Positive margins after lumpectomy Confused...?

pat1154

Hi ladies,I had a lumpectomy on June 15,3 days later received call from surgeon who told me that report showed only DCIS with no invasion, but a marging was positive  and I needed a re excision. which I had 3 days ago,still no news. I do have the report of initial lumpectomy and I'm confused,I will try to condense it so as not to take much of your time:Number of blocks w/DCIS 8,number submitted 30,Histologic type DCIS Grade 3 necrosis present central,Margins positive for DCIS Specify which margins and extent Posterior (minimal/moderate in 2 blocks)  Medial (minimal/moderate in 2 blocks) Distance from other margins:

Distance from anterior marging 2mm,distance from superior 15 mm,distance from lateral 30 mm distance from inferior 33 mm.  Now if I'm not mistaken what the report shows is 4 positive margins and not just one,I also don't undestand if the higher numbers are good news or vice versa,though Dr.underlined the 2 mm...? can any one please explain? I'm so scared to find out that re excision didn't work....what does all of this mean? according to my surgeon except with having to start over everything else looked "very, very good" Thank you All

redsox

From the first lumpectomy it looks like two involved margins:

Posterior (minimal/moderate in 2 blocks) 

Medial (minimal/moderate in 2 blocks)

The other margins are viewed as acceptable.  A higher number is better for distance because it is reporting the distance from the edge of the nearest cancer cells and a bigger distance is better.  The doctor presumably underlined the 2 mm because that is acceptable but barely.  If he was going back to shave the margins more he may have done that one, too.  

Try to hold off worrying until you get the results of the re-excision. We hope that will get good enough margins.

Debbs

Hi Pat,

I was in exactly the same situation as you after my initial wide area excision on the 8th May for DCIS.  I went to see my surgeon the following week who advised that the histology report showed that the margins weren't clear and that he needed to redo the surgery the following week.  He also advised that I had Grade 3 which hadn't been found when the original biospy was taken two weeks previously which only showed up Grade 2 (the 3 was hiding behind the grade 2).

He reoperated again on 22nd May.  On 29th May he advised that the histology report now showed that all the margins were clear and the DCIS was out.  The guideline for a safe margin is, I believe a mimimum of 2mm but you'd need to ask your surgeon (or I'm sure someone on the site can tell you as I'm no expert and wouldn't dream of suggesting something that isn't correct - anybody???) Anything over 2mm is good news, the larger the number the better.

Because I had Grade 3 I am now halfway through a four week course of radio.  I was given the daily option of going every day for 6 weeks or 4 with possibly more side effects - apparently it is the same dose and the results are the same so I decided 2 weeks less of daily visits was right for me but I'm sure your team will discuss with you and make the right recommendation or give you the options.  Hopefully after the radio I am good to go but will be closely monitored for the next 5 years with regular check ups.

Can I suggest that you discuss with your surgeon.  The great news is that there was no invasion so everything was contained.  Hopefully after you've spoken to your doctor again he can reassure you which I think he has already tried to do with his comment that everything looked very very good.  They simply don't say this if is isn't very very good so please take this as a positive.

I wish you well and good luck with any further treatment you have.

Debbs

Beesie

Pat, unfortunately it's not uncommon for those of us with DCIS to have "dirty" margins after our first surgery.  Cancer cells are microscopic so when the surgeon is operating, he (or she) removes what he believes to be the right amount of breast tissue, based on how large the area of cancer appeared on the mammogram films (and/or the MRI and/or the ultrasound). Based on what they see on the films, surgeons do a mental calculation of how much breast tissue to remove, hoping that they get clean margins all around the removed tissue but also trying not to remove too much more breast tissue than necessary.  It's really a bit of a crap shoot and when the surgeon is actually in there operating, he is in effect operating blind, since he can't actually see the cancer cells.

Because of this, having dirty margins is not unusual.  The good news is that requiring a re-excision because of dirty margins has no affect whatsoever on your diagnosis or prognosis.  So long as you end up with clean margins, whether it's after the 1st surgery, or a 2nd or even a 3rd, your prognosis is the same, and for those who have pure DCIS, the long-term prognosis is excellent.  

pat1154

Hello and thank you Beesie, Redsox and Deb!! No soon I finished posting that my Dr, called " All clear no more Cancer found" I didn't know whether to laugh or cry I couldn't believe it.  As you all know all too well ,this was a nightmare from which we couldn't seem to wake up...I'm awake and life is wonderful

 I will start rads in 4 weeks but go back to work next Monday can't wait. A really BIG Hug to you all Thank you!!

Debbs

Pat,

You have brought a massive smile to my face, cannot tell you how delighted I am.  When I was told all clear I burst into tears (hadn't shed one since I was diagnosed and it all came out).  My friend who came with me kept asking if I had 'heard right as it was good news', I just nodded.

Enjoy your day and just keep smiling - fantastic.

If you need any help in getting through rads just give me a shout.

Debs 

Hummingb1rd

Pat1154, Hi there. I'm so happy to hear you had good news. I was told DCIS was the best possible bc scenario and that is the truth, something to be greatfuI for.  So happy to hear your positive attitude. As one of the ladies wrote above, your future is positive & reassuring.

I was diagnosed with DCIS in Feb. I had three surgeries, all with positive margins. My initial decision was to have a lumpectomy & radiation. After so much tissue was taken, my surgeon suggested I at least get an opinion from a reconstructive, cancer surgeon. I did also seek another opinion from an oncological surgeon. I was never told that radiated tissue is difficult to reconstruct. It certainly is not impossible, but something to consider if your surgeries took a lot of tissue. I'm so grateful someone told me because it changed my decisions. I ultimately chose to have bilateral MX w recon. and happy I did. Of course we all choose different routes, none is better than the other as the choice is so personal. My aunt just finished her radiation & is doing really, really good; so, I just wanted to encourage you that no matter which road you take, you have an excellent prognosis & will be on the other side of this soon. Best wishes.