DCIS + MX + Rad

amparoa

Hello there! thanks in advance for any advice or input.

I was dx with unilateral DCIS a little over three month ago and had mastectomy on my left breasr. The size was 15 x 8 cm., margins less than 0.1 cm. They didnt find any invasive focus and I dont know the grade because my biopsy doesnt say so but it does say  the nuclear grade is high and with necrosis. Im 33 but was 32 at the time I was diagnosed. Noone in my family ever had breast cancer.

My oncologist presented my case to a medical board about having radiation because of my age and the size of the tumor. She said that most of the doctors said they recomended rad. Its the best clinic in the country (Im from Chile, southamerica), but  Im having a second opinion on this (even my doctor recomended it, eventhough she wants me to have rad).

Im very confused about this, because she says its to be sure there isnt anything left. She says that the margins were too close but she cannot do surgey again because she would have to take muscle off and Im a very active woman, so thats why she recomends radio, but she also says theres not much literature on this. Also  if the recurrence chances are so low, why have rad?

What are your thoughts? sorry if my english is a bit confusing! hope you get what Im talking about.

april485

Soemtimes they like to make sure that there are no stray cells in the mastectomy scar because they can't possibly remove all breast tissue. As for your grade, if you had necrosis and the nuclear grade was high, it is likely grade 3 which is the most aggressive form of DCIS. They often recommend rads after a mastectomy it seems.

I would get that second opinion and then go with whatever risk you feel you could safely live with. Hoping that you get the results you are hoping for. Best to you!

Beesie

amparoa, your English is great!

The situation you describe - requiring a rads after a mastectomy for DCIS - used to be very rare but has become much more common over the past few years.  This has been driven in part by a couple of small research studies that showed a significantly higher recurrence rate after a mastectomy for DCIS if the margins are close.  

It's been a while since this topic was discussed on this board, but I found a couple of threads from last year where a number of women talked about having rads after a mastectomy for DCIS.  I believe you'll find the information about the research in these threads too:  

Topic: DCIS, BMX/MX, and radiation ladies

Topic: Chest Wall Margin 0.1mm after Mastectomy - radiation decision

So you can see you are not alone in getting a recommendation for rads after a MX for DCIS. 

ballet12

Amparoa,

Best of luck with a difficult decision.  As Beesie said, it is now becoming more common to radiate after mx if the margins are close.  Especially with the high grade DCIS, they want to be aggressive. 

amparoa

Thank you so much for your replies. I thought this was very rare.

Im glad you werent confused by my English!

I dont really understand the biobsy regarding the grade, because even though it says  it was intermediate to high nuclear grade with necrosis, it also says its predominantly papillary... What do you think it means?

Beesie, thanks for the links to the threads, it helps to know its not to rare and make the right decision.

What does it mean that in some cases when theres recurrence the cancer is more agressive? or that grade 3 is more agressive if its still not invasive?

thanks again!

Beesie

amparoa,

DCIS comes in various sub-types, and it's not unusual to have a few different types mixed together. My pathology report showed that I had mostly grade 3 DCIS but also some grade 2, and I had lots of comedonecrosis but also a bit of every other sub-type, including papilllary, micropapillary, solid and cribiform.  So it might be that most of your DCIS was papillary - which is usually grade 1 or 2 - but you also had some comedo-type DCIS was that grade 3. Since the higher grade DCIS is more concerning, the biopsy report and your doctor's recommendations would likely focus on that.  

Grade 3 DCIS with comedonecrosis is considered to be the most aggressive form of DCIS, but it is still non-invasive.  By aggressive, it means that the cells are growing more quickly, so grade 3 DCIS is more likely to be more extensive (spread across a larger area of the ductal system of the breast rather than isolated to one small area) and grade 3 DCIS is higher risk to convert to become IDC within a shorter period of time.  The information on the following page from this website helps explain this:  http://www.breastcancer.org/symptoms/types/dcis/diagnosis 

As for DCIS being more aggressive when there is a recurrence, I think what that refers to is the fact that in about 50% of recurrences of DCIS, the recurrence is not found until the cancer cells have evolved to become invasive.  So a DCIS recurrence is not always DCIS; it can be IDC. The risk that this might be the case is greatest if you are diagnosed with a more aggressive form of DCIS.  

amparoa

Thanks so much Bessie,

It a lot more clear now, you explained it really well.

I ahd the appt with the onc today. He said that I should have rads because of my age, the margins and the size, that the machines they work with now are a lot better than years ago and safer. 

He also said that at my age I had been lucky that I didnt have a more agressive cancer.

So Im going to go for it. 

Thanks again.

Beesie

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