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This question was answered on Tue 02, Dec 2008 04:58pm by Dr Heinrik M, MD

Invasive Ductal Carcinoma Stage IIA Grade 3


    
Asked by shybird (Female; 52; Please see below in 'Question'; Relevant drugs:Fioricet, Maxalt-MLT, Synthroid, Protonix, Lexapro. For Chemo: I believe it is TAC? Not sure. ) on Tue 02, Dec 2008 09:42am

Medical History: Age: 53 Race: White Age at first menstruation: 16.5 years Age of first birth child: 20 Number of births: 2 Surgical Menopause in 1999: Age 44 HRT Patch used since 1999 Medical Conditions: Hypothyroidism Depression Rebound Migraines GERD Osteopenia I was diagnosed with Grade 3 poorly differentiated Invasive Ductal Carcinoma breast cancer. I have had a lumpectomy...my tumor ( pT1c) being 1.5 cm., with one (out of 12) sentinal nodes positive with MESTASTIC carcinoma and focular extracapsular extension. Stage IIA 0/9 Axilliary node disection negative for carcinoma. Had to have another surgery to produce clean margins, which was listed as 1.6mm. (anterior) Angiolymphatic invasion is present. Solid and Cribriform type with comedo necrosis. E-Cadherin Positive ER and PR . Currently undergoing treatment. My questions: 1.) Does Angiolymphatic mean that the cells have travelled through my lymphatic system AND blood system? 2.) Poorly differentiated usually means poor prognosis. (quote) Does 'poorer prognosis' mean that I have a higher risk of mestastisis? 3.) My oncologist did mention that she likes wider clear margins than what my surgeon got for me, but I have small breasts. Why do you think she feels this way? 4.) Researched that E-Cadherin develops into mestastic sites 45-50%of the time. Since one node positive, is that my mestastisis? TOr does the risk mean for distant? 5.) Since I am estrogen positive, my oncologist recommends to stay away from animal fats. She said that fat turns into estrogen. I love cheese, and I love sweets. Once I am put on the estrogen blocker drug, will that also stop the food estrogens? 6.) Give it to me bluntly and truthfully, doctor, because I am not getting that from my oncologist. She uses the phrase 'there is no crystal ball'. Her computer was down to give me the Adjuvent Online scale. (And I do not know if that is what oncologist's use or not, but I've read about it.) If it is, could you email the grafts with my percentages, please? I need and want to know everything, so my mindset can be ready for all of what is ahead for me.
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Answer by Dr Heinrik M, MD  on Tue 02, Dec 2008 04:58pm:

Hi, 1.) The Angiolymphatic invasion is meaningful for those who do not have pathologic evidence of cancer spreading into the lymph nodes. Hence, you may consider this as pre-nodal, meaning the cancer has not reached the nodes, but seems to be going there at the time of surgery. 2.) A poorly differentiated cancer generally tends to grow faster, so that the odds of relapsing would also be higher. In your case, it may be a 10% difference at 10 years time. 3.) It is hard to say how far the cancer really has spread, if the margin was as near as less than a millimeter from the cancerous lump, there is a high risk for regrowth in the surgical area, because of the risk of residual disease left. This is true for most cancer surgeries. 4.) E cadherin is an area of active research, at present it may help distinguish subtypes of breast cancer (whether ductal or lobular). Specific impact on overall outcomes beyond that known for ductal or lobular cancer is not well characterized. 5.) Its not easy making dietary recommendations, as in general most people don't really stick to it more than 2 years down the line. Perhaps a simpler advice would be to maintain your weight, or to avoid getting heavier. 6.) The adjuvant online is a good estimate (or guesstimate if you will). If you use it, the odds of getting cancer in ten years without any further treatment after surgery would be about 35%, with chemotherapy and hormone therapy this could be lowered to 15%. It would also be interesting to know if you are HER2 positive or not. Perhaps this is something to discuss with your doctor. Stay positive.

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Follow up:

Clarification by shybird on Fri 05, Dec 2008 06:05am: 
I am just a bit confused as to the research that I've done on the  E-Cadherin Gene, and your answer
(#4).

As you know, the E-Cadherin gene is known as the tumor suppressor gene.  A mutation of this gene is linked to
breast, lung, stomach, and bladder cancer.  I already have developed the breast cancer.

83% get stomach cancer by the age of 80.
50% get metastasis of breast cancer.

Given my health report, these percentages do not sound good to me.  

Can E-Cadherin be repaired by what the chemo is doing? 

Also, I am not HER2 positive. Only ER and PR.

Thank you for your follow-up.

Comments:

Comment by Dr Heinrik M, MD on Mon 19, Jan 2009 09:19am: On repairing cadherin: The chemotherapy would seek to kill the aberrant cancer cells – it will not likely return the function of the cadherin (not likely that the chemo will trigger production of missing cadherin). However, the process of killing the cancer cells may involve using metabolic pathways that trigger other tumor suppressors to become active – so indirectly – the function of the cadherin is taken up by another protein. On the risk of Cadherin: The information I have is for cases of hereditary breast and gastric cancer. A study done in 1999 did not show any increased risk (Int J Radiat Oncol Biol Phys. 1999 Aug 1;45(1):73-83.) this was actually a small population with less than a hundred cases. I am unaware of any large prospective study in which patients with E-cadherin were followed up to look at how many developed breast or gastric cancer. The converse has been reported: among those with established HEREDITARY breast or gastric cancer, there seems to be an increased incidence of mutations in CDH1 (which encodes the E Cadherin protein). This data however, wouldn’t really apply to you as you do not seem to have a hereditary type of cancer.
Comment by Dorothy on Fri 13, Nov 2009 01:55am: my daughter has just been diagnosed with ductal carcinoma gr3. She is 38 years old, is type 1 diabetic and has krohns disease as well. What type of questions do we ask the doctor. The lump in her breast is 1,3cm.
Comment by bobby s, md on Fri 13, Nov 2009 12:23pm: Hi Dorothy, You need to ask the doctor the stage of the tumor, the hormone receptor status (ER, PR, HER2), the overall prognosis based on her pathology and radiology findings, and about the treatment plan. Mention her diabetic and Crohn's status as well, and ask about surgery, chemotherapy, radiotherapy; the side effects, risk versus benefit, etc. Also, ask about support services, both for patient and care-givers. Ask about availability of suitable clinical trials. Lastly, you should have a discussion on the financial aspects.

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