Topic: Looking for info after worse surgical pathology than expected

Forum: IDC (Invasive Ductal Carcinoma) — Just diagnosed, in treatment, or finished treatment for IDC.

Posted on: Oct 30, 2021 09:30PM - edited Oct 30, 2021 09:34PM by jen2957

Posted on: Oct 30, 2021 09:30PM - edited Oct 30, 2021 09:34PM by jen2957

jen2957 wrote:

I'm feeling so defeated and overwhelmed today. I was given my surgical pathology from the unilateral skin and nipple sparing mastectomy at my one week surgical post-op appointment on Thursday, and I am still reeling from the results. I am just looking for information on how all of the new characteristics of my cancer work together to affect my overall survival and recurrence risks. I am REALLY struggling emotionally right now and am trying to make sense of the new information as I wait to see my oncologist 9 long days from now.

Background: Clear 3D mammogram on October 30, 2020 (actually one year ago today). I began to see an odd indentation on my breast with a lump above it sometime in late spring. Waited a bit to see my doctor because I thought it may have been an injury from carrying metal fence panels that hit that same spot as I carried them. Ultimately, saw my doctor Aug 6, and got a diagnostic mammogram with ultrasound Sept 2. Four Core Needle Biopsies on Sept 16.

Original Pathology from Biopsies:
Ultrasound-assisted CNBs showed two tumors: one 7mm and one 10mm of grade 2 IDC surrounded by intermediate grade DCIS.
ER/PR+ >90%; HER2-; Grade 2 IDC with intermediate DCIS.
Lymph nodes appeared normal.

MRI prior to surgery this month showed one 15 mm tumor with extensive enhancement around it and normal-appearing lymph nodes. The extensive enhancement was thought to likely be DCIS. While I fully understood that things could change once the surgical pathology was completed, I was not prepared for the extent of my disease. I went from expected Stage 1 (maybe 2a) to a Stage 3a. Kind of a gut punch.

Surgical Pathology:

-The IDC tumor was absolutely huge! It turned out to be a 55 mm tumor with an additional 55 mm area of DCIS. -1/3 sentinel nodes had 2.2 mm of macroinvasion.
-No Extracapsular Extension.
-Lymphovascular invasion present.

Margins were not completely clear- they said they took as much tissue as they could take during surgery, but bc the diseased area was so large and I am thin with smaller breasts and less breast tissue to spare, the margins ended up not being fully clear:
-unifocal IDC anterior-inferior margins involved over a span of 3mm (other margins were posterior @2.1mm, anterior-superior @1.5mm, nipple @10mm)
-unifocal DCIS anterior-inferior margins involved over a span of 3mm (other margins anterior-superior @1.8, nipple base 0.3mm over 4mm span). Comment on final DCIS margins: in addition to the positive focus for in situ and IDC, DCIS extends to within 2mm of anterior-inferior margin over a 40 mm span.

The tumor's features (some changed from biopsy to surgical pathology):
-55mm IDC with cribriform features.
-Grade 1 (down from Grade 2 on biopsy)
-ER+/PR+ >95%; HER2-; Ki67 5%
-55mm DCIS mixed with IDC throughout. Cribriform and solid.
-DCIS is negative for extensive intraductal component (EIC).
-DCIS grade 2; necrosis present, central (expansive comedo necrosis).
-DCIS = 50%.
-Allred Score 8


Surgery 10/21/2021 Lymph node removal (Right): Sentinel; Mastectomy (Right): Nipple Sparing, Simple, Skin Sparing; Reconstruction (Right): Tissue Expander Surgery 12/2/2021 Lumpectomy (Right) Hormonal Therapy 12/22/2021 Aromasin (exemestane) Radiation Therapy 1/19/2022 Whole breast: Right breast, Lymph nodes, Chest wall Surgery 4/6/2022 Reconstruction (Left); Reconstruction (Right): Fat grafting Surgery 5/3/2022 Surgery 8/1/2022 Reconstruction (Right): Fat grafting, Silicone implant Dx IDC/DCIS, Right, 5cm, Stage IIIA, Grade 1, 1/3 nodes, ER+/PR+, HER2-
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Nov 22, 2021 05:37AM rah2464 wrote:

Oh Jen hang in there! Lung nodules here, too - a bonus from living in Kentucky most of my life. I vote with AliceB that all are just barnacles. Glad to hear that the surgeon thinks they can go back in, sorry this has been such a rollercoaster ride.

Dx 5/23/2018, IDC, Left, 1cm, Stage IA, Grade 2, 0/4 nodes, ER+/PR+, HER2- Surgery 6/27/2018 Mastectomy; Mastectomy (Left); Mastectomy (Right); Reconstruction (Left): Silicone implant; Reconstruction (Right): Silicone implant Hormonal Therapy 7/27/2018 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Nov 22, 2021 05:57AM gb2115 wrote:

What is it about Kentucky and the Ohio Valley that causes lung nodules?

First Dx IDC in 10/16 at age 38, stage 2A, 1.2 cm ER/PR+ Her2-, Grade 2, 1/3 nodes. Lumpectomy + radiation + tamoxifen. Second Dx IDC recurrence in original location 5/21. 1.3 cm ER/PR+, Her2 -. Grade 2. 2/2 nodes. UMX + AC/T + Zoladex/Exemestane + Zometa.
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Nov 22, 2021 08:59AM - edited Nov 22, 2021 09:27AM by jen2957

Alice- I love it! I will call them barnacles from here on. It really is encouraging to hear that “incidentalomas" really do happen and really can be benign. I'm at the point right now where I feel like every time I get a handle on things and have a plan set, something just takes my feet out from under me. I know that is something we all deal with, but I'm ready for a breather for a minute.

Rah- It is an absolutely beautiful place to live, but those seasons and gorgeous trees have their cost, huh? It's funny, my mom, daughter, and I have a little allergy check text group that we all share any allergy like symptoms we may be having; if more than one of us have similar symptoms, we know it's allergies and nothing to probably worry about cold, flu, or otherwise. 😂. Which region are you in? My husband is from western Ky, and I am from central Ky where we live.

GB2115- Apparently, as I have learned through this last little adventure, lung nodules can be caused by infections such as bronchitis, pneumonia, etc. They can remain as artifacts of those conditions as well. In the Ohio Valley, we have conditions that are perfect allergy-inducers: beautiful, but sneeze-inducing. In Kentucky specifically, we also have bluegrass and lots of ragweed- which equals lots of pollen. Louisville, near where I live, makes the top 5 worst allergy cities in the nation every year, I think. On the upside, we do have gorgeous trees, beautiful horses, and more barrels of bourbon than people (the vast majority of bourbon in the world is made here)! 😊

Surgery 10/21/2021 Lymph node removal (Right): Sentinel; Mastectomy (Right): Nipple Sparing, Simple, Skin Sparing; Reconstruction (Right): Tissue Expander Surgery 12/2/2021 Lumpectomy (Right) Hormonal Therapy 12/22/2021 Aromasin (exemestane) Radiation Therapy 1/19/2022 Whole breast: Right breast, Lymph nodes, Chest wall Surgery 4/6/2022 Reconstruction (Left); Reconstruction (Right): Fat grafting Surgery 5/3/2022 Surgery 8/1/2022 Reconstruction (Right): Fat grafting, Silicone implant Dx IDC/DCIS, Right, 5cm, Stage IIIA, Grade 1, 1/3 nodes, ER+/PR+, HER2-
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Nov 23, 2021 05:11AM rah2464 wrote:

Jen I am originally from south central Kentucky (close to Dale Hollow Lake) but now reside close to Cincinnati. I am in Frankfort often as my DH grew up there.

Wishing you all the best as you slog through this stuff.

Dx 5/23/2018, IDC, Left, 1cm, Stage IA, Grade 2, 0/4 nodes, ER+/PR+, HER2- Surgery 6/27/2018 Mastectomy; Mastectomy (Left); Mastectomy (Right); Reconstruction (Left): Silicone implant; Reconstruction (Right): Silicone implant Hormonal Therapy 7/27/2018 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)

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