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What Does My Biopsy Report Indicate?
Question: need followup with dr indranil XXXXXXX
attachment. please see the attachment for biopsy.
attachment. please see the attachment for biopsy.
Brief Answer:
this confirms cancer
Detailed Answer:
This should have enough tissue to get the receptor status done.
Hence she can proceed with the chemotherapy.
Please let me know if you have any other questions.
Regards
this confirms cancer
Detailed Answer:
This should have enough tissue to get the receptor status done.
Hence she can proceed with the chemotherapy.
Please let me know if you have any other questions.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
what does it mean Lymphvascular invasion is not identified.
One more question is my mother lump is getting softer and lot of liquid is coming out of the lump, it made a small opening in the breast from where liquid is coming off and the lump is getting softer.
One small lump which was there under the armpit is completely gone.
She is going to have chemo after a day, right now she is taking some natural things like apricot kernels, vitamin c and turmeric.
One more question is my mother lump is getting softer and lot of liquid is coming out of the lump, it made a small opening in the breast from where liquid is coming off and the lump is getting softer.
One small lump which was there under the armpit is completely gone.
She is going to have chemo after a day, right now she is taking some natural things like apricot kernels, vitamin c and turmeric.
Brief Answer:
please refer below
Detailed Answer:
Lymphvascular invasion is not identified - this does not have much significance on this small biopsy.
Liquid is coming out - that means it has breached the skin. Some infection was also probably there which may have gotten better with antibiotics. Hence one lymph gland in armpit may have subsided.
please refer below
Detailed Answer:
Lymphvascular invasion is not identified - this does not have much significance on this small biopsy.
Liquid is coming out - that means it has breached the skin. Some infection was also probably there which may have gotten better with antibiotics. Hence one lymph gland in armpit may have subsided.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Here are few more reports of biopsy and chemo plan. Can you please tell some detail regarding these reports and if chemo plan is fine?
Brief Answer:
Chemo plan seems to be okay
Detailed Answer:
The biopsy shows strong hormone receptor expression, so we can give hormone therapy (tablets) after surgery for 5 years. This will help in disease control.
Chemo drugs written are quite standard. Dose calculation is best done by treating oncologist based on patient's height, weight, general health and blood reports. Hence I leave that to him.
Please let me know if you have any other queries.
Chemo plan seems to be okay
Detailed Answer:
The biopsy shows strong hormone receptor expression, so we can give hormone therapy (tablets) after surgery for 5 years. This will help in disease control.
Chemo drugs written are quite standard. Dose calculation is best done by treating oncologist based on patient's height, weight, general health and blood reports. Hence I leave that to him.
Please let me know if you have any other queries.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
one thing I need to check with you that, my mom breast is got a skin rapture that is around 6 cm by 4cm, and fluid is coming out of it, May be infection, so can you tell me can chemo have bad effect on this infection? if yes how to avoid that.
Brief Answer:
yes chemo can cause flare up of infection
Detailed Answer:
But, we need to be sure if it is infection or just dead tumor tissue coming out. For this we should examine the fluid in lab and culture it for any bacteria.
If there is doubt it may be better to give a course of antibiotics first. Probably she has received antibiotics already. In that case culture report is vital to guide antibiotic choice.
If delay in chemo is anticipated, then we can put her on hormone tablets which will prevent further growth or even cause tumor shrinkage. They will not cause infection flare up.
yes chemo can cause flare up of infection
Detailed Answer:
But, we need to be sure if it is infection or just dead tumor tissue coming out. For this we should examine the fluid in lab and culture it for any bacteria.
If there is doubt it may be better to give a course of antibiotics first. Probably she has received antibiotics already. In that case culture report is vital to guide antibiotic choice.
If delay in chemo is anticipated, then we can put her on hormone tablets which will prevent further growth or even cause tumor shrinkage. They will not cause infection flare up.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
can we do this after first chemo, I mean examin the fluid for culture. how much effect of one chemo on white blood cells?
Brief Answer:
better to do know if infection suspected
Detailed Answer:
White cells can fall rapidly after chemo. Day 7-15 is usually the low period. Though her doctor has prescribed an injection to prevent it.
Better to send the culture now and start antibiotics if infection suspected. Culture report will come in 3-4 days and then final decision may be made. If the doctor feels that infection unlikely, then he can proceed with the chemo.
better to do know if infection suspected
Detailed Answer:
White cells can fall rapidly after chemo. Day 7-15 is usually the low period. Though her doctor has prescribed an injection to prevent it.
Better to send the culture now and start antibiotics if infection suspected. Culture report will come in 3-4 days and then final decision may be made. If the doctor feels that infection unlikely, then he can proceed with the chemo.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
but what do you think, like she is not having any pain, can it be a infection?
Brief Answer:
Still it may be
Detailed Answer:
If the fluid has come out the pain may reduce but infection may still be possible. The call has to be taken by the treating physician.
Still it may be
Detailed Answer:
If the fluid has come out the pain may reduce but infection may still be possible. The call has to be taken by the treating physician.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello Doctor,
we went through the two hospitals (Max and Dharmshila), here are the different process of chemo they have prescribed.
Please see the attachments
chemo_Process1.jpg
Vs
chemoProcess2.jpg
I think chemoProcess2 is having more chemo but mild. Can you please have a look and tell some details.
we went through the two hospitals (Max and Dharmshila), here are the different process of chemo they have prescribed.
Please see the attachments
chemo_Process1.jpg
Vs
chemoProcess2.jpg
I think chemoProcess2 is having more chemo but mild. Can you please have a look and tell some details.
Brief Answer:
both are acceptable
Detailed Answer:
Both chemo protocols are quite standard.
The dharamshila one is a three drug combination and can cause more side effects including lower white cell count and more infection. Hence the pegfilgrastim Inj to boost white cell is mandatory. However, it is only 6 doses.
The XXXXXXX one causes less side effects as the first part is 2 drug combination and second part is single drug. But it will require 16 times administration ( 4+4=8 cycles) and take 2 months more. Chemo port insertion may be required.
Response rates and longterm disease control rates are similar.
both are acceptable
Detailed Answer:
Both chemo protocols are quite standard.
The dharamshila one is a three drug combination and can cause more side effects including lower white cell count and more infection. Hence the pegfilgrastim Inj to boost white cell is mandatory. However, it is only 6 doses.
The XXXXXXX one causes less side effects as the first part is 2 drug combination and second part is single drug. But it will require 16 times administration ( 4+4=8 cycles) and take 2 months more. Chemo port insertion may be required.
Response rates and longterm disease control rates are similar.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
hello doctor, can you tell me how it is a 8 cycles, it seems to be 16. what does it mean 16 administration. I am bit confused. it seems like first is having 6 session and another is having 16?
Brief Answer:
please refer below
Detailed Answer:
Dharamshila protocol- 6 cycles, 6 injections
XXXXXXX protocol-
The first part is 3 weekly for 4 cycles (4 injections)
The second part is on weekly basis for 12 doses (12 injections). But it is not considered 12 cycles; 3 doses make 1 cycle, so 4 cycles)
Hence total 4+4=8 cycles but injections 4+12=16
regards
please refer below
Detailed Answer:
Dharamshila protocol- 6 cycles, 6 injections
XXXXXXX protocol-
The first part is 3 weekly for 4 cycles (4 injections)
The second part is on weekly basis for 12 doses (12 injections). But it is not considered 12 cycles; 3 doses make 1 cycle, so 4 cycles)
Hence total 4+4=8 cycles but injections 4+12=16
regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
hi doctor, just need to tell you that, after first chemo, the whole lump had come out, and now nothing is there in the breast. so what do you suggest. can we go for surgery and hormon tharpy only. or we can check with one more pet scan and wait what it suggest?
Brief Answer:
chemo needs to be continued
Detailed Answer:
Maybe the fluid collection has drained so it seems the tumor has come out. But tumor cannot 'come out' like that.
Even if we assume that tumor has responded well, response after one cycle is not used for decision-making. After all, it was a locally advanced tumor.
Hence I feel that chemo should be continued.
chemo needs to be continued
Detailed Answer:
Maybe the fluid collection has drained so it seems the tumor has come out. But tumor cannot 'come out' like that.
Even if we assume that tumor has responded well, response after one cycle is not used for decision-making. After all, it was a locally advanced tumor.
Hence I feel that chemo should be continued.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
hi doctor, my mother is having high fever and chest congestion, can we afford to have chemo in this situation. what need to be done? already shown to doctor for fewer.
Brief Answer:
after resolution of infection
Detailed Answer:
This appears to be an infection which should go away with antibiotics.
Next chemo is supposed to be after 21 days so by that time she should be fine.
after resolution of infection
Detailed Answer:
This appears to be an infection which should go away with antibiotics.
Next chemo is supposed to be after 21 days so by that time she should be fine.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
She is having antibiotics which is also leading to stomach upset. What could we do to help her
Can we give her fresh vegetable juices after washing the vegetables well with hot water
What supplements and probiotics are recommended to help the patient
Doctor has recommended AC cycle every two weeks. Is there any harm in taking it every three weeks? I want to talk to my doctor about it
Can we give her fresh vegetable juices after washing the vegetables well with hot water
What supplements and probiotics are recommended to help the patient
Doctor has recommended AC cycle every two weeks. Is there any harm in taking it every three weeks? I want to talk to my doctor about it
Brief Answer:
yes vegetable juice is okay if washed properly
Detailed Answer:
Routine probiotics are not given with antibiotics. Please discuss with your doctor if this is needed at all.
Anti-diarrhea medicines can be given to reduce diarrhea if it happens. This stomach upset may also be due to chemo.
I usually do not recommend 2 weekly AC chemo in patients older than 60 years and especially in hormone positive tumors. Discuss with her oncologist if 3 weekly should be fine for her.
yes vegetable juice is okay if washed properly
Detailed Answer:
Routine probiotics are not given with antibiotics. Please discuss with your doctor if this is needed at all.
Anti-diarrhea medicines can be given to reduce diarrhea if it happens. This stomach upset may also be due to chemo.
I usually do not recommend 2 weekly AC chemo in patients older than 60 years and especially in hormone positive tumors. Discuss with her oncologist if 3 weekly should be fine for her.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
hi , please see the report of my mother after chemo, its blood report, this is after one weak of chemo, please check if it is ok?
Brief Answer:
low white cells
Detailed Answer:
Hi
Thanks for followup.
White cell and neutrophil counts are quite low. Did she receive the pegylated GCSF (pegfilgrastim) 6 mg inj on the day after chemo?
If so, then no further injections to boost the counts are required. However, any fever should be promptly treated with antibiotics. She was probably on antibiotics recently. In that event, fever may necessitate hospitalization and injectable antibiotics.
The counts will recover gradually.
Regards
low white cells
Detailed Answer:
Hi
Thanks for followup.
White cell and neutrophil counts are quite low. Did she receive the pegylated GCSF (pegfilgrastim) 6 mg inj on the day after chemo?
If so, then no further injections to boost the counts are required. However, any fever should be promptly treated with antibiotics. She was probably on antibiotics recently. In that event, fever may necessitate hospitalization and injectable antibiotics.
The counts will recover gradually.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi,
We had adminstered her Pegrafeel (dr. Reddy's) injection after 24 hours of chemotherapy on her arm subcutaneously. We did not bring the injection to room temperature. Basically, we took out the injection from the refrigerator and injected her. Do we need to bring the injection to room temperature before injecting? If it is not brought to the room temperature, is it still effective?
We had adminstered her Pegrafeel (dr. Reddy's) injection after 24 hours of chemotherapy on her arm subcutaneously. We did not bring the injection to room temperature. Basically, we took out the injection from the refrigerator and injected her. Do we need to bring the injection to room temperature before injecting? If it is not brought to the room temperature, is it still effective?
Brief Answer:
Should not be a problem
Detailed Answer:
it should not cause much problem. Sometimes, even after peg-grafeel, counts can become low but they improve quickly.
get another count in few days
Should not be a problem
Detailed Answer:
it should not cause much problem. Sometimes, even after peg-grafeel, counts can become low but they improve quickly.
get another count in few days
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi,
We have admitted our Mom in the hospital as she was having intermittent fever and her cough was not improving. They are doing intravenous antibiotics and will do CBC and culture tests.
How long does this XXXXXXX lasts. She took pegrafeel 6mg after 24 hours of chemo and two 3mg injections after a week of chemo when her wbc was found to be very low. We are hoping that her wbc comes out to be better now.
If we do only surgery and radio therapy only, what will be chances of recurrence. We are very nervous that chemotherapy instead of cancer will be more harmful to her. May be its because of the experience we are having with the first chemo. Do things get better or worse with subsequent chemos?
I will upload the reports as soon as we have them.
We have admitted our Mom in the hospital as she was having intermittent fever and her cough was not improving. They are doing intravenous antibiotics and will do CBC and culture tests.
How long does this XXXXXXX lasts. She took pegrafeel 6mg after 24 hours of chemo and two 3mg injections after a week of chemo when her wbc was found to be very low. We are hoping that her wbc comes out to be better now.
If we do only surgery and radio therapy only, what will be chances of recurrence. We are very nervous that chemotherapy instead of cancer will be more harmful to her. May be its because of the experience we are having with the first chemo. Do things get better or worse with subsequent chemos?
I will upload the reports as soon as we have them.
Brief Answer:
it should improve anytime now
Detailed Answer:
The XXXXXXX should not last much longer. It is good that she is now on IV antibiotics. Hopefully she will soon come out of it.
I understand that chemo is causing problems but still it is quite important for her, being a locally advanced disease.
After she recovers we can continue the chemo in lower doses (like 80% of previous) along with peg-grafeel. That will probably reduce these side effects a lot. And of course, the interval will be three weeks between chemo. I don't think she will tolerate 2 weekly chemo.
Regards
it should improve anytime now
Detailed Answer:
The XXXXXXX should not last much longer. It is good that she is now on IV antibiotics. Hopefully she will soon come out of it.
I understand that chemo is causing problems but still it is quite important for her, being a locally advanced disease.
After she recovers we can continue the chemo in lower doses (like 80% of previous) along with peg-grafeel. That will probably reduce these side effects a lot. And of course, the interval will be three weeks between chemo. I don't think she will tolerate 2 weekly chemo.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi,
I am attaching the latest CBC, RFT and LFT reports. They will discharge her tomorrow morning.
I am attaching the latest CBC, RFT and LFT reports. They will discharge her tomorrow morning.
Brief Answer:
report is fine
Detailed Answer:
The wbc is improved (it is high but that is due to filgrastim injection). If she is otherwise fine, she can go home.
report is fine
Detailed Answer:
The wbc is improved (it is high but that is due to filgrastim injection). If she is otherwise fine, she can go home.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi,
I have some more questions
1. Can her WBC drop below normal once the effect of peggrafeel subsides
2. In the CBC, PCV is 32.1 and RBC is 3.64 and haemoglobin is 10.2. These values are slightly below normal. Are these of sny concerns.
3. In the urine report, urea, creatinine, potassium, chloride and bicarbonate are slightly off normal. Any concerns here.
4. In the LFT, albumin - 3.4, ag ratio - 1.1 and alkaline phosphatase - 164 are off normal.
5. In the renal profile, potassium, chloride, albumin, ag ratio, bicarbonate and serum urea are low and alp and sgpt are high
6. My mom's PET was done on 2nd Feb and there was no metastasis. Is it possible that metastasis might occur during treatment as the treatment lastsfor more than 6 months.
7. Since PET scan is so central to the entire treatment plan, do people normally get it done twice to eliminate any errors in reporting.
I have some more questions
1. Can her WBC drop below normal once the effect of peggrafeel subsides
2. In the CBC, PCV is 32.1 and RBC is 3.64 and haemoglobin is 10.2. These values are slightly below normal. Are these of sny concerns.
3. In the urine report, urea, creatinine, potassium, chloride and bicarbonate are slightly off normal. Any concerns here.
4. In the LFT, albumin - 3.4, ag ratio - 1.1 and alkaline phosphatase - 164 are off normal.
5. In the renal profile, potassium, chloride, albumin, ag ratio, bicarbonate and serum urea are low and alp and sgpt are high
6. My mom's PET was done on 2nd Feb and there was no metastasis. Is it possible that metastasis might occur during treatment as the treatment lastsfor more than 6 months.
7. Since PET scan is so central to the entire treatment plan, do people normally get it done twice to eliminate any errors in reporting.
Brief Answer:
please see below
Detailed Answer:
1. very unlikely considering the current WBC count
2. nothing do do now apart from some medicines to help improve the hemoglobin, like iron
3. I don't see the urine report attached
4. Again, I can't see the LFT report but apart from high protein diet nothing else to do
5. -Do-
6. Very unlikely and the fact that clinically she is responding makes it even more unlikely
7. PET is not essential. As I said earlier, I would have gone by CT and bone scans. If PET is done, it is also Ok. Nobody does it twice to confirm. It will be a waste of resources.
Regards
please see below
Detailed Answer:
1. very unlikely considering the current WBC count
2. nothing do do now apart from some medicines to help improve the hemoglobin, like iron
3. I don't see the urine report attached
4. Again, I can't see the LFT report but apart from high protein diet nothing else to do
5. -Do-
6. Very unlikely and the fact that clinically she is responding makes it even more unlikely
7. PET is not essential. As I said earlier, I would have gone by CT and bone scans. If PET is done, it is also Ok. Nobody does it twice to confirm. It will be a waste of resources.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
1. Sorry, I am a bit confused. Doesnt PET tell the staging. Is there anything which could be missing in PET scan which could be caught by CT and bone scans?
2. What is the most accurate test to determine stage of cancer.
3. Also, what exactly is the bone scan. Should we consider MRI of the whole body to find anything missing.
4. The reason I was thinking of doing PET again was to catch any human errors in the diagnosis of the staging. Do you think the slides we get from PET has all the information and we could just get the slides reviewed, so that we know for sure that the technician did not make any mistake while determining the staging.
5. I am attaching all the reports (blood and urine) again for your review.
Thanks in advance.
2. What is the most accurate test to determine stage of cancer.
3. Also, what exactly is the bone scan. Should we consider MRI of the whole body to find anything missing.
4. The reason I was thinking of doing PET again was to catch any human errors in the diagnosis of the staging. Do you think the slides we get from PET has all the information and we could just get the slides reviewed, so that we know for sure that the technician did not make any mistake while determining the staging.
5. I am attaching all the reports (blood and urine) again for your review.
Thanks in advance.
Brief Answer:
Please refer below
Detailed Answer:
1. yes, PET tells the staging and in fact it is PET+CT. CT is included in PET-CT. What I mean to say that PET may not be required in these cases and CT scan +bone scan will suffice.
2. For a locally advanced breast cancer CT thorax/abdomen +bone scan is ok. If any doubt in these, PET may be done for confirmation. Alternatively, PET-CT may be done directly
3. Bone scan is a scan to look for bone metastases. If PET has been done, no need to do it.
4. Yes, you may get the films and CD of PET scan reviewed by another expert.
5. I am sorry I am still unable to see any new reports apart from CBC and swine flu test.
Regards
Please refer below
Detailed Answer:
1. yes, PET tells the staging and in fact it is PET+CT. CT is included in PET-CT. What I mean to say that PET may not be required in these cases and CT scan +bone scan will suffice.
2. For a locally advanced breast cancer CT thorax/abdomen +bone scan is ok. If any doubt in these, PET may be done for confirmation. Alternatively, PET-CT may be done directly
3. Bone scan is a scan to look for bone metastases. If PET has been done, no need to do it.
4. Yes, you may get the films and CD of PET scan reviewed by another expert.
5. I am sorry I am still unable to see any new reports apart from CBC and swine flu test.
Regards
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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