Pathology report

I was diagnosed with IDC back in January and had chemo first to shrink a 4.5cm tumour. After 7 chemo sessions I had a final MRI scan before surgery was performed. My oncologist said that there was no sign of the tumour. All he could see on the scan was an area of DCIS. The surgeon came to see me the day before the op and said that my breast now felt normal and that I’d had an excellent response to the chemo. Went back to see oncologist a week after op for pathology report to be told that there was still a 1.8mm tumour in the breast they had removed and that 5 out 7 lymph nodes contained cancer. My response to the chemo has been downgraded from excellent to moderate on the report. I thought MRI was the gold standard of scans and now I’m beginning to realise that they have their limitations. Also I’m now worried that they haven’t taken out all of the cancerous lymph glands/ nodes. Has anyone else experienced this, where the pathology report doesnt match the findings from either a physical exam or a scan result? It’s been 3 weeks since the op and I haven’t heard when I will be starting radiotherapy. What is the usual time to wait between post surgery and starting rads?

Hi Mateface,
There may be others who can better help you, but just wanted to respond. There is another thread where a lady had a similar experience (but different concerns), basically the MRI and post-op pathology report did not tally. Ultimately, as I understand it, the scans can only give an indication. I had tumour which was not visible on 2 MRI scans and was only found post surgery, so while different, I know what it feels like to be failed by s scan. Not only do you have to deal with bad news, it breaks down your trust in something you beleived in.
You dont say whether you have had lymph clearance? This is the way that the lymph nodes are removed. It sounds as though you have ?
Re. radiotherapy post surgery. I had mine 6 weeks post surgery to allow everything to heal.
Hope this helps.

I was wondering if you have had a full Axillary Node Clearance? I can only explain what happened to me. I had a skin sparing mastectomy with immediate reconstruction and the sentinel node was removed. I was never given any indication that I may need other surgery so it was a shock to me to be told that the cancer had spread into 3 of the lymph glands and all the nodes would need to be removed, followed by 6 cycles of Chemotherapy FEC-T. As you know each cancer is different and can change from diagnosis so we just have to try and be optimistic and cope with any disappointments we get along this cancer journey. I hope you get the answer you need and wish you all the best.

Hi Mateface
I had an MRI scan prior to having my op because I decided to go for a lumpectomy and they wanted to make sure that was the best option. The MRI came back just showing the one tumour and so I had the lumpectomy. After getting the results of the pathology report I was told I needed a mastectomy as there were also satellite tumours. So I had the mastectomy a month after the lumpectomy, which delayed the start of chemo and also meant I had two operations to recover from. I was rather dismayed as I felt the MRI had been pointless and just set me back. I partly worried that whoever checked the MRI results hadn’t done the job properly as it hadn’t been done when it should have and my consultant had to phone up for the results while I waited.
As for starting rads, my situation was a bit different as I had the ops, then chemo then started rads about 4 weeks after that.
Best of luck.

Thanks for your reply Rattles. Do you know, I’m not sure I did have full axillary node clearance! Would it say on my pathology report? All I can see on the report is where it states the number of nodes tested from the sample but I don’t know if that’s the same as the number they actually removed. Confused or what! Going to see surgeon on Tuesday and will ask for clarification.

hi mate face did u have a second op? if u did then u would of had a clearance ? xx i had clearance i had the wle and lnb then a second 1 to clear nodes x

Hi mateface,
Just to say I think it would be hard to have a full lymph clearance and not know- you would have had a very sore under-arm (much more so than with the biopsy) and a drain. If you still have doubts, you could look at the Breast Cancer Care Publication/speak to someone at the Helpline. It sounds like its important to clarify as this is how they remove as many nodes as possible to remove any microscopic spread.
Good luck on Tuesday.

Hi Mateface,

There are different levels of node clearance - for example I had a “low axillary clearance” which involved 7 nodes being removed.

Good idea to check with the surgeon when you see him/her on Tuesday. The report from your surgery should say what level of node clearance was done so the doctor you see on Tuesday should be able to refer to that and tell you. He/she should also be able to explain why that level of clearance was done.

All the best for your next appointment - sounds like you have plenty of questions to be answered.

Thanks for your reply. What you say makes sense. I think the surgeon took out only the 7 nodes that were examined in the pathology report. 4/4 level 1 nodes were positive for cancer and 1/3 level two nodes. My main concern is that he didn’t take many out because the results from the MRI scan looked so promising but under the microscope the lymph nodes aren’t looking so good and if 1/3 level 2 nodes have cancer how many more have cancer that he hasn’t taken out?! Does that make sense. All I can think about at the moment is that I still have canceI left in thea lymph nodes and that it mode spread whilst I’m waiting for the radiotherapy to start. What I hate most about this situation is how disempowered you can feel. You are given information but don’t know how to interpret it. I have written down my questions and must now try and put it out of my head until Tuesday.
Thanks again for taking the time to reply

Hi Mateface,
Not sure I can add much. I had mx with sentinel node biopsy before the chemo, they took 4 nodes and 1 showed micro mets, which was a bit of a shock. I then had the full clearance as a separate operation, out of the rest taken, none had any mets at all. I had FEC-T chemo after the 2 surgeries, Rads and just about have my 18th Herceptin next week.
I wish you all of the best for next week and I understand where you’re coming from, that was my reaction before I had the full clearance too, how many of the nodes still in there have got mets/how quickly will it spread, even though I only waited 2 weeks to get the rest out, it is still a head trauma…
Good luck with your appointment and big hugs in the meantime
Bev x