Category Archives: Diagnosis

Breast Surgeon Post-op Visit

I had procrastinated on making this appointment since I thought there was no need to see her again, after all, she performed the surgery and sentinel node biopsy, informed me that the cancer had not spread to the lymph nodes and I survived, what more did I need to know?  As it turns out, quite a lot.

Fortunately, I had phoned her office last Thursday, the 19th and surprisingly was able to see her today, only 4 days later, including the weekend! Originally, I wanted her opinion/advice regarding possible lymphedema.

Dr. Talbert entered the room with her trademark congenial smile and the surgical report in hand, she asked how I was doing and commented that I seemed to be recovering very well.  She handed the report to me as she reviewed what took place during surgery, which seemed uneventful to my mind until she said, “…there were pre-cancerous cells in your left breast.  It was a very good thing that you chose to have it removed at the same time.”

Those words and time froze in my mind, “..pre-cancerous cells in your left breast…”  I heard nothing else that was being said, I was stuck in that moment of, …of… fear?  disbelief? gratitude?  Dr. Talbert must have realized that I was dumbstruck and gave me a moment to regroup and she continued that she would like to see me six months from now for an MRI to be certain that no cancer remained to spread into the chest wall or skin.  WHAT?  Again, I was dumbstruck.  I thought that “this” cancer was done, finito, all gone, never to be seen or feared again.  Hmm, I’m learning that once you have cancer, the rest of ones life is going to be filled with vigilance.

Moving onward from cancer topics, I proceeded to ask her about lymphedema and to give me the “description” of the type of cancer I had since my relatives can tell me exactly the type of cancer they had, example, Lobular carcinoma in situ,triple negative breast cancer, Angiosarcoma, etc..  But, before I record what she explained about the type of cancer, (I’ll type in directly from the report she gave to me) let’s address the lymphedema concern.

I showed her my right arm of which I am aware that it is slightly puffy, less than it had been several days ago.  I digressed as I asked her to point out from where the three lymph nodes were removed.  She touched the area above where my right breast had been, close to the underarm area but still on the front side of the body and explained that those three nodes were the ones that ‘lit up’ from the nuclear injection.

Back to lymphedema, I asked if removal of the lymph nodes is associated with lymphedema, it makes sense to me that it would.  She agreed that in cases where more numerous nodes are removed, the likelihood of lymphedema is much greater.  Looking at my arm, she agreed that it did look slightly swollen and that she would like to send me for physical therapy but could not do that until the reconstruction phase is completed, at least up to and through the permanent implant exchange and recovery.  While telling this to me, she raised one of her arms and showed me how I might relieve some of the pain by slightly raising my arm, above the heart, and gently massaging from my wrist back to my shoulder, to help encourage the fluid to drain into the larger part of the body.

One final question I posed was whether or not I could start doing more physical things, like, moving and burning our wood pile, weeding the front flower bed, vacuuming, etc..  Her eyes got HUGE and she said, “NO!”  I then learned that it would actually take SIX  MONTHS for my internal wounds to completely heal from the extensive surgery, even though I might be “feeling good”, if I overdo anything, I could end up back in the hospital in worse condition than when I left.  Ok, that warning is good enough for me, my activities will remain to be limited to emptying the dishwasher, doing laundry and computer work.

As we closed out the visit, I wished her congratulations as she was closing her practice at this location and returning to Oklahoma University where she would return to teaching and head the new breast cancer research department.  She will have an office at OU with limited patients, I, fortunately, am one of the lucky ones who can count her as my doctor!

From the report:

Right Breast, Simple Mastectomy (A):

  • Invasive, Well-differentiated ductal carcinoma
  • Tumor location – upper outer quadrant
  • Tumor size – 1.4 x 1.1 x 1.0 centimeters
  • Invasive Tumor type – Invasive Ductal Carcinoma, Usual Type
  • Invasive Tumor Grade – Histologic Grade 1
  • Tumor-Associated Microcalcifications – Present
  • DCIS Component – Present (1/9 Slides)
  • DCIS Type – Cribriform
  • DCIS Nuclear Grade – Low-grade
  • Necrosis – Not Identified
  • Surgical Margins – Free of invasive and in situ ductal carcinoma.
    • Closes Margin – Deep – 1.0 Centimeters
    • Additional Margin – Superficial Skin – 1.7 Centimeters
    • Ancillary Studies – Performed on Biopsy at MWR
    • Estrogen Receptor – Positive (95%)
    • Progesterone Receptor – Positive (80%)
    • HER2-NEU By FISH – Not Amplified (1.2)
  • Right Sentinel Lymph Nodes, Excision (B):
    • Three begign lymph nodes negative fore metastatic carcinoma at levels (0/3)

Left Breast, Simple Mastectomy (C):

  • Mild Proliferative Fibrocystic changes
  • Negative for atypical hyperplasia and malignancy

BAR_LINE2

Advertisements

Breast Cancer Pathology Report

PATHOLOGY REPORT

Estrogen Receptor 95% favorable
KI67 MIB-1 2% Borderline
DNA INDEX 1.00 Diploid
HER-2 NEU (FISH) NOT  AMPLIFIED

ESTROGEN RECEPTOR 95% FAVORABLE – PROGESTERONE  RECEPTOR  80% FAVORABLE.
The hormone receptor status of your tumor helps guide your treatment plan. If your tumor is ER+ and/or PR+, treatments that prevent the cancer cells from getting the hormones they need to grow (such as tamoxifen or aromatase inhibitors) may stop tumor growth. Tumors that are ER- and PR- are not treated with hormone therapies.

KI67 MIB-1    2% BORDERLINE
The proliferation rate represents the percentage of cancer cells that are actively dividing. In general, the higher the proliferation rate, the more aggressive the tumor tends to be. The Ki-67 test is a common way to measure proliferation rate. MIB1 is the antibody most often used to label the Ki-67 antigen. You may see these terms on your pathology report. A higher value shows a higher proliferation rate.

DNA  INDEX     1.00 DIPLOID
DNA Index of 1.0 means that the cells are diploid and are similar to normal breast cells in their DNA content.  A DNA content that is aneuploid has an abnormal DNA content……… About 70% of breast cancers will be aneuploid and 30% will be diploid.  The 5 year disease free survival for women with diploid tumors is 88% and for women with aneuploid tumors is 68%. The 5 year disease free survival for patients with a diploid tumor and a low SPF is 90% ………

HER-2 NEU (FISH)     1.2 (NOT  AMPLIFIED)
HER2/neu (human epidermal growth factor receptor 2), also called ErbB2, is a protein that appears on the surface of some breast cancer cells. It is an important part of the cellular pathway for growth and survival.

  • HER2/neu-positive (HER2+)tumors have many HER2/neu genes inside the cancer cells (also called HER2/neu over-expression) and a large amount of HER2/neu protein on the surface of the cancer cells
  • HER2/neu-negative (HER2-) tumors have few HER2/neu genes inside the cancer cells and little or no HER2/neu protein on the surface of the cancer cells

About 15 to 20 percent of breast cancers are HER2+ [29-30 ]. These breast cancers tend to be more aggressive than other tumors.

HER2/neu status helps guide your treatment plan. HER2+ cancers can benefit from trastuzumab (Herceptin) therapy, which directly targets the HER2/neu receptor. This type of therapy is not used to treat HER2- cancers.

Both the  American Society for Clinical Oncology  and the National Comprehensive Cancer Network  recommend HER2/neu testing for all tumors. HER2/neu status can be determined in two ways:

  1. Immunohistochemistry (IHC) testing which detects the amount of HER2/neu protein on the surface of the cancer cells
  2. Fluorescence in situ hybridization (FISH) testing which detects the number of HER2/neu genes in the cancer cells

Most often, IHC is the first test and if the score is +2 (or borderline), the tumor is sent for FISH testing to confirm the status.

RESULTS  OF  AN   IHC  TEST
Score is 0 or +1 Tumor is HER2-
Score is +2 Results are unclear and should be confirmed by FISH
Score is +3 Tumor is HER2+
RESULTS  OF  A  FISH  TEST
Positive (amplified) The tumor is HER2+
Negative (non-amplified) The tumor is HER2-

BAR_LINE2