is DCIS in lumpectomy scar tissue considered a recurrence?

crapshoot

Hi everyone - has anybody ever had DCIS in the scar tissue after going through lumpectomy (twice for clear margins), ACT and herception for a year and radiation, finished herceptin just about a year ago. 

Is this considered a recurrence and what do you suggest treatment would be?  I have been told to get another partial mastectomy.

 the are of DCIS is very small.   Anyone with advice?  Just when ya think everything is going good  WHAM!

MarieKelly

Anytime cancer shows up in a surgical scar, whether it's regarding breast cancer or any other type of cancer, there's the possibly that it's due to surgical seeding of the incision line.  This is why when cancer pops back up locally in someone who's had a mastectomy, it's commonly along an incision line. Scar line recurrence doesn't occur anywhere near as often in those who have had a lumpectomy and that's because most who have had a lumpectomy have also been treated with breast radiation. Although radiating the breast certainly it's any guarantee, it will usually eliminate the threat of surgical seeding.  Sometimes, despite the best efforts of the surgeon, seeding still happens. Sometimes though, it's due to poor surgical technique.

There's a "no touch" rule when doing surgery on a known or suspeced malignant tumor. Basically that just means that they're not suppose to touch areas of healthy tissue with surgical instruments that have previously been used to cut through or dissect out the tumor - they're suppose to switch out for a new set of instruments to close the wound if there's even the slightest indication that there could be cancer cells on one of the instruments. So how well (or not so well) a surgeon adheres to this general rule is what can influence a patients chance of having a recurrence along the scar line or elsewhere in adjacent breast tissue.

Similar issues apply to cancer that reoccurs along a biopsy track or at the external suture line of a biopsy track. When a biopsy needle is inserted down into and through healthy breast tissue for sampling of a tumor, it has to then be withdrawn back to the surface through the same track it made going in. In doing so, there's the possibility that cancerous cells adhering to the biopsy needle are drawn back and deposited into the healthy breast tissue along the biopsy track as it's being withdrawn. Because those who have a mastectomy often have any biopsy track they might have had removed along with the breast tissue, seeding from the biopsy track is usually not of any real concern.  Likewise, those who have a lumpectomy usually also have post lumpectomy radiation - so again , the potential problem is usually avoided, but this time by the use of radiation rather than removal of the track itself. Some surgeons automatically make it their practice to remove a biopsy track when doing a lumpectomy when ever possible but unfortunately, most don't bother.

You asked for advice, so I'll offer mine for what it's worth.  In having already having had a 2nd lumpectomy due to no clear margins the first time and now with an incision line recurrence - if it were me in this situation with a grade 3 and Her2+ breast cancer, I'd go straight to a full mastectomy and forget about any partial mastectomy or lumpectomy.

crapshoot

Thank you mariekelly for your information and your advice.  I am scheduled for lumpectomy/partial mastectomy surgery on the 02nd of March.  I think it would be wise to go for a full mastectomy but may have to wait a bit longer for that surgery to be scheduled.  So i may do the partial and then get a full one booked.  Is this considered a recurrence though?  This was a very small area that showed up on the mammogram this year that was not visible last year although it was very obscure this year and the radiologist had even suggested wait 6 months to do another mammogram and/or stereotactic biopsy.  I opted for the biopsy now because I figured there was really no point in waiting.

 Are you saying this was probably residual stuff not got at the original surgeries?  I am going to have to ask my surgeon about the tools etc. 

MarieKelly

Is this considered a recurrence though?

By definition yes, this would be considered a recurrence. Any time a cancer resurfaces after treatment which made it clinically undetectable, it's considered a recurrence.  However, it looks like your original cancer was ILC and this scar line cancer is DCIS - which makes me wonder how DCIS could suddenly surface in an incision line when the original was ILC . A definate quandry in my mind - since DCIS is of ductal origin and contained within the duct system, how can DCIS be found in a suture line where there surely are no milk ducts?  Did you originally have a mixture of both DCIS and ILC? Could what's in the suture line really be IDC and not DCIS?

Are you saying this was probably residual stuff not got at the original surgeries? 

Yes, I think that's more probable than not specifically because it's in the suture line. As I mentioned previously, suture line recurrences are primarily due to surgical seeding which is the displacement of cancerous cells from one area to another during the surgical process. But again, I think it's very odd that what's in the suture line is being called DCIS (which doesn't exist outside the ductal system)  - especially IF the primary tumor was purely ILC.

Yes , yes yes - be sure to talk to your surgeon about his technique when doing cancer surgeries. Everyone should do this.  Not that you can expect him to admit anything incriminating if there really is is an issue with his technique, but at least you'll get him thinking about it and perhaps stimulate a change for patients thereafter.  My surgeon was just a general surgeon and he was very informed about this issue and assured me that he both changes out the instruments AND removes the biopsy tract (which he did on me) whenever possible. 

crapshoot

Thanks again MarieKelly - i noticed that the original diagnosis said ILC - that was a mistake  - it should have read IDC.  I have changed it but i don't know if it has shown up yet or not. 

I believe there was IDC with DCIS in my original diagnosis and this new DCIS is not really in the scar but scar tissue from the previous surgeries.  

You don't know how much i appreciate your responses.  Thank you so much. 

 I have another question for you now regarding time frame - as i said i am presently scheduled for a lumpectomy/partial mastectomy on the 02nd of March.  My surgeon (also a general surgeon) does not want to do a full mastectomy and so i am in the process now of finding another surgeon.  Should I go ahead and have the partial done and then carry on to a total?  This makes sense to me but somebody suggested that a 2nd surgeon might not do a mastectomy secondarily.  What are your thoughts on this?

roseg

I don't think that makes you stage IV. Isn't there a term "local reoccurence?"

I'd wait and have one surgery. DCIS is not life threatening, if you have to wait a few weeks to get scheduled it's not gonig to matter. 

crapshoot

thank you roseg for taking the time to answer.  I think this is recurrence also - i am actually believing that it is not even recurrence but more left behind.  It is very difficult to find any information on being treated for IDC and then have DCIS recurrence - it is usually the other way around. 

There are just so many possibilities here - is it aggressive and lied dormant while i was getting the chemo/radiation?  Is it recurrence?  I am afraid to go and have another "partial" (there aren't many parts left) mastectomy only to be told a few weeks later that there was IDC involved as well requiring more surgery.  The scenarios are too many.  Driving me crazy!!

GryffinSong

If I were in your shoes I'd wait and have just one surgery. Putting yourself through two relatively major surgeries isn't good for you health, and is twice the stress on your body. I can't really speculate too much about what happened re: the recurrance or whatever. But for what its worth, I had IDC and DCIS. We would not have known about the DCIS, I don't think, if we hadn't removed both breasts and had everything looked at.

On the other hand, it's been several years for you, so who knows.

Hugs and good luck to you!

arby

I had DCIS with an invasive component 2 yrs ago.  It recurred after I had a lumpectomy and 33 rads.  So, the 2nd time, my DCIS showed up in 3 clusters and the scar tissue.  No lumps...all identified by mammo and the fact that I had tenderness and hardness on the scar tissue.  I had a masectomy and chemo.  One surgery is cheaper and easier on the body than to do 2.  No one knows how slow the DCIS grows.  I wish for me that waiting had been an option the 2nd time, but with 3 hot spots, I just as well have the breast removed.  CHemo was a challenge.  Get support from those who've been there.  This website is an excellent source of fellow comrads!  God's healing touch be present as you recover from surgery and may His Wisdom lead you in decision making.

dee1961

DCIS is not invasive and inside the duct, therefore I can't see how it would recurre in a suture line, sounds more probable that it is IDC. I think you will have to have to have a biopsy to find out for sure, good luck to you!

AnnieMc

Hi,

I am sorry that you have had a recurrence of DCIS.  I experienced something similar.  In April 2004, I was diagnosed with stage 1a ER/PR/HER 2 negative IDC and DCIS.  I had lumpectomy, chemo and radiation.  In November 2005, my mammogram showed a suspicious area in the same breast which turned out to be DCIS.  Because I had previously had radiation, I had a mastectomy.  I also had immediate reconstruction.  I have been NED since.

It was a real shock to have a recurrence.  In many ways, it was more upsetting than the original diagnosis, even though it was stage 0.  But, it has been over four years since my mastectomy and I am doing well.  Take care.

IronJawedBCAngel

It sounds like a local recurrence.  Because of the prior radiation to that breast, many doctors would recommend a mastectomy because the breast can not be radiated again. Whether you do a lumpectomy or mastectomy, when they send the tissue off to pathology they should be able to tell if it is a local recurrence or a new primary.  Seeding from a surgery is rare, but there was a study a few years ago with a fairly large following that detailed risk from any needle biopsy, but most feel the risk is very small.  Whatever the reason this is happening, I am very sorry you are having to go through it.