IDC & DCIS and Margin issues

jgbartlett

Hi, I'm looking for some advice, I had a lumpectomy and SNB last week. 

I have my results and my pathology report states a 2.2cm IDC with multifocal intermediate to high grade DCIS in the remaining breast tissue, with microcalcifications (they size of breast tissue they took was 9cm x 8cm x 5cm). My concerns are in regards to my margins and the DCIS.

Resection Margins: Narrowest clearance of the IDC is 2mm at the anterior margin of excision, with clearance greater that 5mm at all other margins. The multifocal DCIS focally reaches to the posterior margin of excision in one histology section.  My surgeon explained that there was not much more she could do about the anterior margin, as she had taken the tissue to the skin, and also for the posterior margin as she had taken tissue to the chest wall.  She suggested an extra radiation boost to those areas. She never suggested mastecomy.  I would love to hear from anyone else who has had unclear margins followed up with extra radiation.

The other thing that worries me was that the DCIS was never found on any mammogram or ultrasound I had prior to surgery.  I have not been sent for any MRIs or other scans.  Now I'm worried the DCIS might be in other areas of the breast that I don't know about and my cancer is grade 3, it could be turning into IDC as we speak.  Has anyone else had any experience with IDC and DCIS, what additional questions should I be asking my surgeon? I meet with her again in three weeks.

ps, I'm in Australia, but find this website extremely helpful.  It seems like most people who post here have had many scans. Was this before or after surgery? (maybe we do things differently down here)

lindaonthelake

Hi there in Australia

My diag is similar to your.  My margins are a great concern as my closets is .5mm....that is like nothing.  They don't even want to give me the boost.....because it is close to the skin I was told.  So I think the boost is for when it is close to the chest wall.  I had DCIS high grade and IDC medium grade. lumpectomy (about the size of a deck of cards).  28 rads and AI to begin soon.  Drs. have been difficult to obtain information from.  BTW - my son-in-law is from Australia and moved to Houston, TX 2 years ago.  He and my daughter want to move to Australia.  That is a very long way from South Carolina.   

LittleMelons

Hi jg - I also have IDC plus DCIS with essentially no posterior margin (.3 mm).  My breast surgeon also said that he took all he could and went right to the chest wall. I was very concerned about that as well. My Rad Onc ordered 8 boosts to that area (along with 16 whole breast treatments).  I think boosts are definitely a good idea when it is so close.  I have a lot of faith in my Rad Onc, she is the head of breast cancer care at a large cancer centre.  When I expressed concern to her about the close chest wall margin, she said the chest wall acts as a natural barrier and it's the DCIS at that margin, so less concerning than IDC.

All the best to you! 

peggy_j

My surgeon told me that they want 2 mm margins around the tumor. In the operating room they eyeball it as best they can, and then the path lab looks at the tissue under the microscope. So if you have 2 mm margins from the path lab, it would seem like you're good. I hear what you say about the boost. That seems like a good idea.

I think your questions are valid, wondering if there's any chance you might have other spots of DCIS. Is it an option to get a breast MRI? My surgeon wanted one before she operated. It is $$$ and we needed the insurance company to authorize it before they would even schedule the MRI, but it does provide better resolution than a digital mammogram (the downside, aside from cost, is that the breast MRI sometimes catches false positives. i.e. it might find a spot that turns out to be nothing). This can be stressful, but FYI. Given a choice, I'd rather have a b-MRI vs. multiple mammograms, since the resolution is better and has no radiation.

best of luck. 

lpkung

I had an excisional biopsy. Acording to the operative report, the distortion area was extremely posteriorly along the chest wall, and a small portion of muscle was taken with the specime B.

The surgeon took 5 specimens of the tissue in the same area. Accoding to the pathology report :specimen A (anterior breast tissue) contains ductal hyperplsia; specimen B (posterior breast tissue) contains IDC and DCIS. The size of  IDC is 0.6 cm (Grade 1), 0.2 cm to the posterior and anterior margins The DCIS is o.1 cm to the anterior margin.

I sent the biopsy slides to a NCI designatedcancer center for 2nd oppinion. Parts A  is DCIS, intermediate nuclear grade. It comes within 0.1 cm to the anterior margin.  Part B is IDC+DCIS. The IDC is less than 0.025 cm if not closer, to the posterior margin and less than 0.2 cm to the anterior margin. The DCIS has intermediate nuclear grade with luminal necrosis. It is less than 0.1 cm to the anterior margin and posterior margin. Part C (superior margin) is borderline ductal lesion, with 0.1 cm of the black inked margin.

I don't know how thick is the fiscia and muscle.The IDC is 0.025 cm to the posterior margin. does it mean the cancer has grown into the muscle?