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Forum Name: Breast Cancer

Question: Breast Cancer Staging- intraductal & invasive duct carcinoma


 wiz2 - Sun Jan 25, 2009 11:51 am

An excisional biopsy showed I had a intraductal papillary carcinoma 2cm in greatest dimension with foci of invasive ductal carcinoma 5mm. On re-excision to get clear margins they found an additional 7mm IDC. My oncologist used a tumour size of 1.2cm (5+7mm) when calculating chemotherapy benefits etc. The tumour is ER/PR positive and Her2 negative. I have an oncotype score of 3. I am planning radiation and tamoxifen. My radiotherapist says my tumour is 2.7cm making me a T2 not a T1. Which is correct?
 Dr. Tamer Fouad - Tue Jan 27, 2009 4:07 am

User avatar Hello,

I would actually take your oncologist's side. We do not add the intraduct component when assessing tumor size. So 1.2cm is my vote.

You have a low oncotype recurrence score which is currently being used to exclude chemotherapy in patients that have a good prognosis because they don't need it.

Good luck with your therapy!
 wiz2 - Wed Jan 28, 2009 9:29 am

Unfortunately another twist in the tale. My CT scan results show three tiny nodules in my right lung - too small for biopsy, PET scan is negative but nodules may be below resolution of scanner. Radiotherapist is suggesting chemotherapy "just in case" but would go ahead with radiotherapy based on negative PET scan if I want to. Would I be stupid to wait until after the radiation is finished to have another CT scan to see if there is any growth?
 Dr. Tamer Fouad - Wed Jan 28, 2009 1:23 pm

User avatar Hello,

Apparently, your radiotherapist was always in favor of chemotherapy from the start. What does your oncologist think? The PET scan being negative is reassuring. It's a good negative test - ie, its a good test to exclude things such as cancer / inflammatory processes.

No I don't think you would be stupid at all to follow up on your issue. That you are concerned is completely understandable.

Obviously, I cannot exclude anything especially a CT scan that I have not even seen. All your other tests though, are more consistent with early localized disease as opposed to metastatic disease.

Most cases with metastasis at presentation will at least have some evidence of spread to the lymph nodes. I am assuming your sentinel lymph node was negative.

Please keep us updated.
 wiz2 - Sat Apr 18, 2009 12:49 am

Update and another question!
My radiotherapist agreed to carry on with the radiotherapy follwoing the negative PET scan. I have finished the radiotherapy and am now on 20mg Tamoxifen once daily. I had my CYP2D6 genotype done which shows I have one normal allele and one inactive allele making me a reduced metaboliser of tamoxifen.
I am perimenopausal - last 2 blood tests showed raised LH and FSH and low oestradiol. I haven't had a period for 2 months and have mild hot flushes at night.
I also have only one ovary, although CT scan showed "bilateral' ovarian cysts. I also have a few small fibroids.
Should I consider having an oopherectomy/hysterectomy and take an aromatase inhibitor? Is intermediate metabolisation of tamoxifen sufficient?
I'd appreciate any comments/information you can give.

Thanks.
 Dr. Tamer Fouad - Wed Apr 29, 2009 9:54 am

User avatar Hello,

It's good to hear from you. Another excellent question. Unfortunately, this is a very debatable issue. To the best of my knowledge it's currently not standard practice to test for CYP2D6 genotypes in premenopausal women. The finding creates a dilemma because while we are certain about the reduction in metabolism of tamoxifen to its active metabolite (endoxifen) we are not certain about the long term outcome of stopping tamoxifen and giving an alternative form of therapy. Currently, postmenopausal women have an equally efficacious (if not better) alternative with aromatase inhibitors. However, the use of AI in premenopasual women in combination with ovarian ablation is still undergoing prospective testing (SOFT, TEXT trials).

One option to discuss with your doctor is to undergo ovarian suppression and either continue or stop using tamoxifen. Ovarian suppression alone is a valid option in premenopausal women.

Best regards,

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