Laymans language please!

[DianneS]

Hi ladies,

I'm embarrassed that I still don't quite understand my diagnosis from August 2008! I had my onc 'explain' it once but I think I have a mental block and don't want to hear it. Maybe if I read it I will understand & be able to absorb what it is saying in layman's terms.

Can someone please explain what this diagnosis means? Does it mean I had IDC 50% in situ, or not? Was the cancer confined to the tumour or beginning to spread to surrounding breast tissue? How do they know there is no vascular invasion if it was spreading?

I subsequently had bilateral mastectomies; simple on the left, modified radical on the right. Lymphs were negative.

Here goes from the pathology report:

Specimen No. 2 (right breast tissue) shows the grossly described mass to consist of a poorly differentiated infiltrating ductal carcinoma compatible with 8/9 points according to the SBR grading system (tubule formation 3, nuclear grade 3, mitotic rate 2). This is associated with high-grade ductal carcinoma in situ with comedonecrosis. There are multiple microcalcifications. There is no definitive evidence of vascular space invasion. The in situ component constitutes approximately 50% of the tumour volume and focally exceeds the area of invasive carcinoma by several millimeters. The invasive carcinoma focally approaches the painted surgical margin up to 1 mm and the in situ component is present within a fraction of a millimeter of the painted surgical margin. The background breast tissue shows benign fibrocystic change. Immunohistochemical staining shows the tumour cells of the invasive ductal carcinoma to be weakly positive for estrogen receptors, negative for progesterone receptors and positive for C-erb (3+).

Diagnosis: Right breast -

Excisional biopsy of right breast fine wire localization positive for infiltrating ductal carcinoma with greatest linear tumour dimension 2.1 cm (gross measurement).
High grade ductal carcinoma in situ with comedonecrosis constituting approximately 50% of total tumour volume. Histologic grade of invasive carcinoma. Grade III/III. Invasive carcinoma approaching surgical margin up to 1 mm.
Ductal carcinoma in situ present with a fraction of a millimeter of surgical margin.

I figure that one of my breast cancer sisters might be able to get through to me whether I had IDC or IDC and DCIS. Thank you for your time, you are a great bunch of ladies and I"m glad you're here!

Diannes

[Lien]

I'm no expert, and I'm not even a native English speaker, but here goes:

Specimen No. 2 (right breast tissue) shows the grossly described mass to consist of a poorly differentiated infiltrating ductal carcinoma compatible with 8/9 points according to the SBR grading system (tubule formation 3, nuclear grade 3, mitotic rate 2).

This means that the mass they took out has a score of 8 out of 9 on the SBR grading system. This means that the cells look very different from normal cells and they multiply rather quickly.

This is associated with high-grade ductal carcinoma in situ with comedonecrosis. There are multiple microcalcifications. There is no definitive evidence of vascular space invasion. The in situ component constitutes approximately 50% of the tumour volume and focally exceeds the area of invasive carcinoma by several millimeters.

There is also an area with high-grade DCIS (non-infiltrating cancer), with comedonecrosis (I think this means that they can see that cells are dying). There are several multicalcifications (signs of cancer seen on a mammogram). They found no cancer cells in the vascular system (I'm not sure whether this includes lymph ducts, or refers to both lymph ducts and bloodvessels). The non-invasive part takes up about half of the total tumor that they found in your breast. So it's half invasive (capable of spreading), half non-invasive (staying where it is). Focally means "in some places", so in some places the non-invasive component "sticks out" a bit.

The invasive carcinoma focally approaches the painted surgical margin up to 1 mm and the in situ component is present within a fraction of a millimeter of the painted surgical margin.

The invasive part is surrounded by a 1 mm margin from where the surgeon cut it out, and the non-invasive part has a less than 1 mm margin.

The background breast tissue shows benign fibrocystic change. Immunohistochemical staining shows the tumour cells of the invasive ductal carcinoma to be weakly positive for estrogen receptors, negative for progesterone receptors and positive for C-erb (3+).


The rest of the tissue shows benign lumps. The invasive part of your tumor is weakly ER positive, PR negative and HER2 positive.

Excisional biopsy of right breast fine wire localization positive for infiltrating ductal carcinoma with greatest linear tumour dimension 2.1 cm (gross measurement).
High grade ductal carcinoma in situ with comedonecrosis constituting approximately 50% of total tumour volume. Histologic grade of invasive carcinoma. Grade III/III. Invasive carcinoma approaching surgical margin up to 1 mm.
Ductal carcinoma in situ present with a fraction of a millimeter of surgical margin.

This part summarizes what was written above and says that they put a wire in the tumour so the surgeon knew where to cut it out. They found a 2.1 cm invasive tumour and DCIS (non-invasive tumor) which had comedonecrosis and measures about half the tumour volume. The invasive tumour is Grade 3, which means it is more aggressive and faster growing.( This also means that it is more likely to respond well to chemo. my comment). The invasive component had at least 1 mm margin, the DCIS has smaller margins.

I hope this helps. Everyone: please correct me if I'm wrong. As said, I'm not English or American, so I may get things wrong.

Jacqueline

[Lien]

I noticed I forgot to answer your questions:
Does it mean I had IDC 50% in situ, or not?
Your tumour was about 50% invasive and 50% in situ, meaning it wasn't spreading into surrounding tissue.

Was the cancer confined to the tumour or beginning to spread to surrounding breast tissue?

The invasive component was spreading into surrounding breast tissue.

How do they know there is no vascular invasion if it was spreading?

In the vascular system they inspected, they didn't find any tumour cells.

A lot of this is explained very well on www.breastcancer.org


Jacqueline

[Rich66]

You don't know what comedonecrosis is?

[DianneS]

Lien, thank you! I think I have a better idea now. My doctor is not good at explaining, esp. when my ears are closed off. You did a great job, you write English very well. Do you speak Dutch?

Diannes

[DianneS]

Hi Rich66,

Ha, that's ONE term I do know. It means it looks like blackheads (yuck) I believe......correct me if I'm wrong.

I don't know if it indicates cells dying off though?

Diannes

[sassy]

I do think it indicates areas where the cells have died or are dying. I had a significant area of comedonecrosis. I think this is found more often in more aggressive or faster growing cancers.

[Lien]

No Rich, I didn't know. Sorry. I thought I was perfect, but now I have to face the fact that there's something lacking. I hope I can get over it. ;-)

Yes, I speak Dutch. So do the other 17 million people around me, so I get a lot of practice. ;-)

I think Sassy is right about the comedonecrosis.

Love

Jacqueline

[jml]

Comedonecrosis
a type of necrosis (cell or tissue death) occurring with glands in which there is central luminal inflam-mation with devitalised cells, usually occurring in the breast in intraductal carcinoma.

[Lien]

So Sassy did get it right. It's dead cells or tissue within a gland.

Jacqueline