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Pathology Results & Update! Pathology Results & Update!

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  #1  
Unread 07-17-2007, 09:46 AM
Red face - Pathology Results & Update! Pathology Results & Update!

I just came back from my doctor's appointment & after checking my open incision he decided it was best to put a drain in, so he froze me locally & did it right there & then. His nurse explained how I was supposed to drain it & I will see him again for that on Friday. After that was all done I got the nerve to ask about my final pathology results & he said it was good news! He told me my final results came back grade 0, more like a pre-cancer! However, I was very stunned when he went on to say that I still need to do 5 weeks of Radiation therapy to "sterilize" the area & as a precautionary measure. He also gave me a prescription for "Tamoxifen" & said I will need to take it for the next five years! I will also be seeing him every six months for the next five years.....so now I have two cancer specialists looking out for me for the long haul! My Gyno Oncologist & my Breast Oncology Specialist. I'm very happy with both of them as they are both among the best in their fields so I feel a sense of security being in their care. I also asked for copies of the pre-op biopsy results & Final Pathology Report. The biopsy results from the "Core Needle Biopsy" say "PAPILLARY CARCINOMA"...... but the final pathology says THE FOLLOWING:

#1, LEFT BREAST(SEGMENTAL MASTECTOMY WITH WIRE LOCALIZATION)
"DUCTAL CARCINOMA IN-SITU"
-NUCLEAR GRADE 1/3 WITHOUT NECROSIS
-PAPILLARY, CRIBRIFORM, & SOLID PATTERNS
-DCIS IS IDENTIFIED IN SIX OT OF TEN SLIDES; EXTENT OF DCIS MEASURED ON SLIDE 1C IS 1.9 CM
-POSITIVE FOR ESTROGEN RECEPTOR (100% OF DCIS CELL NUCLEI STAIN STRONGLY POSITIVE WITH SP1)
-POSITIVE FOR PROGESTERONE RECEPTOR(90-100% OF DCIS CELL NUCLEI STAIN WITH 1E2, VARIABLE WEAK TO STRONG INTENSITY)
-DCIS IS LESS THAN 1 MM FROM THE CLOSEST (POSTERIOR) RESECTION MARGIN

BIOPSY TRACT IDENTIFIED
SKIN WITHOUT DIAGNOSTIC ABNORMALITY

#2. LEFT SENTINEL LYMPH NODE (BIOPSY)
ONE LYMPH NODE NEGATIVE FOR METASTATIC CARCINOMA (0/1)

NOTE:CLUSTERS OF NEOPLASTIC CELLS WITHIN THE BIOPSY TRACT ARE INTERPRETED AS DISPLACED EPITHELIUM SECONDARY TO THE CORE NEEDLE BIOPSY PROCEDURE. iMMUNOSTAINS FOR MYOEPITHELIAL CELLS (P63 & CD10) HAVE BEEN PERFORMED ON BLOCKS 1C AND 1J. THE SENTINEL LYMPH NODE BLOCK HAS BEEN EXAMINED AT THREE H& E STAINED LEVELS & WITH A KERATIN (AE1/AE3) IMMUNOSTAIN; NO METASTATIC CARCINOMA IS IDENTIFIED IN THE SENTINEL NODE.

*Sorry this was so long but I wanted to give all the details so I can get feedback from those of you who have already been through it. I'm a little nervous about the radiation treatments, I will be called to come in for a consultation prior to treatments starting, but I got scared when the nurse told me the breast can turn black & blue from the treatments! Does the skin resume it's normal colour after or is this burn permanent? Anyways I thank God for my good results & this afternoon I'm headed to my church to light a candle for my answered prayers.
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  #2  
Unread 07-18-2007, 01:09 AM
Pathology Results & Update!

(((Mori))) Sounds good! I'm glad you got reassuring news.

The standard of care for a first time diagnosis of DCIS is usually just a lumpectomy, and possibly Tamoxifen for 5 years afterwards. However, that's assuming you have good clear margins on the lumpectomy. It sounds like your margin was less than the required 1mm in one area of the sample; so, then they would want to do the radiation as a precaution in case there might be a few cells even a little further out from the center that were missed.

Did your DR talk about whether you'd be doing external or internal (brachytherapy) radiation? External radiation is typically 5-6 weeks of daily treatments, 5 days a week. The treatments themselves are pretty quick and easy; however, you might experience something like a bad sunburn feeling. It does sometimes damage the skin, which is one reason why you cannot do external radiation twice on the same breast. External radiation is the standard method. I have not heard of it actually causing black and blue breasts, though you do get some tiny blue (usually) dots tattooed on your skin to mark the area that's being treated.

Brachytherapy is a newer technique, and what I had done last summer. It's five days of two treatments a day through a balloon catheter that is implanted in the lumpectomy site. It's much more intensive, but it's over much quicker and the potential for skin damage is less - I had something like a mild sunburn which healed up completely within a couple of weeks after the treatments ended. Brachytherapy isn't done at all treatment centers or hospitals; I had to travel 30 miles each way, twice a day, to have it done by a rad/onc who was trained in the method at a center which had the required equipment (it's very expensive to buy and train on). I posted my experience with radiation in this forum; if you look for a thread I started about Mammosite, that's it.

When do you start the Tamoxifen? I tried taking it when I was diagnosed the first time, but the side effects for me were so severe that I couldn't tolerate it. However, there are plenty of women who do great on it, and it does help reduce your risk of recurrence.

Again... I'm happy to hear the pathology came back so good. I hope you breeze right through the radiation, too!

s,
-Linda
  #3  
Unread 07-18-2007, 05:51 AM
Pathology Results & Update!

Hi SUrferbabe, the doctor didn't mention anything about not having clear margins & said my grade was 0! He said the radiation was to sterilize the area(bed) & the taxomifen to prevent a recurrence. I got the prescription & already started taking it yesterday. I hope I don't experience any side effects. He is thinking of sending me for genetic testing because of my previous endo ca & now this......would that help or be of any benefit? Shouldn't I have a re excision since you mention about the margin not being clear? I'm really scared about the radiation & don't know what to expect. You mention that radiation can only be done once .......what happens if it needs to be treated again for recurrence etc? I know I should be happy with my results but it seems my life will revolve around 2 cancer specialists now......Gyno Oncologist & Breast Oncology Specialist & I will forever live in fear of a recurrence from either. I know you will think I'm totally insane but I still haven't managed to quit smoking & I know I should! The stress & emotional part of all this is so overwhelming that I find it very hard to quit. I still take Ativan whenenever I have a doctors appointment & whenever I feel totally stressed. Thanks for answering my queations & for all your help & support. I will be doing the 5 weeks of radiation daily for 5 minutes & am waiting to be called in for a consultation before begining treatments. Take care.
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  #4  
Unread 07-18-2007, 06:06 AM
Unhappy - Pathology Results & Update! One more question!

Surferbabe it'sme again I forgot to ask......is Taxomifen considered chemotherapy? Will I lose all my hair? The doctor didn't mention anything & when I did a google search I saw hair loss & now I'm freaking out!
  #5  
Unread 07-19-2007, 05:35 PM
Pathology Results & Update!

Mori -
First, Congrats on the good news! DCIS is always stage 0 and what that means is that it has not left the ducts. Also, grade 1 means that the cells were not of the more aggressive type.

As for the margin/reexcision question, you can ask the doctor and/or go for a second opinion if it makes you feel better. In my case, my tumor was 3+cm, grade 3, so I did have 2 re-excisions because the surgeon and radiation onc. did not feel comfortable with a close margin.

Tamoxifen is a hormone treatment that blocks estrogen from the breast cells. It is the standard treatment for DCIS. Some radiation oncs. don't want you taking tamoxifen during that treatment, so be sure to ask that question.

Radiation will be much easier than what you have already been through. Many people have no side effects at all. It can get to be a drag going there every day, hopefully you are not too far from where you will be treated. I just posted a response about experience on the cancer board, you can check that out if you want. Also, there is lots of good information on the Susan G. Komen site and boards - those ladies are how I found this site. Also, Dr. Susan Love's Breast Book is an excellent source of information about breast health.

Good luck, ask lots of questions, do whatever they tell you and most of all, take care of yourself.
  #6  
Unread 07-19-2007, 06:12 PM
Pathology Results & Update!

Thanks gail I read your post on the cancer forums, thanks for the information & your support. Does anyone experience hair loss with Tamoxifen?
  #7  
Unread 07-19-2007, 06:54 PM
Pathology Results & Update!

mori -

there is no hair loss from radiation. the most common side effects are the fatigue and skin issues. a lot will depend on how big you are, how strong your dose is, your skin type, etc. I had virtually no skin issues, not much worse than a bad sunburn. there are many ways to treat it, depending on how you are affected. the therapists, doc, nurse, etc will give you lots of suggestions and monitor it all very closely. really, for me, radiation was a breeze compared to the rest of it.

you'll be fine!
  #8  
Unread 07-19-2007, 06:58 PM
Pathology Results & Update!

(((Mori))) to the extent that Tamoxifen can change your hormone balance, it can cause hair loss in some women. Not the kind of hair loss chemo can cause - nothing that major - but hair loss like some ladies experience when they go through menopause without HRT, for example, or have thyroid problems. It's just one of a host of "possible" symptoms that many women don't experience at all but a few might. (I was one of the lucky ones who gets them all )

Tamoxifen is a type of what is often referred to as adjunct therapy which may be prescribed for women who have had DCIS. It's mainly prescribed to women who still have working ovaries and can also be prescribed to women who have had their ovaries removed and are on HRT. Most commonly, women past natural menopause or who have had a BSO and are not on HRT will be prescribed an aromatase inhibitor such as Arimidex instead.

Tamoxifen and aromatase inhibitors work very differently. Tamoxifen acts like estrogen in some types of tissues (for example, bone and endometrium, which is why it helps maintain bone mass but can also cause endometrial cancer) and acts to oppose estrogen in some other tissues, such as breast tissue. Aromatase inhibitors prevent the production of estrogen from testosterone in tissues by interfering with the action of aromatase, the enzyme we need to convert testosterone to estrogen.

Everyone is different, and everyone reacts differently to treatments and medications. Your rad/onc and breast oncologist can help you decide which treatments are right for you; and, of course, if you feel your questions aren't being answered sufficiently or you're not getting the straight story, it's good to get a second opinion.

s,
-Linda
  #9  
Unread 07-19-2007, 07:23 PM
Pathology Results & Update!

Hi surferbabe, now I'm a little confused. I've had a hysterectomy so I have no ovaries & assume I'm post menopausal......so why was I prescribed tamoxifen instead of that other drug you mentioned?
  #10  
Unread 07-19-2007, 07:25 PM
Pathology Results & Update!

P.s. I'm also not taking any HRT.
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