Diagnosis DCIS so many questions!

Beesie

Carrol, no, invasive ductal carcinoma (IDC) is not DCIS.  DCIS is ductal carcinoma in situ.  Both types of breast cancer are similar, with the development of the cancer starting in the milk ducts ("ductal carcinoma").  With DCIS, the cancer cells are completely contained with the milk ducts of the breast ("in situ") and therefore the cancer can't travel outside of the breast.  With IDC the cancer cells have broken through the duct and moved into the open breast tissue ("invasive"). For this reason, IDC usually is treated more aggressively than DCIS.  IDC most often develops from DCIS so it's very common to find the two together within one tumor or mass of breast cancer.  Because of this, most women with IDC have a pathology report that includes both IDC and DCIS.

Hope that helps clarify your diagnosis.

sunnyhou

bump

terry54

I too was dx with DCIS - hi grade 3 on one breast three weeks ago. Because it is multi-focal, my BS is doing a mastectomy with SNB and immediate TE reconstruction . Her concern is that some of the cancer cell might have leak out of the duct. She will only take out the other lymp nodes if the SNB is positive. I read from the previous postings that it seems you have an option for no SNB to avoid other complications. My ER/PR receptor are negative but HER2 is positive. ( which I was told is not a good sign )

Does any one have similar situation ? My surgery is scheduled in less than 2 weeks and I am starting to get nervous about the whole thing. Thanks for any info.

Beesie

Terry,

First of all, being HER2+ on DCIS is really not an issue.  A large percent of DCIS is HER2+.  HER2 status is very important for invasive cancer but for DCIS, there is no definitive conclusion on what it all means.  Some studies suggest that HER2+ status on DCIS may mean that it's more aggressive but other studies suggest that HER2+ DCIS may be less aggressive.  All the studies have been very small so what it all means is that at this point nobody knows.  At this point there is also no difference in treatment for those who have HER2+ DCIS vs. those who have HER2- DCIS.

As for doing the sentinel node biopsy, it's really only necessary for those who have invasive cancer.  DCIS cannot travel to the nodes.  But here's why your surgeon is recommending the SNB for you.  Even though your preliminary diagnosis only shows DCIS, she is concerned that there might in fact be some invasive cancer in your breast as well.  Until the mastectomy is done, she won't know whether there is or not.  But if it turns out that the mastectomy does uncover some invasive cancer, then you would need to have the SNB done at that time.  The problem however is that an SNB is very difficult to do after a mastectomy.  In order to find the sentinel node, the process is to inject isotopes into the breast, either in the area of the cancer or around the nipples. Once your breast is removed, this can't be done.  That's why women who have mastectomies for DCIS often have SNBs done at the same time, if it's believed that there is a reasonable risk that some invasive cancer might be found.  If you were having a lumpectomy; you could have the SNB later, if invasive cancer were found.  But with a mastectomy, you can't.   So that means that if invasive cancer is found, you would need to have an axillary node dissection, which would remove more nodes and increase your risk of lymphedema.  That's the dilemma.  

nwshannon

Terry54 - I am wishing you the best of luck, just so you know when I did go in for my lumpectomy & even though the biopsy said highly suspicious of micro-invasion in 2 areas my final path report was pure DCIS so until the final surgery path comes back you do not know for sure. I also had 7 nodes removed at the same time due to the poss. micro-invasion biopsy & because it was a Grade 3. I knew that I would not want to go back again if in fact invasive cancer was found to test the nodes, it is a very difficult decision to make and there is always a risk of lymphedema, I have not had any problems thus far with that & I am in my final 2 treatments of Rads.

Beesie has been the best support with a DCIS diagnosis, she has alot of knowledge, I have some great threads regarding DCIS, node removal, and micro-invasion under my profile that she helped me with. I was so scared as I am only 38 yrs old but after the love & support I have found on here it has made this crazy journey a whole lot easier. I have found some wonderful life long friends on here & we continue to support eachother. Sunnyhou is a great friend as well, she had a similar diagnosis that you have as well & she will be quite helpful to ask any questions you may have. Just remember it is all personal choices that we have to make and for me I went with all the recomendations that my breast surgeon recommended & also my oncologist.

imatthew

terry - my wife's diagnosis was similar - 3 areas of DCIS, 1 of grade 3 IDC (poorly differentiated) in her right breast, nothing in her left and MRI/CAT/Bone scans were all negative.  

She had a unilateral skin-saving mastectomy with immediate DIEP reconstruction last week.  They tested her SNB the morning of surgery, found it to be positive, and removed the rest of the lymph nodes in the area, we are now waiting for her pathology report.  We expect 3 months of chemo and a year of herceptin.  Our prayers are with you.

terry54

Beesie..thanks for the info and clarification on DCIS & HER2+ I have been reading a lot of posting and still trying to process it all. I was very nervous after the dx and just wanted to move forward as quickly as possible but maybe I didn't allow myself enough time to do more research.

nwshannon.. I can see that everyone is very supportive and sharing on this site and I know that I have a place now to express my concerns and fear. I will go to some of the earlier DCIS site to get more info.

imatthew...Sorry to hear about your wife's positive SNB. I am sure your strength will also help her through it all.  Thanks for sharing.