Expert: Claes-Gustaf Nordquist, M.D. - 2/4/2010

Question
I am puzzle??? Because I do not understand the results of the pathologist diagnostic.  They just want to rush you in the operating rooms with all these maybe's or we do not know and they do not give you time to think things over!! The Specimen consists of eight tan needle cores of soft tissue, the largest measuring 5.7 cm in length and 0.6 cm in diameter and the smallest measuring 101 cm in length and 0.7 cm in diameter.
Section: in toto
A1-A4 - left breast (2each)
ah
The Final  core biopsy pathology results are left breast: Ductual Carcinoma IN SITU of Breast, intermediate to high grade, Comedo, micropapillary, and cribriform patterns, with microcalcifications.(see Immunohistochemistry results)
Stromal and periductal fibrosis of breast.
ER / PR By IMMUNOHISTOCHEMISTRY
Type of    % of positive    Staining   Interpretation
Receptors      Nuclei       Intensity    of results
Estrogen        80%         Intermediate  Positive
Progesterone    40%         Intermediate  Positive
                             to strong
Comment: Both Estrogen and Progesterone nuclear receptors are positive In the DCIS lesion
Breast Cancer:
Numerous studies on formalin-fixed paraffin embedded tissue sections using Monoclonal Anti-Human Estrogen Receptor Clone 1D5 to be accurate in providing prognostic information regarding endocrine therapies with a sensitivity of 98% and specificity of 73%(if 10% positive nuclei cut-off is used). We report a positive staining for both ER and PR when 10% or more tumor nuclei are positive.

Clones used:
Immunohistochemical evaluation for Estrogen Receptor (ER) and Progesterone Receptor(PR) was performed on formalin-fixed paraffin-embedded tissue sections using Monoclonal Anti-Human Estrogen Receptor Clone 1D5, Monoclonal Progesterone Receptor clone Ab-8 (hPRa2+hPRa3) and the Vector ImmPress Peroxidas Anti-Mouse 1g detection system.
The pathologist Joseph F. Tomashefski,Jr., M.D.was the research doctor that created this needle biopsy technique. and was the one that did my needle biopsy as well.
I want to know exactly what this test is reading on a 6th grade level because I have no knowledge of medicine and I want to wait for about a year or so to see if there is and change. The doctor said there is no change since my 2007 biopsy test and mammograms.
Does these results read I am going to die soon. I am scared. I am 55 years old never had any medical problems and I am not on any medications and I still have a regular monthly period. Thank you

Answer
I have to take command and tell you what to do - what needs to be done - since you seem to be unable to understand that yourself. Sorry for my frank and blunt language but it seems to be needed so that you will understand the real situation and it in fact only describes the actual reality. You have a breast cancer! That is a fact and can not be forgotten, denied or ignored! However I lack some information that would be of help for a better evaluation. I would like to see your full mammography report and all full pathology reports of your biopsies. I need that in order to know the size of your lesion. You can copy those reports here. However your breast cancer seems to be an in situ cancer (cancer stage 0) and it has hormone receptors. Does it have HER2 receptors? Try to find out and tell me! IMPORTANT! The fact that it is an in situ cancer (only found in its site of origin and therefore not even growing in its immediate surroundings) and that it has hormone receptors are actually GOOD SIGNS! It makes your treatment easier, simpler and much more certain of success (though as with all cancers no guarantees can be given). If your lesion is small enough which is rather probable then only a lumpectomy (small surgery where your cancer is removed but leaving your breast intact) is needed followed by radiation therapy to your breast and later by hormonal therapy (including a stop of your periods) since otherwise your sex hormones may stimulate any cancer cells. With that kind of treatment your chances of success are most probably very good and any risk of your death remote. BUT by nature cancers are growing. What I have described is what is present here and now! That may change if you wait (very probable) and that would change this fortunate situation in a negative way. That is something you can NOT afford! So you CAN NOT wait with this! That your doctors want to do surgery as soon as possible in this situation is MOST understandable (I fully agree) and only dictated by concern for your health. You should NOT hesitate on this! You admit that you have no knowledge of medicine. Well I do have (check my points given by those who have asked previously) - and that is probably why you ask me - and I tell you to follow the advice of your doctors as soon as possible! Because that is the best solution to this problem of yours! Good luck!  P.S. I'm not only a cancer doctor, I'm a cancer patient (prostate cancer) myself! So I can and do see this from both sides (and both my parents died of cancer as did my mother in law).



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