Log in to post a reply
Sep 27, 2018 01:46PM
carolinagirl - just wanted to clarify a couple of things - you mentioned in your post that your sister was diagnosed with a stage 3, growth rate 7 (aggressive), 1.8cm tumor. Prior to surgery staging is clinical, but for your sister to be staged at 3 with a tumor that size, she would need confirmed malignancy in at least 4 lymph nodes, or a tumor greater than 5cm. I am thinking that the staging info was miscommunicated, and that she is actually - at this point pre-surgically clinically a Stage IIA. I have linked staging criteria from Breastcancer.org for you below. The growth rate you describe, which is grade, would actually be a Grade 2, which is intermediate. The number 7 is comprised of 3 categories of cell appearance, each given a score of 1-3 depending on specific factors. These 3 scores are added up with 3-5 being Grade 1, 6-7 being Grade 2, and 8-9 being Grade 3. Also linked is grade info from Johns Hopkins with a very good explanation of how grade is determined and the specific of what the pathologist is looking for.
As far as having no pathologist on site - often during breast related procedures the pathologist does a cursory exam of the removed sentinel lymph node(s), but it is not a full pathological exam of either the sentinel node, or the removed tissue from the breast. The disadvantage of not having an immediate look at the sentinel lymph node(s) is that if there was a spread to the nodes it might not be discovered while your sister is in the OR if the area of cancer is not grossly evident. If there is found to be a spread to the nodes she might need an additional surgery later to remove more, but the tumor board would weigh in on whether this is necessary or if her subsequent radiation - customary after a lumpectomy - would be enough to deal with that. Not all surgeons have a pathologist look at the breast tumor while the patient is in the OR to determine margins, this is usually done in the lab later. Usually for the breast tumor the lumpectomy patient is taken to radiology and a wire is inserted, using mammography, that guides the surgeon to the area that needs to be excised. Even with wire guidance, and even at NCI centers and university based hospitals, there is about a 20-25% re-excision rate, meaning that another surgery needs to be done to get clean margins. This is the nature of lumpectomy, which is a balance of removing the minimal amount of breast tissue while still trying to remove all cancerous area. For the lymph node(s) removal, a dye and/or tracer is injected - sometimes the day before, sometimes in pre-op, sometimes in the OR - to guide the surgeon to the first node(s) in the axilla (underarm) away from the breast that take up the dye/tracer, and those are removed and sent to pathology. As far as the wait for pathology, 5 days is not uncommon and if her sample had to be sent away, it is actually reasonably fast. I waited longer than that and I had access to a university based hospital, and my oncological breast surgeon is the former head of breast surgery in the NCI center directly across the street from where my biopsy was performed. I waited about a week after surgery as well, the surgical pathology was reviewed at my post-op appointment.
Due to the family cancer history it seems genetic testing is warranted, but it is important to note that the majority of breast cancers are not linked to known genetic mutations. I would advise that if your sister's tumor is ER+ and Her2- (these are hormonal receptors and Her2 status - which should already be known from her biopsy sample - and the most common receptor/Her2 arrangement among those diagnosed with breast cancer) then the OncotypeDx test, which is genomic testing, should be performed on her surgical tissue sample to help determine whether there is any benefit to adding chemo to anti-hormonal therapy. Here is a link to that testing information:
Wishing you and your sister the best, it is awesome that you will be there to support her. If anything I have posted leads you to more questions please do not hesitate to ask!
BMX w/ TE 11/1/10, ALND 12/6/10. 15 additional surgeries. TCHx6 2/17-6/2/11. Herceptin until 1/19/12. Femara 8/1/11, Arimidex 6/20/12, back to Femara 6/18/13-present.
9/27/2010, DCIS, Stage 0, Grade 3
9/27/2010, IDC, Right, 2cm, Stage IIB, Grade 3, 2/14 nodes, ER+/PR+, HER2+ (IHC)