Expert: Claes-Gustaf Nordquist, M.D. - 7/6/2009

Question
QUESTION: hello, i had a grade 3 (T2,P3,M3) infiltrating ductal carcinoma, measuring 16mm, with possible lymphovascular invasion seen, i had clear lymph nodes. i was told that i would have chemo, then when i saw the oncologist he said i would not benefit from it. because of this i fought to have my ovaries removed (i have a family history of cancer), i am now on aromasin. should i have been offered chemotherapy?
thank you

ANSWER: What stage did they classify your tumor in? If possible provide me with your full pathology report. You can in that case copy it here. I assume that your tumor was hormone receptor positive? Was a HER2 analysis done? If so its result? What other treatment did you have?



---------- FOLLOW-UP ----------

QUESTION: i will add what i can,i don't have a scanner
the dcis grade was high, dcis growth pattern was comedo
my oestrogen receptor status was 7/8, my progesterone receptor status was 6/8 (Allred), my her2 status was a weak score
it also says EGFR-neg,Ki67 - 32.3%, tumour extent was localised and vascular invasion was seen, axillary nodes were clear.
i was told when i first got my histology by the surgeon that i would have chemo, a few weeks later i was told by my oncologist that i would not benefit from it, the copy of my histology had typing errors on it, and on one page it says i did not have an invasive carcinoma, and that it was a grade 2, also, i read in my notes that i had declined chemo twice, this has now been taken off my records but i found all this out after i had had my hysterectomy and oopherectomy.
thank you for taking the time to look at this
regards


ANSWER: THANKS! But one important thing is still lacking! What STAGE have you been put in?


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QUESTION: i have never been told, the only stage it mentions is the axillary staging that was 0/9

Answer
Well that is not staging. That is just the status of your axillary lymph nodes. Was any other lymph node (sentinel node?) biopsy done? If not I have at least some idea of your stage situation. What was your surgical treatment? Mastectomy? Lumpectomy? In the absence of any clear spread to lymph nodes your dr's later reluctance to order chemotherapy is more understandable. On the other hand your HER2 test seems to have shown a weakly positive result (correct me if I'm wrong) and there was at least lymph vessel involvement. Blood vessels (vascular) too? In that situation I would probably have ordered chemotherapy. But I can not be sure that that would be the right decision. Sorry, this is as far as I can come based on available information.