Patient question: disease: intermediate grade carcinoma in situ in the right breast duct
Description of disease: patient is 44 years old, no family history. mammogram on May 28, 2014 suggests: dense patchy shadow in the upper quadrant of the right breast, with an extent of about 14mm*12mm and still clear borders. Suggestion: small clusters of calcified foci in the upper limit of the right outer breast (BI-RADS IV), malignancy was not completely excluded and biopsy or MR was recommended for further examination.
B ultrasound suggested bilateral breast hyperplasia and no significant abnormality was seen on the breast MR enhancement scan. Usually no pain, no itching, no sensation, and not palpable by palpation, the minimally invasive pathological biopsy on June 10 was a mid-grade ductal carcinoma in situ of the breast. Pathology report: the ducts of the right supratentorial lesion showed CK5/6 (periductal +), P63 (periductal +), CerbB2 (2+), PR (80% strong +), ER (95% strong +), Ki67 (5% +). No evidence of invasive cancer was seen.
Radical breast-conserving surgery + lymphatic anterior debulking was performed on June 24.
The pathology report was microscopic: dilated breast ducts with partial ductal epithelial hyperplasia and myoepithelial hyperplasia, filling the ductal lumen and forming chisel holes, with no cellular anisotropy.
The pathological findings after radical surgery showed: (right breast mass) ordinary type hyperplasia of the breast ducts, no cancer (residual).
No cancer metastasis was seen in the lymph nodes of “axillary anterior sentinel lymph nodes 1-4”.
No cancer was seen in the “proximal and distal nipple margins, internal, external and basal margins”.
I was discharged from the hospital 5 days after surgery and the wound is now recovering well, but the axillary lymph node wound is slightly swollen.
I would like to help: I was rechecked 20 days after surgery and the wound is recovering well. The follow-up treatment plan given by the doctor is radiotherapy + endocrine therapy with regular follow-up. Endocrine therapy will take 5 years. I usually have normal menstruation, which is more suitable and has less side effects, to take Faradone or Tamoxifen? In my case, I have already had a right upper resection, the mass is 1cm, and all the cut edges are negative for lymphatic metastasis, is radiotherapy necessary? I heard that I have to undergo several dozens of radiotherapy sessions in a row, so I am quite afraid. What are the chances of recurrence with or without clinical radiotherapy and what should I do? If radiotherapy is necessary, when is the best time to do it? How many times do I have to do it in my case? What kind of radiation therapy should I choose? I’m sorry for the many questions, but I’m very anxious about this disease every day, and I’m looking forward to professional guidance from my doctor!
Treatment: Minimally invasive biopsy for intermediate-grade ductal carcinoma in situ, radical breast-conserving surgery on June 24
Medication: Name of medication: Faradone
Dosing instructions: 1 tablet per day
1.Which one is more suitable and has less side effects, Faradone or Tamoxifen?
A: Both can be used. The recommendation of the Health and Welfare Commission and NCCN is to take oral tamoxifen. You can change to Faradone after side effects such as thickening of the endometrium are detected during the course of taking the drug. The side effects of Faradone are relatively smaller.
2.In-situ cancer is said to have not broken through the basement membrane. In my case, the right upper limit has been removed, the mass is 1cm, and all the cut edges are negative for lymphatic without metastasis, does radiotherapy have to be done?
A: It is best to do radiotherapy for breast-conserving surgery. The significance of radiotherapy is to reduce the risk of recurrence of breast cancer in the remaining breast on the affected side.
3. I heard that it is necessary to have continuous radiotherapy for dozens of times, which is quite scary. Radiotherapy has radiation, and continuous radiotherapy is worried about the effect on the body. What is the chance of recurrence with or without clinical radiotherapy and what should I do? If not, are there other treatments to prevent recurrence?
A: According to the information you provided, the molecular typing of your breast cancer is Luminal A low risk type. Treatment is based on endocrine therapy and chemotherapy is not needed. As breast-conserving surgery is done, whole breast radiotherapy is recommended.
4.If radiotherapy is necessary, when is the best time to do it? How many times do I need to do it in this case? Which kind of radiotherapy should I choose?
A: You can start radiotherapy once the incision is healed, and the radiotherapist will provide you with the best plan.
In addition: you found it very early, and the treatment is very timely and accurate! Standard treatment prognosis is very good! Good health and no entanglement!