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What Does The Following Pathology Report Indicate?
Question: Hello Dr,
Following up after the following thread
http://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=201943
My mother completed her Paclitaxel chemotherapy on 8th Aug and underwent Modified Radical Mastectomy whereby doctors removed her Level 1 and Level 2 Axilla and few nodes from Level 3. Out of the total 21 removed nodes, 1 was found to have metastatic deposits.
I have attached the pathology reports and have the following questions
1. As you will see, that as per this report, the size of the tumor is close to 3cm. The ultrasound we did before the surgery, the tumor was reported to be close to 1cm. Is the way to measure tumor in Ultrasound different from physically measuring it?
2. Does that mean that before she started the treatment, the tumor was larger than what was reported by PET/Mammography/Ultrasound
3. What are the negative factors in this report and what do they mean and how do they affect the treatment?
Based on this report, and the fact that she had a pretty good response to chemotherapy, and that there was only one node which was positive, and that the grade of the tumor is 2 and surgeon got clear margins and the tumor is ER/PR+ 8/8, should we consider Radiotherapy?
If yes,
1. What are the benefits and what are the risk factors.
2. Which one is the most advanced form of radiotherapy available in XXXXXXX preferably in the New XXXXXXX region
3. Should we have her supraclavicular fossa region irradiated as well? Can we avoid it?
4. Which all regions of her chest/breast should be irradiated?
Thanks for all your answers thus far.
Following up after the following thread
http://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=201943
My mother completed her Paclitaxel chemotherapy on 8th Aug and underwent Modified Radical Mastectomy whereby doctors removed her Level 1 and Level 2 Axilla and few nodes from Level 3. Out of the total 21 removed nodes, 1 was found to have metastatic deposits.
I have attached the pathology reports and have the following questions
1. As you will see, that as per this report, the size of the tumor is close to 3cm. The ultrasound we did before the surgery, the tumor was reported to be close to 1cm. Is the way to measure tumor in Ultrasound different from physically measuring it?
2. Does that mean that before she started the treatment, the tumor was larger than what was reported by PET/Mammography/Ultrasound
3. What are the negative factors in this report and what do they mean and how do they affect the treatment?
Based on this report, and the fact that she had a pretty good response to chemotherapy, and that there was only one node which was positive, and that the grade of the tumor is 2 and surgeon got clear margins and the tumor is ER/PR+ 8/8, should we consider Radiotherapy?
If yes,
1. What are the benefits and what are the risk factors.
2. Which one is the most advanced form of radiotherapy available in XXXXXXX preferably in the New XXXXXXX region
3. Should we have her supraclavicular fossa region irradiated as well? Can we avoid it?
4. Which all regions of her chest/breast should be irradiated?
Thanks for all your answers thus far.
Brief Answer:
Good response to therapy
Detailed Answer:
Hi
Thanks for followup. She has done well so far. My responses..
1. As you will see, that as per this report, the size of the tumor is close to 3cm. The ultrasound we did before the surgery, the tumor was reported to be close to 1cm. Is the way to measure tumor in Ultrasound different from physically measuring it?
A. The pathological report is much more accurate as it is the actual measurement. USG is only a prediction. So it is usually less than actual measure as on path report.
2. Does that mean that before she started the treatment, the tumor was larger than what was reported by PET/Mammography/Ultrasound
A. Yes, that is what usually happens
3. What are the negative factors in this report and what do they mean and how do they affect the treatment?
A. Nothing is negative as such here. Response has been good but could have been better. Pathological complete response is the best response.
should we consider Radiotherapy?
A. Yes, definitely
If yes,
1. What are the benefits and what are the risk factors.
A. As it was a locally advanced tumor to start with, radiotherapy is definitely recommended. Also, when neoadjuvant chemo has been given, radiation is mandatory
2. Which one is the most advanced form of radiotherapy available in XXXXXXX preferably in the New XXXXXXX region
A. She should get either 3D-CRT or IMRT as per radiation oncology suggestion. Given by LINAC machines, available in many centers in NCR
3. Should we have her supraclavicular fossa region irradiated as well? Can we avoid it?
A. Yes, in locally advanced tumors, supraclav fossa irradiation is recommended
4. Which all regions of her chest/breast should be irradiated?
A. We recommend the chest wall and supraclav fossa. Breast has been removed already.
Hope this helps.
regards
Good response to therapy
Detailed Answer:
Hi
Thanks for followup. She has done well so far. My responses..
1. As you will see, that as per this report, the size of the tumor is close to 3cm. The ultrasound we did before the surgery, the tumor was reported to be close to 1cm. Is the way to measure tumor in Ultrasound different from physically measuring it?
A. The pathological report is much more accurate as it is the actual measurement. USG is only a prediction. So it is usually less than actual measure as on path report.
2. Does that mean that before she started the treatment, the tumor was larger than what was reported by PET/Mammography/Ultrasound
A. Yes, that is what usually happens
3. What are the negative factors in this report and what do they mean and how do they affect the treatment?
A. Nothing is negative as such here. Response has been good but could have been better. Pathological complete response is the best response.
should we consider Radiotherapy?
A. Yes, definitely
If yes,
1. What are the benefits and what are the risk factors.
A. As it was a locally advanced tumor to start with, radiotherapy is definitely recommended. Also, when neoadjuvant chemo has been given, radiation is mandatory
2. Which one is the most advanced form of radiotherapy available in XXXXXXX preferably in the New XXXXXXX region
A. She should get either 3D-CRT or IMRT as per radiation oncology suggestion. Given by LINAC machines, available in many centers in NCR
3. Should we have her supraclavicular fossa region irradiated as well? Can we avoid it?
A. Yes, in locally advanced tumors, supraclav fossa irradiation is recommended
4. Which all regions of her chest/breast should be irradiated?
A. We recommend the chest wall and supraclav fossa. Breast has been removed already.
Hope this helps.
regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Can she develop hypo thyroid after radio therapy?
Is IGRT given by Novalis Tx equally superior as IMRT?
What other side effects she could have?
Is IGRT given by Novalis Tx equally superior as IMRT?
What other side effects she could have?
Brief Answer:
no, risk of hypothyroidism is low
Detailed Answer:
As far as I know, 3dCRT is good enough for post-mastectomy radiotherapy and in some situations IMRT may be required.
IGRT is not usually required for post-mastectomy radiotherapy. Rest you can discuss with radiation oncologist.
Other side effects may be skin peeling, blackening, etc. Not much problematic as compared to chemo.
no, risk of hypothyroidism is low
Detailed Answer:
As far as I know, 3dCRT is good enough for post-mastectomy radiotherapy and in some situations IMRT may be required.
IGRT is not usually required for post-mastectomy radiotherapy. Rest you can discuss with radiation oncologist.
Other side effects may be skin peeling, blackening, etc. Not much problematic as compared to chemo.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Is IGRT more advanced?
Are the treatment protocol standard? Do you have a link to the standard treatment protocol for adjuvant rafiotherapy?
Does treating the internal mammary chain increase the risk if lymphedema?
Are the treatment protocol standard? Do you have a link to the standard treatment protocol for adjuvant rafiotherapy?
Does treating the internal mammary chain increase the risk if lymphedema?
Brief Answer:
see below
Detailed Answer:
IGRT is required only for moving organs like lung tumors. I don't see its utility in chest wall irradiation.
Treatment protocols are fairly standard.
The following link can provide more details http://www.guideline.gov/content.aspx?id=37924
I don't think IM chain RT will increase irradiation but it is not a routine procedure performed in all cases. The above link does discuss about IM chain RT.
see below
Detailed Answer:
IGRT is required only for moving organs like lung tumors. I don't see its utility in chest wall irradiation.
Treatment protocols are fairly standard.
The following link can provide more details http://www.guideline.gov/content.aspx?id=37924
I don't think IM chain RT will increase irradiation but it is not a routine procedure performed in all cases. The above link does discuss about IM chain RT.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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