multifocal cancer

kyliet

I am interested to see that there are a few grade 1's with multifocal. My 2nd tumour wasn't found till op. I had a lumpectomy and onc said RT would 'get' any other small tumours. I also had FEC-D chemo. 

Docs kept telling me grade 1 is slow and wouldn't spread. Total shock that I also had 3 +ve lymph nodes, ECE and lymphatic channel invasion. I was wondering if it is because grade 1 has been there so long that it spread? Anyone know?

LuvLulu07

katopet   I also was Grade 1, and multi-focal.  Second smaller mass wasn't detected until pre-surgery MRI.  

Not sure what to tell you about Grade 1 being slow growing.   My 2 tumors were not detected a year earlier, with a routine mammogram.  Surgical pathology showed that the bigger mass was 1.8 cm and the smaller, 1.6 cm.  Either the mammogram missed two sizable masses, or they grew a lot in the course of a year.   

jrgolomb

I was also grade 1 multifocal and it was not discovered until the MRI and confirmed during the mastectomy.  I was treated with taxotere/nasty FEC and radiation. 

stepmic

Hi,

I am multi-focal as well and am wondering who needed rads? I had two IDCs which were measured at 1.3 and 1.6cm as well as a few small other areas. Also some DCIS found in breast. Nodes are negative, clear margins, mastectomy so I was surprised by the suggestion that I do rads. RO said it is because I am multi-focal but is going to check with other ROs as I am in the grey area. MO also wants to do chemo but I am arranging to have oncotype dx test here and she said she will go with score to decide. It isn't covered in my province in Canada so I have to pay for it but if I have a low score and could not have chemo then it would be worth it!

Just went to see oncolgists yesterday so all this is sinking in. Not what I wanted to hear...

Thanks to anyone who can share.

stepmic

Yeah, my RO called yesterday and he checked with other experts in the field and is now not recommending rads. I am so happy about this! Now just waiting to see what oncotype score is, then I will know about future chemo plans.

Summer-sky

I have IDC, one tumor 2.8cm in size and multi-focal.  2 lumpectomies, because I could not get clear margins the first time.  I was told that with the multi-focal properties there is a greater chance of local recurrance.  I was happy with the clear margins, and am starting A/C (x4) on 8/15/2012 followed by radiation.  I am just curious stepmic, did you choose a MX because of the chance of it coming back, or because there was more than one tumor and not great cosmetic resluts?  My husband wanted me to think about a MX to skip rads, but I'm too chicken.

stepmic

Summer-sky - The surgeon wanted to do MX to be sure as it was multi-focal, three small tumours. Was a good call as there were smaller DCIS also that showed up when pathology was done. Best call for me. I am happy you got clear margins!

 I am thinking that multi-focal properties aren't as rare as I first thought they were. There seem to be many women in the same boat!

jrgolomb

Stepmic-- I know, right!?  I shoud probably go through this and count how many of us, at the very least, are even on this thread!

mcdonalm

My diagnosis was multifocal invasive carcinoma. The two foci were very small. 1.1 mm and .6 mm. I also had 6 mm of High grade DCIS. Had lumpectomy in Dec and Sentinel lymph nodes removed in Jan.13. The doctor ordered the SNB, as she was surprised to find the invasive carcinoma since non of the mammograms showed anything but a very tiny section of DCIS. My nodes were clear but I am still concerned with having such a mixed bag in my breasts. Had an MRI in Jan that showed several adjacent lesions in my left breast but the findings were inconclusive as there was no comparison against prior findings. I am waiting for a targeted ultrasound.

I am waiting to meet with the cancer centre(team of specialists. e.g. oncologist, radiologist) to discuss my adjunct treatment. My concern is that while my tumour was very small, the grade on the pathology report was high. It was suggested by the surgeon that i would likely only need radiation. Not sure if chemo will be recommended but considering my tumour histology, should it not be? What have other multifocal patients experienced?

The research is mixed on multifocal tumours as it relates to recurrence rates. I will ask about the Oncology test. But I am curious as to other small tumour patients experiences. Should the treatment wait until the left breast has been cleared? It is now 4 weeks post surgery, so treatment needs to begin. Thoughts?

Yayme

Hi all...

I also had multi focal high grade IDC stage 1 no negative Triple Negative......

Oh yeah...and some DCIS thrown into the equation. I had a BMX, and chemo. There are many different studies out there..so there is really no direct answer.....however your stage is directed by the largest tumor. The reason some of the studies are split is that they seem to take different tacts....such as 1) one study said that the tumor load increases node positivity thus making it more aggressive...2) another study said there is no actual data to suggest that multifocal has any effect on outcome...(I tend to agree with that one), as I had read more evidence on that study....it is more common than we think. There are both triple negative, and ER+, as well as HER2+ ladies on these boards with multifocal breast cancer...

Chemo usually starts as a protocol as soon as possible and up to sometimes 12 weeks depending on the circumstances. I started mine at 8 weeks plus a couple days....

Lisa

LuvLulu07

mcdonalm   I was grade 1 multi-focal IDC with a bit of DCIS, my treatment did not include chemo or radiation as nodes were clear,  LVI was not apparent, and I had low oncotype dx scores.  Have you had the oncotype dx test?   For some low stagers this is another piece to the puzzle that can help to determine treatment.  

corgi09

I had 10 tumors/tumorlets, micormets in 2 nodes with extranodal extension in one of the nodes, grade 2.  My oncetype came back as 10.  My path says 1b, rad says 2a.  I had a umx and radiation and started on tamox.  It feels so contradictory.  The cancer isn't aggressive but likes to go places.  Smalll tumor(s) but lots of them.  Micromets but extranodal.    My onc. assures me that because of how tamox works it will take care of any cancer floating around.  Every time I see her.  More than once in a visit.  15 months out from diagnosis and everything is fine.  I just wish they understood multifocal more, that there was definitive information about it.

Lmimp64

Hi all. I'm multifocal 5 tumors in r breast ranging from 2.5mm to .5mm. Had BMX jan 9 and surgeon ans mo predicted hormone therapy only. Even gave me the script and we filled it. Onco came back on the largest at 18. Tumor board met an suggested 4 rounds tc. I was a little emotional - didn't expect it. The mo then suggested ovary abulation chemically then surgically. She said either would reduce my reoccurance rate by 4%. She also said 3/100 women get their lives saved by the chemo. The others do it for no benefit. Then she said that I should also consider the five tumors. They make it less simple. Any thoughts? I'm confused. I'm trying to get a second opinion and make the decision quickly.

corgi09

I would get the 2nd opinion, if only for peace of mind.    Are you close to menopause?  I needed barely a nudge.  

Lmimp64

I have no idea how close I am. No tests done. I am 48 though. I will ask about that.

Musicmomjv

I was diagnosed in June of 2012 with DCIS and after an MRI was told that I had IDC and it was also multifocal. The only way to get clear margins was to have a mastectomy.

After much thought. I decided to have a bilateral mastectomy even though the r breast showed no signs of cancer. I felt peace of mind taking this route and have never regretted it.

Musicmomjv

Forgot to mention that 3 tumors were found the largest being 1cm. Lymph nodes were clear. No radiation or chemo required. I an on tamoxifen for 5years.

LuvLulu07

Musicmomjv   My surgery and treatment plan are similar to yours.  Due to being multi-focal, I had a mastectomy and opted for prophy MX on the other side - no regrets.  No chemo or rads, Tamoxifen for 5 years.  I also started ovarian suppression, because I am (was) pre-menopausal.  

lemonadehk

Hi all, I was diagnosed in Jan with multifocal IDC. 12 tumors, the largest one is 3.8mm. There is one micrometastasis in one sentinel node. So stage 1B. Had chemo AC-T. Now considering whether to have rads or now. Most doctors said not necessary, but a couple said I should due to my age (37) and the multifocal nature and node. It's such a hard decision. Any advice?

Sneakychiquita

Lemonadehk - Ask your doctor (or someone else who can access journal articles) to review this article with you as a starting point:

"Locoregional Recurrence Rates and Prognostic Factors For Failure in Node-Negative Patients Treated with Mastectomy: Implications for Post-Mastectomy Radiation" by Jagsi et. al., Int J Radiation Oncology Biol. Phys. Vol 62 No 4 pp 1035-1039, 2005

Not sure if you fit the patient population this study applies to, but maybe it will give you a bit more insight. It's a very hard decision to make. This was the one step that my gut told me not to take, but I couldn't deal with having to tell my kid I didn't take all treatment options available if it ever did return, so I went into it very grudgingly.

lemonadehk

Thanks, Sneakychiquita! I am going to see my RO in a few hours. I guess I will do it for the same reason you mentioned. But still feeling uneasy... This is the hardest decision by far in this process!