Hi
New here, so apologies if I am doing this all wrong!
I have a pathology report but I am concerned that the cancer marker results don't seem to be typical for the primary cancer I have been diagnosed with. I understand that the markers aren't always 100%, but how many would have to be present to get the correct primary diagnosis?
I am diagnosed with Invasive Ductal Carcinoma of the breast - 3cm grade 1 tumour entirely within the nipple (but not pagets disease), 2 lymph nodes involved.
The markers identified in my pathology report are:
ER/PR positive
HER2 negative
CK7 negative
mammoglobin negative
TTF1 negative
E Cadherin positive
Extensive perineural invasion
No lymphovascular invasion
Single cell invasion of malignant cells into basal epidermis
I did read the Q and A's and see that you ask not to interpret reports, but all I really want to know is if I can be confident in the diagnosis or should I be asking more questions? I am concerned because it took them a long time to identify the lump and when they did the surgeon told me it was because they had never seen anything like it, which doesn't fill me with confidence!
Thank you for any help.
Emily.
Reply # - February 19, 2015, 08:17 AM
I think having an ER and PR
I think having an ER and PR positive tumor within the breast is likely to justify the diagnosis, but we would definitely defer to the doctors directly involved. As you mentioned, the marker studies are not infallible, but aside from that, cancer doesn't necessarily respect any rules. My mindset is that if one bit of information doesn't fit with the others that fit together, it's most appropriate to go with the prevailing picture, especially if there is some variability in the poor fit piece.
If you are concerned enough, you can see about getting a second opinion on the pathology.
Good luck.
-Dr. West
Reply # - February 19, 2015, 09:01 AM
Thank you very much for the
Thank you very much for the reply Dr West.
I guess the ER and PR status is pretty conclusive - are any other cancers ER/PR receptive?
I think I became worried firstly because it took so long to reach the diagnosis, and then when I started reading about how they are studying mammoglobin to see if it could be a viable blood test for breast cancer - but it would not have found mine.
I think having cancer has just made me a bit of a worrier at the moment!
Thanks again,
Emily.
Reply # - February 19, 2015, 01:26 PM
Hi Emily, I'm so sorry about
Hi Emily, I'm so sorry about your dx. I'm afraid if you look very far at all you'll find that most people with cancer have something quite unusual about their case. It's a very frustrating and frightening aspect of cancer. Your not alone.
Cancer is dx by determining from where the cells originate which is normally the first part of the diagnostic work up. In your case the cells in the tumor would look like those from the duct walls within the breast. Next steps in the diagnostic work up involve testing for ER and PR receptors. So the primary is already concluded on. I did a search on the google for "cancer ER PR receptor" and only came up with Breast cancer in the search returns.
From a blog post written by Dr. Cianfrocca these receptors are explained, "Estrogen and progesterone are female reproductive hormones. Before the tissues of the body, including the breast and breast cancer cells, can respond to these hormones, the hormones must bind to proteins on the surfaces of the cells called receptors. A simple way in which this is often described is as a “lock and key” mechanism. Females produce estrogen, and this is the “key”. It is then able to bind to the receptor, which is the “lock”, thereby “unlocking the receptor” and allowing estrogen to stimulate the tissue. Breast cancers that have these receptors on their surfaces are called ER-positive, or hormone receptor-positive. Approximately 2/3 of breast cancers are ER-positive, and this percentage increases with increasing age of the patient. Breast cancer cells that have estrogen and/or progesterone receptors are stimulated by estrogen, and therefore drugs that block the receptors or reduce the amount of estrogen are treatment options. All breast cancers are tested for ER and PR receptors, and this can be seen on the pathology report." http://cancergrace.org/breast-cancer/2011/09/06/breast-cancer-101
http://cancergrace.org/breast-cancer/2012/10/03/molecular-subtypes-of-b…
Janine