What would you do?

CKE19

After having surgery to remove LCIS a 2mm carcinoma was found in pathology with clean margins.  Sentinel node biopsy of 2 nodes was negative.  Surgeon suggested seeing radiation oncologist for a round of radiation.  Had an appointment today and he said because tumor was so small, removed with clean margins and no node involvement it was up to me as to whether or not I want to do radiation.  Had the pathologist not found the tumor I would have been treated with tamoxifen and closely monitored. I want to do what is best for me long term.  Any opinions out there????  I have an appointment next week with a medical oncologist to discuss.

Mouser

Hi CKE -- 

Do i understand right that you have LCIS plus a small IDC?

My first thought is that if a specialist says his specialty is unnecessary, it probably is. And it would be nice to take the radiologist's word and skip rads... Unfortunately the literature is pretty clear. I really looked into this carefully when i was diagnosed, because i *so* much wanted to avoid rads. (I had a 4 mm IDC with 1 cm DCIS, plus another 1 cm focus of DCIS.)  My understanding is that for both DCIS and IDC, radiation really cuts the recurrence rate, and I seem to remember that without rads, local recurrence runs as high as 30%. But maybe LCIS makes a different situation -- i know it acts differently from DCIS... 

Of course, rads only prevent local recurrence, they do nothing to prevent metastases - but they do make a serious difference in the local recurrence rate. In theory local recurrence can be treated by another lumpectomy or mastectomy -- but 50% of recurrences are already invasive when found, so they do pose a risk of more widespread disease.

Can you get a 2nd opinion? From a different place, not from someone in the same clinic? Best is a big center or medical school. Of course, the oncologist will probably also weigh in with an opinion; that may settle the issue for you.

Remember that you have time to think - don't act in a hurry. So much of the treatment is a matter of weighing risks against benefits, it's best to take your time and figure out your own comfort zone.

pshelton

I was told by my radiologist that if lumpectomy was an option then I would need radiation.  I have to have a mastectomy though because a total of 6 masses have been found and multiple quadrants in my breast is involved.  I will need radiation if they find after the mastectomy 3 or more lymph nodes are involved.  After reading your post I think I would chose the radiation but definitely get second opinions and discuss all your options with the team.

Paula Shelton, BSN, RN