Oct 30, 2021 09:30PM
Oct 30, 2021 09:34PM
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.
-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
10/21/2021 Lymph node removal (Right): Sentinel; Mastectomy (Right): Nipple Sparing, Simple, Skin Sparing; Reconstruction (Right): Tissue Expander
12/2/2021 Lumpectomy (Right)
12/22/2021 Aromasin (exemestane)
1/19/2022 Whole breast: Right breast, Lymph nodes, Chest wall
4/6/2022 Reconstruction (Left); Reconstruction (Right): Fat grafting
8/1/2022 Reconstruction (Right): Fat grafting, Silicone implant
IDC/DCIS, Right, 5cm, Stage IIIA, Grade 1, 1/3 nodes, ER+/PR+, HER2-
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