confused again!

bexybexy

Just had another look at my report that I was given when first diagnosed with DCIS. I must admit I didn't want to pay too much attention to it as knew I would be googling and stressing myself out. I keep hearing about clear margins etc and feel like a real dummy here but still don't really understand it all. I think my surgeon was more wanting to just stress that it is a stage 0 cancer, and that I am having a mastectomy and it will all be taken care of, he said about 3 times he is "not worried." That has helped me remain very positive but looking at the report I just wish it was easier to understand to a non medical professional. This is basically what it says, I would love for someone just to explain it in laymans terms please. I don't want to be unnecessarily worried so please no doom and gloom lol I know people wouldn't do that here I am just so weary of being scared all the time! The main thing I know is I am getting it treated.

Intermediate Nuclear Grade DCIS solid type.

Shows Comedo Necrosis extends over 32mm

Lies more than 10mm frommedial and resection margins

DCIS extends to involve all the margins.

No evidence of invasion.

This last sentence is of particular importance to me! I am having the sentinel node done on the day of the operation and am having mastectomy and reconstruction at the same time.

Many thanks (and I am hoping Beesie is reading this!)

xxxxxxxxxxxxx 

Beesie

bexybexy, can you be clearer on what you are confused about?  As I read the parts of the pathology report that you've provided, it sounds exactly like what your doctor told you.

Here's my interpretation:

• You have grade 2 (i.e. intermediate grade) DCIS.  
• The subtype of DCIS that you have is "solid" and 3.2 cm of your DCIS (or 32mm) includes comedonecrosis. Usually the combination of "solid" type DCIS and comedonecrosis would mean that the DCIS is grade 3 so it's interesting that yours is considered to be grade 2 (which is slower growing and therefore less aggressive than grade 3).   
• It's hard to tell from how this is written up here but I believe that this is saying that the comedonecrosis is far from the margins.  That's good since it means that the more aggressive stuff is probably all already removed.
• You do have DCIS (less aggressive, without comedonecrosis, I would assume) right up to all the margins. That's why more surgery is required.
• There is no evidence of invasive cancer.  That's very good.

.

Having a large amount of DCIS and/or a more aggressive form of DCIS increases the risk that some invasive cancer might be found in the middle of the DCIS.  That's the biggest concern.  But it appears that you are okay on this count since there is no evidence of invasion.  For you what's most important now is removing any DCIS that might be left in your breast and hopefully getting decent margins.  While the type and aggressiveness of the DCIS matters when the DCIS is in your breast (because it presents the greater risk of invasion), once all the DCIS is successfully removed - with good margins - then in the end it really doesn't matter what the specific pathology of the DCIS was. All DCIS is Stage 0 and has the same excellent prognosis.  

bexybexy

Thankyou so much Beesie. I think I just needed clarification and you have given it! I was confused like you about the grading but maybe it's like borderline that is why they have classed it intermediate. I just didn't understand all the margins side of stuff before as they didn't really explain it well.

I think the main thing as you say it that it is going to be removed. Even if my DCIS was agressive all it would mean is that there is more need for the mastectomy this is probably why it was suggested. I did tell the surgeon I was worried about the invasive cancer side of things but he said there was none suspected and that is why they are doing the mastectomy and reconstruction, if invasive cancer was suspected there is no way that would be in the pipeline as it would obviously alter the scheme of things, this I see as a positive indicator. Does this make sense? I know I am not very good and putting things across. Thankyou so much once again!