Malignant cells found ... one year later

concerned sister · Guest

Hello Dr. Leo,

I'm not even really sure what question I want to ask, as we don't have very much information at this time. My older sister (dx at 41, now 42) had a lumpectomy, then simple mastectomy almost a year ago today (dx: extensive dcis, unclear margins).

This past weekend, she found a lump under her arm on the mastectomy side. Ultrasound showed a cyst, oncologist was concerned, called it a 'complex' cyst, and aspirated on the spot. Initial report back today, shows malignant cells present. We're overwhelmed ... and wondering how this could have happened, when her cancer was "contained". Did they miss some of it?

Not sure what her treatment will be at this point, but wanted to know if you think they would treat this as another primary cancer or a metastasis? Also, how can a cancer spread when she had a clear sentinel node and they took the breast off?

As I said, not even sure what other questions I have. Just regretting I'm here to begin with.

I appreciate your time and the service you're offering to those who need it.

Thank you.
Concerned Sister[/u]

leo · Owner Joined: 23 Sep 2004 Posts: 1574

Hello, and thanks for posting.

Unfortunately, sentinel lymphnode is a very good technique, but in Medicine there is no technique that is 100% certain. So there are cases that even when the sentinel lymphnode is negative, there may be positve axillary nodes. I am afraid this may have happened with your sister, but I can not be sure. So at this point this may be considered recurrent breast cancer to the axillary lymphnodes. She will probably have another staging evaluation, and be treated appropriately.

I hope she does well. There are several approaches that may be taken, and it looks like she has a really good doctor.

regards,
Leo
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Disclaimer: this information is for informational purposes only. It is not medical advice.

concerned sister · Guest

Thanks for your response, and so quickly. We should learn more today.
And I hadn't even thought of the staging evaluation or how they will determine that. More to come I'm sure.
CS

leo · Owner Joined: 23 Sep 2004 Posts: 1574

CS

If you need anything else we will be available.

regards and good luck
Leo
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Leonardo F - Webmaster Cancer Forums
Disclaimer: this information is for informational purposes only. It is not medical advice.

DJ56 · Guest

Dr. Leo:

What is "staging" and how is it determined?

thanks,
Dianne

DJ56 · Guest

Dr. Leo: please disregard that last question.. re: staging.. I meant [b]grading[/b].

DUH, forgive me.. I'm blonde. Embarassed

thank you!
Dianne

Muttsmom

ROFL I'm not blonde and I have alot of DUH moments.

The grade is how aggressive the cancer cells are. Grade 1 is slow growing, I was Grade 2 (of course I have to be different) which is not the slowest, but not the fastest, and Grade 3 is the fastest growing cells. Most ladies I know are grade 3. I don't know if that's more common or just the ones that I've gotten to know. From what I understand and thank God we have Leo to correct me if I'm wrong. Chemo responds better to faster growing cells, so if you are a grade 2 or 3, it will respond generally to those, BUT like everything else with this disease, everyone regardless of their grade could respond the opposite. Grade 1 may still respond well to chemo and some Grade 3's don't. It's a crap shot, but I'm betting on the winning side Smile

Nancy

leo · Owner Joined: 23 Sep 2004 Posts: 1574

Hello

When we talk about histological grade is how well differentiated a group of cancer cells look under the microscope. Differentiation referers to the degree of how a cell looks like it should....maybe a better definition is exemplifying.:

a well differentiated cell: a cell that has features that are more similar to the tissue it came from. The less differentiated, the more aggressive the cell is, but not necessarily clinically aggressive.

I just found this reference for you to take a look at. They explain a bit better than me Smile

http://imaginis.com/breasthealth/histologic_grades.asp?mode=1

regards,
Leo
_________________
Leonardo F - Webmaster Cancer Forums
Disclaimer: this information is for informational purposes only. It is not medical advice.

Muttsmom

Hi Leo,
That link has me wondering something. It's showing what the 5 year survival rate is, not sure if it means survival without a reoccurence or survival period. It's showing after 5 years the survival rate goes down. I thought the longer out without a reoccurence the better chance not to have one, but that link says differently.

Next question.... lol Not sure if i want the answer though.. When it comes to er/pr+......is it better to be 80% er/pr+ as far as prognosis and using Arimidex, Tamoxifen or whatever or is it a better prognosis if your er/pr + is 30%?

Don't you love my questions.... lol
Thanks
Nancy

penelopez · Senior User Joined: 11 Oct 2004 Posts: 165

Hi Nancy,

I will share with you what I was told (until Dr. Leo gets here).

I was told that the higher your ER and PR are, the better. Mine is ER 70 and PR 60 and I was told that is a very favorable prognostic indicator. I've seen some gals have 98 or 99 percent! This means the response from the hormonal therapy would be way up there. But they also say that even if one is only a few percent positive that there is still some benefit, just not as much.

I know what you mean about the survival charts. My docs told me that most recur within five years (about 80 percent) and that the rest would recur (IF they are going to recur) anytime during the rest of your life. But most charts do show drops after five years all the way to ten years. It doesn't make sense to me either.

Hope this helps a little! Have a great day.

Hugs,

Margie

MuttsMom · Guest

Hi Margie,
You definately answered my questions. I was 78/79 er/pr+ which I thought was good, especially being Stage III. Then someone told me theirs were 30% and their onco said that, the lower, the better, which didn't make sense to me, but what about this disease does. Thanks for clearing it up and I DO like your answer.....lol

Those charts just really confuse me. Mine said the longer you go, the least likely to have a reoccurence. I'm a little over 2 1/2 years out and mine said he was "encouraged". I know it could come back at anytime, but I pray if it does, it's wayyyyyyy down the road when there is much better treatments and better chances. I opted for a double mastectomy and glad I did. I've seen so many local reoccurences on ladies that were late stages that had lumpectomies, but of course, we would celebrate a local reoccurence over distant mets for sure. We can celebrate some strange things... lol

Thanks again
Nancy

penelopez · Senior User Joined: 11 Oct 2004 Posts: 165

Hi Nancy,

Perhaps she misunderstood her onc. We have a high level of anxiety when we're in that office and we have lots of information to remember.

That's great that you're so highly positive. The more things we have working in our favor, the better!

I'm 14 months out of diagnosis and 7 months out of treatment and I'm thinking like you.......no recurrence but if it did recur down the road, I'd deal with it then. There should be lots more available treatments by then. I read that eventually chemo will be a thing of the past for most people and you will just take a pill every day that will "target" the tumor cells for destruction, but not destoy the good cells, which would produce much fewer side effects.

Anyway, I'll be interested to see what Dr. Leo says about those survival numbers going lower after 5 years.

Hugs,

Margie

Lee · Guest

Hi all,

I am about 5 months out from my DX and I have never heard of this before. My list of things to talk to my ONC about is growing. Does this show on your path report? I didn't get the last report that had the er /pr and her2 on it. I will. I know what it said but was really having a bad day when we got the results on these. This is all very interesting. I learn more everyday. Some still scares the heck out of me. Keeping you all in my prayers.

Best to you all.
Lee

penelopez · Senior User Joined: 11 Oct 2004 Posts: 165

Hi Lee,

If you are referring to the ER and PR percentages - They told me I was ER PR positive but the exact numbers (percentages) were not stated on the pathology report. I didn't know about it either. (No one bothered to tell me). I happened to hear some ladies discussing it on another board. So.....I asked my rad onc's nurse at my radiation session what the numbers were and why no one showed them to me. She said they were not on the pathology report, but were on another report they termed the "prognostic indicators." It said in that report I was 70 - 60 and that this was a favorable prognostic indicator. I told her I wanted a copy of that report. Again, if I had not heard it from ladies on other boards who were kind enough to share, I'm not sure I'd know either. It also mentioned the score of the HER2neu test. My advice: Tell your doc you want a copy of this information. They should have it. It's too bad we even have to ask for copies of this information. They should automatically give all this information to us!

Good luck.

Hugs,

Margie

DJ56 · Guest

Physicians often examine hormone receptors in breast cancer cells at the time of biopsy or breast surgery to determine whether estrogen receptors (ER-positive) or progesterone receptors (PR-positive) are present. [b]Patients whose cancers have ER or PR-positive receptors tend to have a better prognosis than patients whose cancers do not have these receptors. [/b]Cancers with ER or PR-positive receptors are also much more likely to respond to chemotherapy or hormone treatment.

Crying or Very sad

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