Looking for information on "clean margins"

HeatherBLocklear

Hi all,

After apparently misunderstanding the BS when I thought he said only a small area of dead cancer cells remained in the breast, I've now found out from the oncologist that there was a locus of viable cancer (< .50 cm) inside a mass of dead cancer cells and scar tissue in the breast. The lymph nodes (19 in all) were matted and scarred, but free of cancer.

I'm told the remaining neoplasm was removed during surgery. Now I'm wondering about the following:

1.) what exactly does "clean margins" mean? How are clean margins determined? Does having clean margins significantly affect survival rate?

2.) how likely is it that distant cancer (in the form of micro mets) also remains when viable cancer is discovered at time of surgery?

3.) does the fact that the cancer in the nodes was killed have any real impact on ultimate survival?

I'm sure other questions will occur to me, but those are the ones I can think of this evening. I've been a bit shell-shocked since Friday; hence, also, my rudeness to a certain Dr. ItalianName on this site. Hope I can be forgiven.

Thanks to all,

Annie Camel Butt

otter

Hey, Annie,

I'll try to tackle Question #1 with a non-answer.  Having clean or clear margins (vs. not having clean margins) affects the local recurrence rate.  I had the impression that, ideally, the margin of healthy tissue surrounding the excised tumor should be around 1 cm (on all sides).  I even thought that my onco surgeon had said, "Ideally, 1 cm" when I asked her what constituted a "clean margin."

Now, I'm not so sure where I heard that, or whether it is true.  My dh can't remember whether my surgeon actually said, "1 cm".  I tried googling the issue, and found one decent commentary:  http://health.yahoo.com/experts/breastcancer/2300/how-are-your-margins/

"One of the keys to a successful lumpectomy is ensuring there are "clear margins." Few issues are more important than this when it comes to reducing risk of local recurrence.

"The term "clear margin" refers to the area of tissue around the tumor that is free of cancer cells. This rim of healthy tissue is a critical goal of breast surgery. Despite the importance of clear margins, there is no consensus on how much of the tissue surrounding the tumor should initially be removed.

"Some breast centers consider removing a 1-mm margin of tissue to be adequate; others require a margin of 2 mm, and still others 4 mm. There are even some breast centers that remove 10 mm (1 cm, or about two-fifths of an inch). ..."

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I also read in a couple of places that 2 mm of normal tissue is considered a "clear margin" at some hospitals.  That implies anything less than 2 mm might not be considered "clear".

How were your margins?  My smallest margin with my mastectomy was the margin against the chest wall.  It was 8 mm, which surprised me.  I assumed it would be easy to get really big margins with a mast for a 1.8 cm tumor.  That was one reason why I chose a mast rather than lumpectomy/rads.  I guess my breast was small, after all; and the tumor was deeper than I thought.

How is the cleanliness of the margin determined?  When the tumor is removed, the surgeon tries to take it out as a "chunk" (a block of tissue).  Someone takes the chunk and ties a piece of suture through one side of it.  Another side is dipped (pressed) into a colored dye.  A third side is marked with a different suture, or a different-colored dye; etc.  It goes into the fixative after all the sides are marked.  The pathologist looks at the tissue and measures the distance from the outermost tumor cell(s) and the first evidence of a marking (e.g., dye) on each of the sides.  That's the margin on that side.  The path report should contain a notation of the margin at each of the sides that was marked.  Sometimes all it says is "No tumor cells at the margins," or, "Margins are clear," which I find frustrating. 

As for your other two questions, I'm going to wait to see if someone else jumps in here.  My opinion hasn't really changed on those.  Has your onco hinted at a more aggressive post-surgery systemic treatment than "just" Avastin?

I doubt Dr. ItalianName is feeling very wounded.  I suspect he is thicker-skinned than many of us are.  Writing letters to the editor on controversial subjects (like epirubicin vs. doxorubicin) isn't something for the weak-at-heart. 

Hugs, Annie...

otter