Understanding diagnosis-IDC/multifocal

nybc2013

What does it mean when people say multifocal?  Is IDC multifocal and DCIS? I have grade 1 that is ER pos and PR pos BRCA neg and HER2 neg. 

doxie

nybc2013,

So sorry you have to join us here.  

IDC that is multifocal means there is more than one tumor in the same breast.  I'm not that familiar with DCIS, but there could certainly be more than one area in the same breast.  Multifocal IDC is usually a strong indicator for treatment with chemo.  

indenial

Yes, it means multiple tumors, same cancer. I had 3 IDC tumors (and an area of DCIS). According to my oncologist, multifocal increases my chances for recurrence by 5-10%. Aside from that, I haven't really been able to find much info on it.

Colt45

I believe I read where mastectomy for multifocal disease brings you back to no significant increased risk for recurrence, though. Please, anyone, correct me if I'm wrong.

Blessings2011

I was diagnosed in September 2011, with multifocal IDC, AND multifocal DCIS in my left breast. There were two invasive tumors, and two areas of pure DCIS.

I was initially offered a lumpectomy, but the Breast Surgeon said that she would have to take such a large wedge of tissue to get all the invasive and non-invasive cancer, I would be better off considering a unilateral mastectomy.

In the end, because of my history (mom had BC, I had dense, fibrocystic breasts, my radiologist could never be completely sure that there was nothing on the right side) I made the decision to have a bilateral mastectomy.

I had my BMX on December 5, 2011, with immediate reconstruction in the way of tissue expanders. All margins were clean, and there was no lymph node involvement. I did not need radiation or chemo.

My MO said that after my surgery, my risk of recurrence was 1% - 2%!

I also went on a medically supervised liquid diet and began an exercise program, and lost 60 pounds. That furthered my recurrence risk by 23%.

Then the MO put me on Anastrozole (generic Arimidex), which she said reduced my risk of recurrence by another 50%!

kyliet

My doctors keep telling me because I was multi-focal but the tumours were only 1cm apart it made no difference than having one tumour. I find that really hard to believe especially being Grade 1 and lymph node involvement. 

besa

 Multifocal means that there are two or more tumors in the same quadrant.  (Multicentric means that there are multiple tumors in different quadrants.)

I had multifocal IDC and was staged using the pathology and size of the largest tumor (and of course node status).  I had an oncotype dx test that came back low and did not have chemo.  My understanding, and from researching the literature and talking to my MO,  is that being multifocal, in and of itself, does not increase the chance of recurrence.   

indenial

"Multifocal means that there are two or more tumors in the same quadrant.  (Multicentric means that there are multiple tumors in different quadrants.)"

Ah this is interesting. I thought the two words were synonymous. I guess mine was multicentric then... they were in different quadrants but I'm pretty sure the doc said multifocal. I wonder if multicentric increases recurrence but multifocal doesn't?

besa

When I looked at the models being multifocal seemed to increase the chance of being node positive (see sloan Kettering nonogram link below)- I ended up being node negative. (If the link doesn't work just search on "sloan kettering" "nomograms" and "breast cancer"

http://nomograms.mskcc.org/breast/

gardengumby

I had multiple IDC in the same breast (one was 13mm, the other 3mm), and I believe in the same quadrant - but the DCIS involved more than 1/2 of my breast.  Both of the IDC originated from the same DCIS.  I didn't know that was multi-focal.  I though the IDC had to originate from separate DCIS to be either multi-focal OR multi-centric.  Could someone more knowledgeable than I elucidate?

besa

Researched this question up in the "uptodate" database (I think a good resource) and they say that "the impact of multifocal"  ... or multicentric... tumors on prognosis is controversial with some evidence that they are associated with a poor prognosis and other data suggesting they do not impact prognosis"    They go on to say that right now "the TNM staging system does not asssign independent value to multifocality or multicentricity and uses the diameter of the largest lesion to assign T stage."

gardengumby

Thank-you, Besa.

thirdgenerationmomof2

I'm curious what multifocal means to? I was originally diagnosed with 1.1 cm IDC in left breast. When final path came back said not only did they find the IDC tumor but also DCIS wad present. No size listed, just grade 2. My IDC was grade 1. Right breast path report said negative for tumor but benign breast tissue with fibrocystic changes.



Last visit with my MO I glanced at my chart with his clinical notes and saw the word multifocal. Does having IDC and DCIS mean I have multifocal cancer?



Jen

oneday

My breast surgeon told me that because my tumors all arose from the same area of dcis, they are assumed to have the same histology. 

Here is a study I found, which looked at what percentage of multifocal do not share the same histology: http://annonc.oxfordjournals.org/content/early/20...

Personally, I think multifocal means more than one tumor in a single quadrant of the breast and not much else. There appears to be no other conclusions which can be drawn about multifocal tumors as a group. Some researchers report that the tumors should be added together for staging because it more accurately reflects survival in multifocal. 

I would love to know why so many of us in our 30s and early 40s with no family history and no risk factors for cancer have this extensive dcis with lots of little invasive tumors. Is there something in our environment that is causing this? 

(And isn't it sad how younger women have to find their own breast cancers and then convince their doctors of it. Not to mention fertility concerns, young children to raise, and body changes related to chemo, surgery, zoladex, tamoxifen.)

Josefine

 I was diagnosed, after fine-needle aspiration biopsy in early December 2013, with multifocal tumors, non  palpablel with the size of 10 mm, 5 mm and 5 mm. All three tumors in the same quadrant 11 o clock to 13, all with cancer cells grade 1. Seccond opinion on patholog report showed no cancer but abnormal cells. A core biopsi was made on the largest tumor and it showed IDC and also non- invasive ductal carcinoma. So I am schedule for unilateral mastectomy. I have understood that the spacing of the tumors must be at least 5 cm to be multicentriskt and can only be seen by a 3 D image such as MRI.  Are there different prognosis for multifocal and multicentrisk tumors? Why do treatment differ so much? Radiation, chemo ???

Xrayalli

Hi, I was originally diagnosed with DCIS, a very small area seen on mammo found by me, I am a mammographer and my mammo was read negative. I basically had to ask for additional imaging to look closer at the area. They ordered a biopsy and even then thought the area "looked fine". They called the next day with the diagnosis. My lumpectomy came back clear but because I remembered that the X-ray of the specimen mentioned calcifications my surgeon had the pathologist look for the calcifications and that's when they found 11 more areas of DCIS. I then had a mastectomy with sentinel node biopsy not expecting any positive nodes because with DCIS that would be very odd, well, I had a positive node. My surgeon wouldn't rest until they found why and they finally found an invasive tumor that never showed on mammo or MRI. So until my mastectomy I had multi-focal DCIS, IDC and an incidental finding of radial scar. Someone above mentioned how sad it was that us young women (I am 42) have to fight and find our own cancers and advocate so much. I say follow your gut, listen to your body. Forgot to mention, I had nipple discharge for 6 months leading up to my mammo, which raised a red flag for me. I saved my own life. I have my 3rd surgery tomorrow and I'm praying for no more positive lymph nodes. 

domesticwomen

If I may ask....why is that, that we can't find much information on multifocal lesions of the breast? Is ir really that rare? 

My MRI just discovered that,  but since it was 5mm it was to small to do anything with 6 months ago. I now am returning this week to have further screening's and hopefully schedule surgery to see if it's benign or cancerous.