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This question was answered on Wed 19, Mar 2008 08:47pm by Dr Fernando, MD

What do you think? please - Cells after biopsy were high grade with necrosis


    
Asked by hazellynn (Male ) on Wed 19, Mar 2008 08:34am

Hi, I had 5mm dcis - had a lumpectomy and there was 1mm found close to the edge of the margins. The doctor thought maybe more had invaded, so wanted to do another lumpectomy. I said No - a mastectomy - he did this and took the lymph nodes too. He told me that there was no more invasion, the multi focal was negative, the nodes were negative. He put me on Tamoxifen for five years and said that I should live forever. Apparently the cells after biopsy were High Grade with Necrosis. Do you agree with what he has said and with the cells having been High Grade does that make a difference? I see my oncologist tomorrow. I am 48 premenapausal, had 4 children late in life, am Hormone Positive and Her Negative. My mother died of breast cancer with secondaries. What do you think about my situation, is it possible that I am cured??
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Answer by Dr Fernando, MD  on Wed 19, Mar 2008 08:47pm:

Hi, The mastectomy is adequate initial treatment for multifocal ductal carcinoma in situ (DCIS). I gathered the information you posted and used these to calculate your ten year mortality and relapse estimates using a computer software called Adjuvant Online. The results came out as follows: Ten year survival rate without additional treatment: 91.2% Ten year survival rate with Tamoxifen: 92.7% Ten year recurrence rate without additional treatment: 24.2% Ten year recurrence rate with Tamoxifen: 16.6% So what do the above numbers mean? With the type of treatment your doctor has planned for you (mastectomy then tamoxifen for 5 years), you have an excellent chance of survival (92.7%) after ten years. However, there is a small chance (16.6%) that the breast cancer could come back within ten years. If you do not have recurrence of breast cancer within the next ten years, then that is the only time we can say with certainty that you have been cured of the disease. I hope the explanations helped.

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Comment by hazellynn on Sat 22, Mar 2008 02:40pm: Thank you Doctor for your reply. I havent seen the Oncologyst yet, so still have questions, with my situation, do you think I would need Radiotherapy as well? or even Chemo?? or do you think that the initial lumpectomy, then Mastectomy and Tamoxifen will be the total of my treatment - my surgeon/doctor seems to think this is enough, but I always like to triple check. Thank you in anticipation. Have a great Easter Hazel
Comment by Dr Fernando, MD on Fri 28, Mar 2008 05:43pm: Hi, I don't think you need to undergo radiation therapy at this point. But there may be an option to do chemotherapy. The high grade nature of your DCIS may warrant the use of chemotherapy, but this is a gray area. Some doctors have the opinion that mastectomy and hormonal therapy are adequate treatment for this situation.
Comment by hazellynn on Sat 29, Mar 2008 06:31am: Hi, thank you for your answer, it did help. If I had the chemotherapy as an option, would it increase my survival rates long term? and by what percent?. Thank you once again. Hazel
Comment by Dr Fernando, MD on Mon 31, Mar 2008 03:57pm: Hi. If you had chemotherapy in addition to the hormonal treatment, you could expect a very modest increase in ten year survival rate from 92.7% to 94.6%. Again, this was calculated using the Adjuvant Online software. Note that the addition of chemotherapy only adds a 2% 10-year survival benefit. This has to be weighed against the expected adverse events which you will likely be experiencing while undergoing chemotherapy, or even afterwards (e.g. chronic numbness of fingers and toes).
Comment by hazellynn on Sun 13, Apr 2008 09:21am: Hi, again thanks. I have another issue at the moment and that is I havent seen an Oncologist through any of this - my mastectomy was over six weeks ago now. The doctor told me I would see one and when I try to get to find out via his secretary when that time will be, she is very unhelpful and gives me no information. I have tried every route to ask a simple question - when shall I see an Oncologist and she will not let me know, she seems to think I dont need one and that I will just go away. So, six weeks have past and I am worried that I dont have all the information and that the oncologist may think I need some other treatment. Does my situation need an oncologist, and if so, when should I have seen him? This secretary is very dangerous to work in a cancer hospital, and will make a major complaint once I am sorted out. Many thanks.

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