interpreting pathology report; post mastectomy

Hi

My co-sister (30 yrs old) had MRM and oophorectomy 2 weeks ago, following a lumpectomy 6 weeks ago. The lumpectomy revealed a 5 cm IDC Grade III,  ER-, PR+, HER2 -. The doctor wasn't too happy with the clearance margin and advised MRM.

Now, the pathology report post the mastectomy and removal of nodes indicates:

1. 2 greywhite lesions in the breast tissue, each ~ 2-3 cm, arranged in nests, sheets, cords. They are around 1.5 cm apart.  

2. 2 lymph nodes in the breast with cancer, (greywhite), without perinodal spread.

3. 1 lymph node in level 1 with cancer with focal perinodal spread.

The whole breast tissue is fibrous.

The doc says this means she is T3N1, stage 3a. He also suspects that the 2 lesions that we have found in the post-MRM excision are actually a single big tumour, part of the original lump taken out in the lumpectomy. He also says that while the chemo wd kill any microscopic cells, there is a 60% possibility of recurrence....We are going in for chemo in 2 weeks, when the wounds heal. I have the following questions:

1. If they all are one single tumour - it would have been ~ 10 cm!!  But the mammo revealed only a 5 cm lump... Is there a chance the mammo could not have detected the other 2? And since the lumpectomy removed only half the tumour, wouldn't this have made the tumour spread faster? Is there a higher risk now of spread?

OR - Is there a chance that the other 2 lesions only grew AFTER the lumpectomy?  In which case, does it mean the cancer is very aggressive? growing 2 lesions in a month?

We just want to understand this report better. Any help appreciated. thanks.  

If you are unable to get an answer to your questions from anyone at CC, you might send an email to Dr Susan Love - she is one of the foremost experts on breast cancer, and has a special interested in helping women gain insight and understanding into the disease and treatment.

I do not know that she will respond to your email, but think it would be worth a try.  Give her  the exact language of the path report and include the questions you asked us.   You can get the email form at this web address:

http://www.dslrf.org/endingbc/contactus.asp?L2=4&L3=6&am

Good luck,

Tre

Re: . 2 greywhite lesions in the breast tissue, each ~ 2-3 cm, arranged in nests, sheets, cords. They are around 1.5 cm apart.  

There was similar wording on my pathology report and my surgeon referred to my tumors as nesting or sheeting rather than lumps.  I have inflammatory breast cancer...no lump, just the nesting and sheeting of tumors.  I didn't know other types of breast cancer had nesting or sheeting.

Claudia