Interpreting post surgery histopathology report / Preparing for final treatment plan appointment

Going through breast cancer treatment Surgery
1

I had my post surgery (Single Mastectomy + SLNB) appointment recently and have received my histopathology report which I’m trying to understand prior to my next appointment tomorrow where I expect to be given my treatment plan based on the CT scan that was performed post surgery.

Pre-surgery: Stage 1 Multifocal G2 IDC, ER+, PR+, HER2-, LVI, Axillar clear in Ultrasound

Post-surgery: Stage 1 Multifocal G2 IDC, ER+, PR+, HER2-

The primary differences I see/understand between the original information I was given pre-surgery and that in the histpathology report are:

  1. Clear margins, muscle shave tumour-free 

  2. lymphovascular and perineurial invasion present

  3. Metastatic carcinoma in 1 of 4 sentinel nodes; additional soft tissue deposit, Extranodal spread is not identified. 

  • I have an elementary understanding of lymphovascular invasion (LVI) based on the description provided here but haven’t come across the term perineural invasion. Does anyone know what that means and the implications of it in a broad sense?
  • Additionally what does “foci” stand for - I see it mentioned in the 5 page report?
  • What does (T3 P2 M1) stand for? It doesn’t seem to be the same as what I’ve seen described as TNM in the CancerResearch UK website.

I am preparing for questions to ask at my appointment tomorrow. During my original appointment I was told that a CT scan had been requested based on the fact that 1 of 4 nodes taken during the SLNB was positive.

I was also advised of possible treatment management options I could be given - so I’m trying to get facts to help in the next decision I expect I will need to make (following CT scan result review in MDT). 

  1. Axillary node clearance (surgery) OR Radiotherapy to the axilla

Would anyone who has been through this choice be able to advise what you considered when deciding between these two options? I’m trying to understand pro’s and con’s of each to help me make an informed choice.

  1. Chemotherapy

As this wasn’t in my pre-surgery treatment plan I hadn’t really done a lot of reading around this. What questions should I ask with respect to this? All I have in mind at the moment is this and I don’t even know if this is one I can ask the surgeon or will it need to wait until I have an appointment to see an oncologist?:

  • What criteria has been used to establish (weigh) & reach a decision that the benefit of Chemo outweighs the risks for my particular cancer profile? LV, Perineural invasion? Other? (I’ve not had a OncoType DX due to 1 out of 4 nodes coming back positive.)

Appreciate thoughts & any information from fellow BCNer’s.

2

Perineural invasion is when tumor cells are encroaching on a nerve. It is a rather rare thing from what I’ve read. T3 P2 M1 is describing how you cells acted under a microscope and is why it’s considered a grade 2 as opposed to a grade 3. M stands for mitosis but I forget what the other two stand for. You can plug in that description on to the search engine here though and there are conversations that have been had about it. Since you were hormone positive they should be sending your tumor off for an oncotype test. That will influence them when deciding whether chemo is needed but it shouldn’t be the only thing they consider. Your Lymph node, LVI, and PVI status should also be taken into account. 

I am so sorry you are here though. We are a great club but no one wants to be a part of it regardless. I wish you the best of luck in making the decisions needed for your treatment.

3

Hi @TDG  

I have found myself in similar situation. Almost 4 weeks post op masectomy and immediate reconstruction, although I’m very flat chested when given this as on option with the surgeon who does plastic surgery as well it felt like the right choice for me

The nodes are now a new predicament as 4 were removed with 1 being positive. I will have to have radiotherapy to the breast so have asked about this to the arm pit instead of the auxiliary surgery. I am awaiting meeting with oncologist to discuss this.

It’s a really hard one, as am already struggling a bit with arm not having full movement and not sure I want more surgery so soon and then long term risk of lymphoedema. Although will radiotherapy pose that risk as well, I can’t find a clear answer to that. I don’t have the full report and details from histology but some further plans for my journey will have to work to the fact that I’m 52 and not yet menopausal still peri!

Just keeps making my head spin and the anxiety is there again just when you think you’re getting a handle on things.

Sending hugs xx

4

yup