What does this biopsy report indicate?

Posted on Fri, 27 Apr 2018 in Cancer
Question: Dear Doc

I was diagnosed with Invasive Ductal Carcinoma Grade II recently. In this regard, I was in contact with Dr. XXXXXXX Sundriyal (On-Line Oncologist at Health Care Magic) earlier regarding Lumpectomy vs Mastectomy. Based on his views (after reviewing all my reports) and suggestions from my Oncologist here in Pakistan, I opted for lumpectomy.

Attached herewith is my latest biopsy report after Lumpectomy which was done on 24th November, 2017 afternoon. The BIOPSY REPORT covers the CIST + LYMPH NODES. Please refer to Report attached: Subject: Final Biopsy No: 13A,13B & 13C - 3 Pages dated 29th November 2017 (Today)

Firstly please kindly share your general views regarding my previous reports (12 reports are attached in my dash board apart from 13A/13B & 13C). Basically I want to know if my cancer was diagnosed at stage 1 or say at a very early stage? I have learned from internet that 2 CM tumor with clear lymph nodes and margins at 2.00 O Clock position is known as Stage 1A? or is it Stage 1B?

The reason why I want to know if its Stage 1A or Stage 1B is that I have heard that in Stage 1A, sometimes Doctors opt to skip Chemotherapy and only rely on radiations

Now my main questions are:

1.     Is it mandatory to get “Chemotherapy” done in light of this report?
2.     Is there any other alternate treatment other than Chemotherapy?
3.     If Chemotherapy is a MUST, how soon it should start?
4.     Can we share the name of medicines my "Radiology Oncologist" will advise with
you for 2nd opinion?
5.     I understand that targeted radiation is a MUST after surgery but how soon it
should be done?

If targeted radiations on local area (affected area) are not possible in Pakistan, is it a good idea to get them done from Singapore? (coz' I can go there for short treatment). I cannot go abroad for Chemo coz' it will take a lot of time and I cant afford to be out of home for so long but for radiation I can go provided it's for a shorter period

I understand that normal radiations process will take 15 days plus / minus and there are no immediate side effects (as such) but in the long run the effects can be lethal? Thus targeted radiations should be considered over normal radiations as the chances of damages to lungs & heart are less with targeted radiations? And I assume that targeted radiations will take less time as compared to normal radiations

I am sorry for asking too many questions in one go but I dont want to disturb you again and again so thought i should put everything together

Please do review my last reports and my today's FINAL BIOPSY REPORT

Thanks for your support
Answered by Dr. Deepak Sundriyal 8 hours later
Brief Answer:
Hello. Please upload the new reports

Detailed Answer:
Hello dear and welcome again. First of all, please upload your post surgery histopath reports. After seeing reports, i can give you more details for chemo. Radiation is must after bcs and it should be done withing 6 months after surgery. Radiation nowdays is always targeted and involves tumor bed only without affecting other organs. You cab take further treatment at Singapore.
Thanks and regards
Above answer was peer-reviewed by : Dr. Yogesh D
Follow up: Dr. Deepak Sundriyal 15 hours later
Hi Doc

Thanks for your reply. I have attached my latest report already - Its in my dash board. As mentioned earlier, please kindly check Report No 13A/13B & 13C. I am sending them by email again for your convinience

Accordingly let me know your views / replies on the below listed questions:

1. Is it mandatory to get “Chemotherapy” done in light of this report?
2. My HER2/neo is Evocable - Its not positive. What should be our next step?
3. Is there any other alternate treatment other than Chemotherapy? Can I get away from Chemo?
4. If Chemotherapy is a MUST, how soon it should start? My Doctor is saying 5 weeks after surgery - To me it sounds a bit too long?

I share the name of chemo medicines my "Radiology Oncologist" will advise with you for 2nd opinion?

Other questions:

Can I take 2 glasses of RED WINE at night? My surgery was done on 24th Nov, 2017 and now I have stopped taking pain killers as well. Is it safe for me to consume Red Wine? or White Wine?

Thanks Doc

Waiting for your reply

Sorry I meant Equivocal (2+) - Its neither positive nor negative...

Answered by Dr. Deepak Sundriyal 45 minutes later
Brief Answer:
Hello. Fish rest for her2 is must

Detailed Answer:
Hello dear. Your her2 report is equivocal. Next step is fish test for her2. If it comes positive then chemo is must. Fish should be ordered immediately. Chemo should be started between weeks 2 and 3rd post day of surgery. There is no alternative for chemo. Radiation is must in your case. You can take any wine but not more than 60 ml per day.
Thanks and regards
Above answer was peer-reviewed by : Dr. Prasad
Follow up: Dr. Deepak Sundriyal 26 minutes later
Thanks Doc for your reply

I forgot to tell you that FISH has been ordered today by my Doctor. But what if my FISH test comes as negative? In case of negative result, can I get away from Chemo? What will be the next step if FISH comes negative?

Regarding wine, I am a little confused. A standard glass of wine is usually 150 ML (basically 1/5th of a bottle). Therefore 60 ML means hardly 2 to 3 sips...Please don't take me wrong but this much quantity is way too less then my expectation so I better avoid taking wine for now. But can you advise me when I can start wine (like 2 glasses - say 250 to 300 ML - 11% alcohol) again? My surgery was done exactly 01 week ago

Also my Doctor confirmed that they will start chemo on 27th Dec - meaning 31 days after my surgery. Should I ask them to start earlier?

Thanks again

Answered by Dr. Deepak Sundriyal 7 hours later
Brief Answer:
Hello. Oncotype dx if fish is negative

Detailed Answer:
Hello dear. If fish is begative, then oncotype dx can be done and if it shows a low risk, only then chemo can be avoided. However, its a costly test and takea a 1 month time. If it comes high or intermediate risk then cheno has to be done but bt then we will loose 1 month period. Chemo should be started within 2nd and 3rd week to gain
Maximum benefit.
If its a 11% alcohol then you cab take 300 ml daily.
Thanks and regards
Feel free to ask further
Above answer was peer-reviewed by : Dr. Yogesh D
Answered by
Dr. Deepak Sundriyal


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