forming a single mass lesion." The DCIS is appx. 7cm and the report says, "the maximum overall dimension of the invasive carcinoma has to be assumed to be between 5 - 7 cm." Later in the path report it says the diagnosis is extensive high-grade DCIS with scattered foci of IDC. TNM stage: pT3, N0.

The earlier biopsy, which was done on the main tumor, reported 6mm of DCIS with 2mm of IDC. Predominately DCIS, with IDC grade 1. I realize the biopsy is only a small sample of the whole, but I was surprised at the variation between the reports.

My question is, considering the clear nodes and earlier biopsy report, why did the pathologist report 5-7cm of IDC? My understanding is that true T3N0M0 cancers are very rare and typically low-grade. It seems that 5-7cm might be an overstatement, no? I wonder why the pathologist did not give the measurement for the main tumor, or state the percentage of IDC within the DCIS? 5-7cm of IDC is 70-100% of the 7cm DCIS, so why give a diagnosis of extensive DCIS with scattered foci of IDC at all if it going to be counted as mostly IDC?

The bs is sending for the oncotype dx, hopefully that will give more information regarding treatment. I'd like to avoid chemo.

Diagnosed at 37. Extensive DCIS (7cm) with scattered multifocal IDC. Oncotype 12. Dx 12/18/2017, DCIS/IDC, Right, Grade 3, 0/3 nodes, ER+/PR+, HER2- (FISH) Surgery 12/26/2017 Lymph node removal: Sentinel; Mastectomy: Right; Reconstruction (right): Silicone implant
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Jan 7, 2018 02:16PM beauz wrote:

Hi Axolotl, my understanding from reading is that your IDCs were scattered in an area of dimension 5-7cm. Best wishes for your following treatment.

Dx 01/Dec/2017, invasive carcinoma of mixed type. Mixed no special type(60%) and micropapillary type(40%). High grade DCIS present within and beyond invasive carcinoma. Right, 5cm, Stage IIIB, Grade 2, 3/15 nodes, ER+/PR-,Her2- Dx 5/2017, IDC, Right, 5cm, Stage IIIB, Grade 2, ER+/PR-, HER2- Chemotherapy 6/27/2017 AC + T (Taxol) Surgery 11/28/2017 Lumpectomy: Right; Lymph node removal: Right, Underarm/Axillary Chemotherapy 1/10/2018 Xeloda (capecitabine) Radiation Therapy 4/17/2018 Whole-breast: Breast Hormonal Therapy 9/18/2018 Femara (letrozole)
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Jan 8, 2018 08:19AM beach2beach wrote:

Hi,

They never truly know until they actually go in and take out a larger area to see the extent. I was initially diagnosed on biopsy as IDC. After mastectomy my pathology was changed to ILC with LCIS and DCIS. Do you have a copy of your final pathology? Mine only goes as far as to say as the size of the largest invasive carcinoma is 0.7cm and when it lists DCIS it says several ducts and LCIS as present. Margins uninvolved by carcinoma is nearest margin 0.7cm and unviloved by DCIS 0.7cm. Lumps it all together in the same tumor without distinction of how much made up how much of it.

Dx 7/28/2017, LCIS/DCIS/ILC, Right, <1cm, Stage IA, Grade 1, 0/2 nodes, ER+/PR+, HER2- Surgery 8/8/2017 Mastectomy: Left, Right; Reconstruction (left); Reconstruction (right) Hormonal Therapy 9/12/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Aug 21, 2018 08:26PM Palesa2018 wrote:

Axolotl, your diagnosis is incredibly similar to mine and I also had an Oncotype of 12. I hope you since got the answers you were looking for. My DCIS was over 6cm and I had two nodes of IDC measuring 5.5mm and 3mm. The true picture only comes out after surgery.

Besides the mastectomy what other treatments have you had and how are you coping? I had direct to implant mastectomy. While the cancer was on the right I decided to go bilateral to prevent on the left because of family history. I am scheduled for radiation because of the DCIS. I have an overly cautious medical team. I will also start tamoxifen and Zoladex.

All the best with your journey!!

Dx 6/7/2018, DCIS/IDC, Right, <1cm, Stage IA, Grade 3, 0/2 nodes, ER+/PR+, HER2- Surgery 6/11/2018 Lymph node removal: Sentinel Surgery 7/8/2018 Mastectomy: Left, Right; Prophylactic mastectomy: Left; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Surgery 8/8/2018 Hormonal Therapy 9/11/2018 Zoladex (goserelin) Radiation Therapy 9/15/2018 Whole-breast: Breast, Chest wall Hormonal Therapy 11/3/2018 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Aug 25, 2018 03:23AM - edited Aug 25, 2018 03:26AM by Axolotl

Hi Palesa2018,

I didn't have radiation or chemo. Currently I'm on Lupron and Aromasin. I'm experiencing some side effects from them, including hot flashes and night sweats, but aside from that am doing well. We decided to go with Lupron and Aromasin because of the SOFT and TEXT studies which showed that this combination is stronger than Tamoxifen alone in younger women (I'm 37). I think Lupron serves the same function as Zoladex. I'm trying to stay fit and eat well. 4 months post surgery I did a Spartan Sprint, and also participated in a 42km cycling event. I don't have a family history, so I kept my good boob although I'm no longer as symmetrical as I'd like.

After going through everything, I feel that at this point I can only wait for the treatment to end (I'll be on the medications for 5 years) and hope I never have a recurrence. I'll have my next follow-up with my breast surgeon in October.

All the best to you as well!!! This journey is not easy.

Diagnosed at 37. Extensive DCIS (7cm) with scattered multifocal IDC. Oncotype 12. Dx 12/18/2017, DCIS/IDC, Right, Grade 3, 0/3 nodes, ER+/PR+, HER2- (FISH) Surgery 12/26/2017 Lymph node removal: Sentinel; Mastectomy: Right; Reconstruction (right): Silicone implant

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