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    What does this pathology report indicate?

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Posted on Tue, 14 Feb 2017 in Cancer
Question: My aunt is diagnosed with ductal carcinoma T2N0M0. She got operated 8 days back by a surgical oncologist(lumpectomy with lymp node removal) . Final pathology report is attached for the reference. She is at present 53 years old.

My questions are:
1. How serious the reports are and can this be cured completely?
2. Today I spoke to the oncology surgeon who operated her and he was mentioning that the chemotherapy may not be needed but radiation and hormonal therapy is must. I will be meeting a oncologist tomorrow in his clinic to get further opinion. Kindly let me know your advice after seeing the report.
3. Surgeon mentioned that the radiation will start after 1 month of surgery. Is it ok to wait one month for the radiation?
4. What precautions she should take to avoid the recurrence of the disease?
doctor
Answered by Dr. Deepak Sundriyal 34 minutes later
Brief Answer:
Hello dear. Chemo may be required

Detailed Answer:
Hello dear. I have gone through the details. So its a luminal a type of cancer and chances of complete cure are about 85 percent. Chemo. May be required depending upon atest known as oncotype dx. You can discuss this with your chemophysician. Radiation should be done after chemo.
After that hormonal treatment will be given for at least 8 years.
Usually in 85 percent, it wont recur. Just a regular follow up is all what is needed.

Thanks and regards
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Deepak Sundriyal 49 minutes later
Thanks for the response.

I heard that the chemotherapy decisions can also be taken based on the Ki 67 value which is showing 15% in the result. Request you to provide your opinion on this.

I will definitely ask questions on oncotype dx when I meet the oncologist tomorrow and get it done.
doctor
Answered by Dr. Deepak Sundriyal 43 minutes later
Brief Answer:
Hello dear. No it cant be taken on ki67

Detailed Answer:
Hello dear.

Ki67 is not a standardized test yet . Only Oncotype DX is approved test.


Thanks and regards


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Deepak Sundriyal 4 minutes later
Thanks for the response.

Is this Oncotype DX test available in Bangalore?
Please let me know if you have any idea on where to contact for this test?
doctor
Answered by Dr. Deepak Sundriyal 6 hours later
Brief Answer:
Hello dear. Oncotype dx is not available in XXXXXXX

Detailed Answer:
Hello dear. This test is not yet available in XXXXXXX However, many labs like quest and onquest are probably sending samples to USA. Results are expected in a month. But still only a handful if patients will be found to have no benefit from chemo as per this test. Majority will still require chemo. And wasting a months time is not good. So in my personal opinion, chemo should be taken as patient is still young.
Feel free to ask further if you have any doubts
Thanks and regards
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Deepak Sundriyal 2 days later
Today, we have been told to meet the radiation oncologist by our surgeon and the plan is to start her with radiation first from 31st XXXXXXX Doctor mentioned that we need to do below blood test before coming for radiation.
CBC
RBS
BUN
SCRENT

Doctor also told that some scan will be performed before starting the radiation and based on the progress they will decide on how many days it has to be given and also chemotherapy is needed or not.

He also mentioned that her age is the only factor to consider for the chemotherapy, otherwise there is no reason to choose it.

I asked him about the ONCOTYPE DX test but he mentioned it is very expensive and there is an equivalent test available in XXXXXXX which would cost around 40k. He told some name but forgot it. Are you aware of any test like this?

Basically they will take a decision on the chemo during the course of radiation. I am not very sure whether we are in a right path with the treatment. Please advise.

Hormone therapy will follow.
doctor
Answered by Dr. Deepak Sundriyal 10 minutes later
Brief Answer:
Hello. Please visit a medical oncologist first

Detailed Answer:
Hello dear. You are yourself letting your patient into trouble. Visit a medical oncologist to take decision regarding chemo. How can a surgeon guide you regarding chemo.
If chemo has to be done, it has to be done prior to radiation. Radiation comes in the end. This is because of the reason that radiation prevents local site recurrenc only and chemo prevents both. If you dont do chemo first and do radiation first then during that period, tumor cells with metastasize to distant site as radiation will act only on chest. Doing chemo first will kill tumor cells both at local site and as well as in the blood circulation thus preventing them to settle at distant sites.
Only oncotype Dx is the FDA(USA) approved test. PAM 50 and endo predict are other test developed in XXXXXXX at low cost. I Donot beleive in any test develop in XXXXXXX as far as cancer is concerned.
If you really want to do justice to your patient, visit a trained medical oncoogist first. Of course the benefit of chemo will be small, still it should be given if oncotype dx is nto being done.
Thanks and regards
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Deepak Sundriyal 1 hour later
Thanks for your response.

As suggested, I will book an appointment with medical oncologist at the earliest to get the treatment plan and will update you.

Just curious to know, even in this case 6 to 12 rounds of chemo is recommended? Asking this question because in my known circle, most of the cancer cases received these many rounds of chemo. I know it depends on the stage and other factors but just trying to understand the protocol.
doctor
Answered by Dr. Deepak Sundriyal 1 minute later
Brief Answer:
If chemo is planned, 4TC protocol is ok

Detailed Answer:
Hello. Only 4 cycles of, TC protocol will be ok.
Thanks and regards
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Deepak Sundriyal 1 hour later
If in case we decide to go with Oncotype DX test and considering result take 1 month to come, then is it ok to go with radiation first as planned and then decide on the chemo after seeing the report?
doctor
Answered by Dr. Deepak Sundriyal 5 hours later
Brief Answer:
No. Chemo. Must be done earlier

Detailed Answer:
Hello dear.

As i've explained you earlier., chemo should be done earlier to prevent distant relapse. By default, it has to be done earlier.


Thanks and regards
Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Dr. Deepak Sundriyal

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Practicing since :2005

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