My biopsy shows invasive ductal carcinoma. Can it spread?

Question

Hello doctor,

I am a 47-year-old woman who found a hard lump in my left breast during self-examination, and my mammography and biopsy confirmed invasive ductal carcinoma, grade 2, measuring 2.5 cm. I am diagnosed with breast cancer.

My pathology report showed the tumor is estrogen receptor positive (90 %), progesterone receptor positive (70 %), and HER2 negative. My oncotype score is 18, indicating intermediate recurrence risk, and staging scans showed no evidence of distant metastasis (stage IIA).

My CA 15-3 tumor marker is slightly elevated at 32 U/mL, and I have a strong family history, with my mother having breast cancer at 52.

Could this cancer spread to my lymph nodes or other organs despite early detection, and am I at risk for developing cancer in my other breast or ovarian cancer, given my family history?

Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I hope you are doing well. I understand that you have been very worried, especially since there is a history of cancer in your family.

I have gone through your reports (attachments removed to protect the patient's identity). Finding out about your own breast cancer is definitely stressful and adds extra pressure. I want to reassure you that your cancer is in the early stage, which means it has not spread to your lymph nodes, and the chance of it spreading is very low.

Another positive point is that your tumor is a hormone receptor–positive, which is good because this type of tumor usually grows slowly and is not aggressive. Your Oncotype DX score is less than 18, which also means the tumor is low-risk, the chance of recurrence is low, and it is not aggressive.

Because of this, chemotherapy is not needed in most cases. Since you have a strong family history, we recommend doing a BRCA (breast cancer gene 1 and 2) test. This test helps us know if you carry a gene mutation that increases your risk for breast and ovarian cancer.

If the test is positive, it means about a 50 % risk for breast cancer and a 10 % risk for ovarian cancer. In the future, if needed, PARP (Poly(ADP-ribose) polymerase) inhibitors can be considered, but mostly in later stages.

The standard option is removing the tumor only (lumpectomy). Some people with high risk choose to remove the whole breast. Sometimes the ovaries can also be removed if the risk is high. If you prefer not to do extensive surgery, that is fine.

You will still get hormonal therapy for about 10 years, which effectively prevents recurrence and metastasis. We can also monitor your CA (cancer antigen) 15 to3 marker for control.

Do follow up with me after seven days.

I hope this explanation is clear and helpful. If you have any questions at any time, I am always here to help you.

Thank you.