Topic: tubular carcinoma

Jan 24, 2013 07:03PM vrsecond wrote:

I was just diagnosed 1/14/13 awaiting MRI 1/29/13 then meet with surgeon to determine course of treatment. I'm scared. here's the path report notes:

Invasive duct carcinoma well differentiated (tubular carcinoma). No in-situ component present. ER/PR+ Her2neu Negative

Anyone have any insight for me? thank you for your help!

Feb 18, 2013 11:49AM TaTaForNow wrote:

Vrsecond, Just saw your post and Voraciousreaders suggestion to check the NCCN treatment guidelines - great idea. How are you now and have you made your treatment choices?

Mine was a pure tubular  Got a second pathology report from another hospital to be sure it was pure  (that is, over 90% tubular). For me  this  helps to figure treatment. I think if it's less than 90% tubular, you can get different treatment outcomes -  so the data in these studies may not apply.

Local oncologist and radiologist offer the standard treatment (rads,  no adjuvent per the NCCN guidelines). However my breast surgeon understands I don't want to overtreat and is agreeable to increased surveillance if I don't have the rads (ultrasound, breast check. maybe MRI at 6mos). 

Cocococo, Voraciousreader, MarieKelly and others - you really helped me learn to think about this problem and consider treatment decisions. Thank you.

I'm getting a second opinion from a  teaching hospital  next week - by the end of the month I should be able to make a decision that makes sense to me. Which may be nothing more than increased surveillance.

Also, Oncotype and KI-67 cell proliferation test make treatment (for me anyway) more of a reasoned decision. Although there is still a guesstimate factor. 

Good luck fellow tubular!

Feb 18, 2013 01:56PM - edited Feb 18, 2013 01:57PM by voraciousreader

Welcome sisters. Hope this thread doesn't have to become too active! I hope you all can come back here and can help others thru their journey. On the mucinous thread, I put links to all the journal studies on mucinous breast cancer. Some of the studies include tubular... Perhaps one of you can do the same here....there needs to be a place for the newly diagnosed to find as much info on our rare favorable types of BC.


I wish all of you newly diagnosed well during the time it takes to make a treatment decision and especially well during active treatment.

Feb 27, 2013 10:39AM voraciousreader wrote:

momof5inva...I found this abstract:

Clinical-pathologic features and long-term outcomes of tubular carcinoma of the breast compared with invasive ductal carcinoma treated with breast conservation therapy.

Source

Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT 06520-8040, USA.

Abstract

PURPOSE:

To evaluate our institutional experience of treating tubular carcinoma of the breast (TC) and invasive ductal carcinoma (IDC) with conservative surgery and radiation therapy, to compare clinical-pathologic features and long-term outcomes.

METHODS AND MATERIALS:

A review of our institution's tumor registry from 1975 to 2007, followed by a central pathology review of available slides, yielded 71 cases of Stage I/II TC and 2,238 cases of Stage I/II IDC treated with breast conservation therapy. Clinical-pathologic features and outcomes were analyzed by subtype to detect significant differences.

RESULTS:

The median follow-up was 7 years. The TC cohort presented more frequently with pT1 disease (97% vs. 80%, p = 0.0007), pN0 disease (95% vs. 74%, p = 0.0004), hormone-receptor positivity (ER+, 89% vs. 62%, p = 0.0001; PR+, 81% vs. 52%, p = 0.0001), and HER-2 negativity (89% vs. 71%, p = 0.04). Clinical outcomes also favored the TC cohort, with lower rates of breast cancer-related death (1% vs. 10%; p = 0.0109) and distant metastasis (1% vs. 13%; p = 0.0028) and higher rates of 10-year overall (90% vs. 80%; p = 0.033), cause-specific (99% vs. 86%; p = 0.011), and disease-free (99% vs. 82%; p = 0.003) survival. There was a nonsignificant trend toward improved breast cancer relapse-free survival for the TC cohort (95% vs. 87%; p = 0.062) but no difference in nodal relapse-free survival or contralateral breast cancer relapse-free survival (all p values >0.05) between the cohorts.

CONCLUSION:

Our institutional experience suggests that TC, when compared with IDC, is associated with more favorable clinical-pathologic features and comparable, if not superior, outcomes after breast conservation therapy, suggesting the appropriateness of a conservative approach to this rare subtype.

__________________________________________________________

Notice there were 71 cases of Tubular bc.  Of them, 89% were ER Positive.  So, while Tubular is rare, Tubular that is ER NEGATIVE is rarer...occuring in 11% of cases.  But notice, according to this study...at 10 years...disease free survival was 99% for all cases.  So, even those who were ER NEGATIVE, they had EXCELLENT outcomes.

I think it's a great idea to have the Oncotype DX test.  However, for Tubular and Mucinous breast cancers, the test is not as strongly validated as it is for "traditional" types of breast cancers.

Good luck.  Let us know your score and decision.

May 26, 2013 11:17PM - edited May 26, 2013 11:21PM by raspberry

Hi All,

- in this rather small group of people. It is strange to be diagnosed with a rare-ish form of IDC. I gather mine is pretty much a "pure form" - they don't give me as many details as I would like on these histology reports.

Anyway, survival rates seem to be really good with or without radiotherapy, but in New Zealand, where I am, although they are careful not to over-treat, I still still have to do radiotherapy, with my first session tomorrow, the dry run for measurements etc.

I wonder if they have considered that I may not need the radiotherapy. Although lumpectomy followed by radiotherapy is standard for all breast cancers in NZ, as a minimum treatment it seems. I got off having to take Tamoxifen though, as it only improved my survival by 1.7% and my surgeon said "it is not an innocent drug". I hated the sound of the side effects. I have my ovaries, but had an abdominal hysterectomy last year. Although I don't get periods I have absolutely no symptoms of menopause yet at 50. I really am glad I can go naturally towards that and not suddenly.

I am more afraid of depression than anything and there was a chance of that with Tamoxifen. That definitely was the worst disease I ever had.

As my tumour removed was 1.6cms I am ok about having radiotherapy, as anything over 1.5 can mean it could have gone somewhere, although my lymph node was clear (the removal of that is much ouchier than the breast part of the op isn't it?)

Anyway, is there anyone out there who had a lumpectomy only, because it is tubular carcinoma, because their doctor recommended no further treatment?

I believe I may have caused this cancer by drinking alcohol, a moderate to heavy to drinker, only had about three days off per week and when I did drink it was 4+ either wine or a third of vodka, a bit heavy I must admit.

Since diagnosis I have completely stopped drinking and lost four kgs, as a result. I am at my perfect weight for me, under 63kgs

My doctor took large margins, as I requested, since the affected breast was quite a different shape and larger (it had become a different shape - that was my symptom, but it had always been larger). With such large margins, they were clear.

Along with the 1.6cm cancer there are 8mm of cribriform carcinoma in situ, so 2cms all up of bad stuff.

May 27, 2013 09:23AM auntienance wrote:

Thank you all for all the information you have provided. I have a very confusing diagnosis. Although my tumor was 95% tubular, my oncotype score came back a 26. When discussing my treatment options with my MO I questioned him about what seemed a rather high score for such a tumor type. His opinion was that the test caught something that the human eye (pathologist) missed. Obviously not very comforting to someone looking for the most positive outcome. At any rate, I'm happy to read about others experiences with this diagnosis. Info is sometimes hard to come by.

May 28, 2013 08:04AM - edited May 28, 2013 08:11AM by raspberry

Thanks Auntie and Voracious - so today was just a consultation with the oncologist, not the measurements etc., so that is next week. An MR scan and all (eek, a bit claustrophobic).

So now the oncologist is surprized I haven't been recommended Taxomifen as well and I told her the surgeon thought I didn't need it. I was told I needed six weeks radiotherapy and then today I was told it was three weeks plus a booster into the bed where the tumour was, 56 gys all up I think?

Opinions sure do vary out there amongst the medical professionals. Oh, I just want to get on with the radiotherapy and then I won't feel weirded by the next unknown factor of this journey. 

I haven't heard this for years, but she said I was "young" to get cancer at 50 and that in itself was something of a risk factor because I am still premenopausal, as far as I know (no uterus, just ovaries).

The oncologist also said lumpectomy and tamoxifen is as effective as lumpectomy and radiation? - that's a new one?

In regards to alcohol, I find it hard to have just one drink, so I just abstain - I like 4! but now I haven't been drinking, I don't want at all. Its about as attractive to me as smoking, which I gave away 30 years ago.

My main reason why is that even three drinks a week, spread out over a week, is known to triple the chances of reoccurence for those who have had BC (as someone said above - much worse for someone who has had BC). 

In regards to a score, I had a score of 12 for a test for ovarian cancer about 1 year ago - but since then it turns out that test is more accurate testing breast cancer. That 12 was in relation to 32 being the limit where it becomes suspicious for cancer circulating - I wonder if this is the same test. I must find those bits of paper. 

Jun 1, 2013 11:08AM voraciousreader wrote:

Rasp.... Looks like you are voraciousreader 2!! Good luck with your active treatment. I wish you well!

Aug 22, 2013 10:36AM - edited Mar 11, 2014 06:04AM by LuvSnow

Dec 5, 2014 03:55AM becca333 wrote:

Age 64, Dx 4/07/2014, IDC, Type- Cribriform Tubular, 1cm ,grade1, stage1, ER+95%, PR+90-95%, HER2-, Node Negative, OncotypeDX Score 8.  
Surgery: 5/15/2014, Lumpectomy (Right), Clear Margins.

Recommended Treatment:  Radiation Therapy - 25 secessions with 5 secession booster, Hormone Therapy (anastrozole for 5 years)

After doing extensive researching on both the type of cancer that I had versus the recommended standard treatment given me, I discovered that the treatment recommended for me was the same for patients having stage 2, 3, and 4 ER+,PR+, Her2-, Node Negative cancers.  How could that be?    I chose not to do radiation or hormone therapy.    Instead I would detox my body by eating right and exercising.  I would find out how I got cancer in the first place.  

What was causing my estrogen and progesterone levels to be so high?   What could I do to naturally lower my estrogen and progesterone?   While researching how I could test my estrogen levels, I came across articles and ads about cancer patients and the importance of testing ones PH levels.  The articles explained how cancer grows and thrives in acidic environments and environments low in oxygen, and that cancer CANNOT thrive or grow in alkaline environments or environments high in oxygen.  The articles claimed that cancer patients have acidic PH levels.   Was that true, was my PH level acidic like the article had claimed?  I rushed to the drug store to buy a package of PH testing strips to check my PH level.  To my surprise I was totally acidic.  I immediately began researching on what I needed to do to become alkaline.   While researching, I came across articles about how by taking 1 teaspoon of baking soda with a glass of water will immediately bring a persons body into an alkaline PH balance.   Better yet, by taking 1 teaspoon of baking soda with a glass of water once or twice a day, (depending on how acidic a persons PH level is) will not only prevent a person from getting cancer, but will also prevent those who had or have cancer from their cancer returning.   And even better than that, the article claimed that baking soda also gets rid of cancer tumors within a six week period.  

It was now 5 months after my lumpectomy.  I had started on the baking soda regimen for 3 days.  I noticed a small lump in the same spot that the tumor was removed.  Could it be scar tissue or another tumor forming?  To be safe I went to see my family doctor.  After examining the lump, my family doctor recommended that I have an ultrasound done. After leaving the doctors office while driving home in the car, I started to second guess myself as to whether or not I did the right thing.  Should I have done the radiation treatment, would that have helped?   And what about the baking soda, it was only day three.  Should I immediately rush to make the ultrasound appointment or should wait 5 1/2 weeks to see if the baking soda regimen really worked or not.  How would I know if I didn't at least give it a try.  So I decided to wait.  As the weeks went by I kept feeling the lump.  Some days it seemed smaller, than others days it seemed to feel the same.  On week five I went in for the ultrasound.  It was on a Thursday. The ultrasound reading came back reporting a suspicious malignant tumor.  A mammogram was also done confirming the ultrasound reading.   A biopsy was scheduled for the following Tuesday.  Over the weekend I kept feeling for the lump.  It was there on Thursday, I had taken a picture of the tumor on Thursday from the ultrasound screen with my iphone.   It was now Sunday and I couldn't feel lump.  Was it possible that the tumor could disappear that fast!  

My husband went with me for the biopsy.   When my name was called, both myself and my husband were escorted into a sterile operating room where biopsy instruments were lined up neatly ready for the surgery.  I was told to put on the famous hospital gown, to relax and not to worry, that the doctor would be in shortly.   Within a few minutes the doctor came in the room.  After washing hands, the doctor put warm ultrasound gel on the area of where the lumpectomy tumor was located and began going back and forth over the area to locate the new tumor of which it could not be found.  The markers from the lumpectomy were located but nothing else.  No tumor, nor scar tissue, no nothing. I couldn't believe it!

Another month and a half has passed and I haven't missed a day of taking 1 teaspoon of baking soda with a glass of water.  I couldn't feel any better than do or be any happier than I am.   I am still shocked by the whole thing.  To think that something as little as baking soda can change a persons PH balance from acidic to alkaline, and also dissolve cancer tumors, not to mention prevent cancer tumors from forming.  

I hoping that this information will be of help others.  And I'm wishing everyone the very best no matter what cancer treatment options they choose.

God bless all.

Becca333

Dec 5, 2014 11:31AM becca333 wrote:

Thank you, I will consider doing so.

Mar 20, 2015 12:08PM voraciousreader wrote:

eagle...I strongly recommend that you register at the NCCN'S website and read the professional version (red logo) of their breast cancer treatment guidelines. Specifically, read the page devoted to mucinous and tubular breast cancer. That said, when there is invasive cancer, the standard of care recommends checking lymph nodes. Furthermore, there is evidence that older patients may not need radiation.

You don't mention the size of the tumor nor other specifics. If it is ER + andHER 2 negative, you might request the OncotypeDX test. Please keep in mind that for favorable rare types of breast cancer, the OncotypeDX DX test is not as strongly validated as it is for other types of BC.

I wish you well!

Apr 4, 2015 12:03PM voraciousreader wrote:

Carol...I hope you will read the NCCN's breast cancer treatment guidelines (professional version-red logo) at their website. Specifically, read the page devoted to tubular and mucinous. From your description, you may very well be able to CONSIDER NOT having additional treatment. Your prognostics are excellent. That said, because you have excellent prognostics, you have many choices to make. I wish you well.

Jul 21, 2015 04:19PM Dina44 wrote:

hi need help

Radiology report

The symptomatic lump lateral to the nipple is 29.20.29mm irregular low reflectivity mass calcification a are seen at11-12o'clock with irregular segmental low reflectivity tissue with associated increased vascularity u5U

Us axilla RT multiple small nodes a couple of which have vortices which appear thickened in relation to short axis

Distortion spanning at least 40 min the breast centrally with malignant segmental calcification extending from within 2 mm of the nipple which is slightly retracted

Can any one help me please

Jul 24, 2015 09:56AM BookWoman wrote:

I have not had a cancer in the other breast develop after having tubular carcinoma, but I did have DCIS in the other breast before the tubular carcinoma.