Expert: Claes-Gustaf Nordquist, M.D. - 3/20/2009

Question
Hello,
My co-sister (30 yrs old) had MRM and oophorectomy 2 weeks ago, following a lumpectomy 6 weeks ago. The lumpectomy revealed a 5 cm IDC Grade III,  ER-, PR+, HER2 -. The doctor wasn't too happy with the clearance margin and advised MRM.

Now, the pathology report post the mastectomy and removal of nodes indicates:
1. TWO greywhite lesions in the breast tissue, each ~ 2-3 cm, arranged in nests, sheets, cords, with necrosis. They are around 1.5 cm apart.  

2. TWO lymph nodes in the breast with cancer, (greywhite), without perinodal spread.

3. ONE lymph node in level 1 with cancer with focal perinodal spread.

The whole breast tissue is fibrous.

The doc says this means she is T3N1, stage 3a. He also suspects that the 2 lesions that we have found in the post-MRM excision are actually a single big tumour, part of the original lump taken out in the lumpectomy. He also says that while the chemo wd kill any microscopic cells, there is a 60% possibility of recurrence....We are going in for chemo in 2 weeks, when the wounds heal. I have the following questions:

1. If they all are one single tumour - it would have been ~ 10 cm!!  But the mammo revealed only a 5 cm lump... Is there a chance the mammo could not have detected the other 2? And since the lumpectomy removed only half the tumour, wouldn't this have made the tumour spread faster? Is there a higher risk now of spread?

OR - Is there a chance that the other 2 lesions only grew AFTER the lumpectomy?  In which case, does it mean the cancer is very aggressive? growing 2 lesions in a month?

We just want to understand this report - and her chances - better. Any help appreciated. thanks.

Answer
1. When I add the sizes you mention I reach a size of between 5.5 to 7.5 cm. That is much closer to the the original 5 cm. So I'm not sure there is any discrepancy at all especially as all the sizes you mention are approximate. BUT to do a "lumpectomy" of a 5 cm. breast tumor is stupid. It is far too big for that! Why?
2. No, such a growth in one month is not possible!
However I do agree on the chances (= risks) of a recurrence unfortunately.