Lobular Cancer

Hi Shybird, I apologize for the follow-ups, subsequent comments do not seem to trigger alerts. I look at the roster of questions and new comments are not indicated. I can’t really say I could remedy the situation beyond informing the technical staff (which you have done). I will go back to some of the unanswered queries: 1.) Are axillary nodes the same as sentinal nodes? Sentinel lymph node biopsies (SNB) are a method of finding where a primary is more likely to spread. The goal is to avoid extensive dissection on the armpit. There are staging criteria for either axillary dissection or SNB. You can think of it as an alternative means of staging the axilla. 1.) The surgeon removed 30% of extensice DCIS. I feel that if my body produced DCIS once, it can do it again. The DCIS raises the risk of subsequent cancer, and hence removing it is recommended. DCIS with comedo necrosis is a precursor for subsequent invasive disease. The most we can say is that the same breast may also produce another DCIS, hence additional therapy (beyond excision) may be the way to go if the breast is conserved. Another question is that your breast produced invasive disease, so does it mean that the other breast is automatically at risk? At present, a breast MRI is the most sensitive test to find early breast disease, and patients who have a personal history of breast cancer are not necessarily candidates for screening (meaning the risk isn’t high enough). On bilaterality and the comment about the lobular component: In situ disease of ductal (DCIS) or lobular (LCIS) has been known for decades. It was believed that both increased the risk of subsequent breast cancer and hence recommendations then were for excision. LCIS however is usually detected incidentally, as it is usually not seen on a mammogram. This makes it difficult to ascertain their behavior. But it seems that about a third would have LCIS on the opposite breast (hence the issue of bilaterality). To make matters more complicated, LCIS doesn’t always become cancer. Only 10 to 20% develop cancer after 15 to 25 years. As you have DCIS with some lobular features – the question is whether this would behave similarly to LCIS? At the present we don’t really know, so recommendations for or against aggressive management would have their merit. 2.) Could I have spread more cancer cells through my system by first having the needle core biopsy, followed by the lumpectomy, and then the margin surgery? While there are theoretical concerns about this due to manipulation and possibly transfer of cancer into the blood, when done by trained personnel, the risk doesn’t seem to be significant. Women who get repeat procedures still manage to obtain similar outcomes with those who only get 1 stage procedures. There are even protocols that specifically call for repeat biopsies in research settings. 3.) If more cancer cells are found (if I decide on the bilateral surgery), will more chemo be needed, you suppose? 1.) Did I have two tumors? I see one as 1.5 and one a 1.6) Let me try to answer this together. Strictly speaking yes, there is more than one cancer here. The risk for patients with multicentric disease is likely different from those with single disease. Most of the information is based on single cancers. However, consider if you didn’t have any intervention for another year or so – the two sites may become a single mass and hence there is no way of knowing you had multicentric disease to begin with. At any rate, invasive cancers less than 1 cm are unlikely to metastasize so excision would be adequate. Even if you had two big lumps, over each breast, treatment would be considered for each independently. The chemotherapy will not double in number of cycles – but your doctor would probably choose a more intensive combination (TAC is pretty good). 2.) Am I just ER and PR positive? 3.) Low steroid receptor levels are associated with short term 5 year metastisis. that My oncologist said she believes this is referring to ER and PR. Can you tell from the pathology report about the levels? The intensity of the uptake is the 2+, and the percentage of cells is the 40%. There is some data that more extensive expression of the ER would correlate with a more dramatic impact of hormonal therapy. This research used FISH instead of IHC to quantitate, so in the future, there may be more information to correlate a differential in effect (within patients who are all hormone receptor positive) if you are IHC 2+ vs 3+ or 40% vs 80% . At present, what is important is that you would have the additional protection of hormone therapy. do I have a bad cancer that has a high risk of distant recurrence? The strongest predictors seem to give enough reason to be hopeful – ER positivity, Her2 negativity, small primary, only 1 node positive. Stay positive.

Detailed answer for your question: Available in paid version. - Click to pay.
Second opinion from another doctor: Available in paid version. - Click to pay.