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Breast Cancer

Pathology report and prognosis

08/21/2007

Question:

I have been diagnosed with Stage IIIC breast cancer. Tumor-4 cm (IDC w/no clear margin); 19 of 21 lymphnodes with metastatic adenocarcinoma (one in the Tail of Spence); Nottingham histological grade 3; ER/PR +; HER-2/neu +1; Ki67 intermediate; and abundant vascular invasion.

I have had a lumpectomy w/lymph node removal, followed by a second surgery to remove more breast tissue. I am on 6 months of Adriamycin (weekly), 15 weeks of Cytoxin and Neupogen, to be followed by Taxol. My question - I am having a hard time understanding the pathology report and the oncologists explanations of the prognosis. Does this sound like a cancer that can be arrested before it has spread to other areas? Is there a good outlook on prevention of reoccurance? Thank you so much for your time and answers.

Answer:

These are difficult questions to answer without having a full evaluation, including exam, scan results and review of the pathology. However, in general, chance of cure is small when a large number of lymph nodes are involved. Chemotherapy can help prevent recurrence and is necessary after a serious breast cancer such as yours. We often use a regimen of chemotherapy with Cytoxan and Adriamycin given every 3 or 4 weeks for 8-12 weeks followed by 8-12 weeks of taxane chemotherapy (docetaxel or paclitaxel). Radiation to the remaining breast tissue and lymph node regions should be given after chemotherapy. Because your tumor was estrogen receptor positive, you should receive a hormonal treatment in pill form (tamoxifen or if you are postmenopausal, anastrazole) for at least 5 years after radiation.

To further explain the pathology report, Stage IIIC most often means that there were more than 10 involved lymph nodes but no evidence of spread to other parts of the body. Grade III tumor refers to the appearance of the cells, Gr III being more aggressive tumors. A good feature for you is the ER/PR + (estrogen and progesterone receptor positive) as this predicts a better prognosis and allows hormonal treatment after chemotherapy which improves survival. Her2/neu 1+ is considered negative and also carries a better prognosis than if positive. The Ki67 intermediate has little impact and is a measure of the rate of tumor growth. The "abundant vascular invasion" means the pathologist can see small lymph channels within the removed breast tissue that contain tumor cells. This is a common finding when many lymph nodes are involved, as in your case.

Despite the seriousness of this cancer, all oncologists have women in their practices who have survived very similar situations. Good luck and good health.

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Response by:

Paula  Silverman, MD Paula Silverman, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University