Hello,
Thank you for your query at DoctorSpring.com
This probably seems to be a multifocal lesion involving the breast tissue with nodal involvement. Biopsy is the only confirmatory test to prove as cancer. If diagnosed as breast cancer, it would be an early stage with high chances of cure. Other pathology parameters needs to be correlated. Please let us know when biopsy report is available.
The probable treatment options vary only with management of the breast. She needs axillary (armpit) surgery anyway to assess nodal status irrespective of breast surgery, but both done simultaneously.
There are 2 options regarding breast surgery.
1. Complete removal of breast with reconstruction using prosthesis for cosmetic purpose.
2. Wide excision of the lesion in the breast followed by radiation to the breast.
Both are accepted options based on scientific data.
Post surgery chemotherapy may be needed. Radiation to be decided based on the type of surgery and exact stage of the disease.
Hope your concern is addressed.
Feel free to discuss further,
Regards.
Patient replied :
Sir,
Thank you for your reponse. The MRI report also categorised it as BIRAD VI. Could there still be reason of it not being malignant?
Hello,
Thank you for the follow up.
The only way to say with certainity regarding malignancy is based on the biopsy results.
Imaging studies only provide supportive evidence.
Hope this helps
Patient replied :
Dear Sir,
I have received the pathology report.The impression is as follows:
BREAST,LEFT SIDE ,MRM.
INVASIVE DUCTAL CARCINOMA,NOT OTHERWISE SPECIFIED TYPE.TWO FOCI(MAX SIZE 5.5 CM AND 0.8 CM RESPECTIVELY)
HISTOLOGICAL GRADE III/III(TUB3+NUC3+MIT3,SCORE 9/9) BY ESBR CRITERIA.
MITOTIC INDEX 3%(30/10 HPF)
LYMPHOVASCULAR INVASION IS SEEN).
NIPPLE AEROLA AND DEEP RESECTED MARGIN, FREE OF TUMOUR.
PERITUMOURAL LYMPHOID RESPONSE IS MINIMAL.MICROCALCIFICATION IS ABSENT.
LYMPH NODE,LEFT AXILLARY,LEVEL I AND II EXCISION - 1 OUT 18 LYMPH NODE SHOW METASTATIC CARCINOMA. NO PERINODAL SPREAD SEEN.LARGEST DEPOSIT MEASURES < 0.2 CM.
Sir, MRM is already done and mentioned above is histopathology report. Further Estrogen receptor is positive (30-40% positivitty and intensity of 2+)Progesterone receptor is is positive ,20-30%positivity,intensity of 2+)HER 2NEU is negative. Be grateful if you could sepceify the follwoing: 1. Would you still call it early stage?2.Chances of cure.3. Stage of the cancer and treatment plan.4) chances of recurrence Thanks and respectfully waiting for your immediate reply.
Hello,
Thank you for patience while awaiting a reply.
The tumor node metastasis (TNM) staging system for breast cancer is an internationally accepted system used to determine the disease stage. The overall stage of the tumor depends upon the particular combination of Tumor, Node, and Metastasis characteristics. According to the information that you have provided, the breast cancer is at T3 N1, which is stage 3 disease. With this stage, the chances of cure are relatively high with good prognosis, approx. 70%.
With regards to treatment, now that she has undergone MRM, she may need chemotherapy followed by hormonal therapy because of her ER (estrogen receptor) positive status. Radiation may or may not be needed as per treating physician’s discretion. The exact combination of what will be done for the patient depends upon the treating physician, but the MRM surgery has to followed up with a combination chemotherapy (which is given in cycles), hormone therapy + or – radiotherapy to achieve maximal eradication of cancer cells.
I look forward to answering any further queries that you may have, hope this helps
Patient replied :
Sir,thank you for your response. I wanted to know that though the MRI and PET CT showed a tumour of 2.6 cm ...is it possible for the tumour to be 5.5 cm in hstopathology(double the size) and why?Sir when you say 70% do you mean she has chances of gettting cured by 70%?what are the chances of recurrence? Sir and 70% means the data which the medical fraternity might have analysed about 5 years or 10 years bac? Is it possible that there might have been further improvements in medication since the last 5/10 years and probably when we would be reading the statistics of prognosis after 5/10 years from now for this stage the chances of 70% would be even further increased to 80-90%?
Hello,
1. The exact size as measured in pathology specimen is more accurate. Hence I would consider 5.5 cm as tumor size. Hece designated as T3 disease.
2. Statistics are more of an corroborative evidence for a particular type of treatment. However an individual's outcome is very hard to predict. This percentage denotes the response for the group which had similar features who responded to therapy. however 30% still did not respond. Please be informed.
3. Probably yes, you are correct. Medical science is constantly evolving and together is the therapeutic advances.
With newer drugs and formulations, improvements are seen but it takes time to analyse and report them.
Regards