DCIS Remaining after Lumpectomy

Allenan

Hello,

I am rethinking my treatment.  I had a lumpectomy  for IDC and 2 re-excision back in May/June.  The final pathology report showed that 2 out of the 11 slides had DCIS at least 1mm away from the inked margin.

Although I already moved ahead with my treatment and completed chemo, I am being haunted by that path report that mention those 2 slides with DCIS and wonder if I should have made a different choice.  As in, requesting an MX. 

I am suppose to start radiation soon, but have this nagging feeling.  Now I feel I need answers as to what would be the best recommendation given my final path report.

Hope to hear from you ladies who may have been in a similar position or even if you are not in the same position.  Thanks for reading.

dsj

I am not in your position because I didn't have IDC, just DCIS.  I did have close margins but was told that radiation with a boost would "sterilize" any DCIS left behind.  If I were you, I would talk to your oncologist and ask him/her about your concerns.  Margins are the most complicated part of DCIS decisions, and as hard as I tried I never really felt like I understood what was involved.  My oncologist said that the size of the margin is dependent on a number of things, including how the tissue was handled by the pathologist.  

jazz3000

Allenan - Have you called the American Cancer Society and asked one of the counselors there? They are so good at explaining a lot of things to me and may be able to clarify some of your concerns as well.

Mantra

I had one close margin and the BC surgeon put my case before the tumor board because she needed input from others. My cancer was DCIS but because it was grade 3, multi focal and multi quadrant, she just wasn't convinced that she got it all. She explained that with so many tumors it was just as likely there were additional tumors in the area she didn't touch. She booked me an MRI but before the appointment date the tumor board came back with their recommendation. Everyone on the the tumor board recommended a mastectomy. 

I did have the mastectomy and it turned out that there were no additional cancer cells . . . all cancer was infact removed by the lumpectomy.  So you can see that it is just as likely all cancer was removed during your lumpectomy. 

Allenan

Thank you all so so much.  I will call ACS and speak to a counselor.  I have also scheduled a meeting with my BS and oncologist so I can have my concerns address.  I was so positive I made the right choice of lumpectomy, but after he did the 2 re-excision and I read that there were 2 slides with DCIS 1mm away from the inked margin, I started to have doubts but went along with my treatment because I felt that the chemo and rads will get it all.  It seems that there is no way of knowing.

Should I insist on an MRI.  I am thinking that is probably a good thing to do before making my decision.

Again,  thank you all. 

A

LouLou40

Discuss it with your BS further and have all the facts before making a decision as it all depends on which margins My posterior margin was 1mm and my anterior/subcutaneous margin had extensive IDC and DCIS involvement. My BS explained that he removed all the visible cancer and felt confident that Rads would clear the subcutaneous margin as it was just below the skin surface.The posterior margin is the one close to the chest wall and there was no more tissue to take. My Rad Onc said close margins are considered OK and Rads take care of them.

I have trust in my medical team who all agreed no mx was necessary in my case, approaching the 3 yr mark since dx and I'm great.

Good luck with your decision either way. 

Lou 

Allenan

Thank you Lou.  The DCIS is at my inferior margin.  I was told the same thing as you.  That rads and chemo would take care of it.  This was told to me by the nurse though.  Not the BS.  Your story helps.  I will post after I meet with the BS and oncologist.

DebiMetz

I was recently dx'd with DCIS in my left breast, stage 0, grade 3 but after a lumpectomy by BS told me that DCIS was found in 20 out of 22 slides so she definitely didn't get it all and doesn't see how it would be possible to get it all with another lumpectomy, so I am now facing the fact that I will have a mastectomy.  I have an appt with the PS next week and have lots of questions.  I am also worried about the "good" side since the DCIS was only found through the lumpectomy.  I did just have an MRI so I am hoping that will shed light on both breasts so I can decide whether to have a unilateral or bilateral mastectomy.  This is so consfusing and I am very nervous!  I think the MRI will be helpful and I will have both breasts removed if it means DCIS is in both bc I don't want to go through this twice if I can avoid it.  BIG DECISIONS TO MAKE!! 

Allenan

Hi DebiMetz:

Seems like you are on the right track in your thinking.  I made the decision to go on with my current treatment since DCIS was only found in 2 of 11 slides.  I did speak to the BS and asked him questions about the margins.  He at first seemed a bit taken back by my questions at this latter stage in the game but he answered saying if he though I needed a mastectomy he would have said her.

Good Luck in your decision making.  I am sure you will do what is best for you.

Keep me posted,

Love,

Ann