IDC chances with DCIS lumpectomy

percy4

Have read here there is about a 20% chance of finding a higher grade (mine is less than a centimeter, low grade DCIS from stereotactic biopsy, ER+) DCIS, or even an invasive cancer, in DCIS lumpectomy.  Does anyone know; if IDC is found in the lumpectomy, would it be stage 1 or could it be any stage?

Jelson

Here is an explanation of staging

http://www.breastcancer.org/symptoms/diagnosis/staging

it will depend on the size of the idc and whether it is found in a lymph node. I am guessing it would most likely be stage 1a because of the estimated size of your DCIS. It might be a micro-invasion which would be treated like DCIS.

ballet12

The odds are very much with you, Percy4. As was recently stated by Beesie, only 15 to 20 percent of lumpectomies show an upgrade to IDC, and the majority of those upgrades are to microinvasion (1mm or less, I believe), in which the treatment plan is the same as for DCIS. Only 5 percent have an upgrade to IDC which is greater than a microinvasion. The chances of microinvasion/invasion increase when there is a lot of DCIS, although there is one member of our bco community who had both a small amount of DCIS and a small amount of IDC.

Just take it one step at a time. If you have to deal with microinvasion or the very very unlikely event of IDC, you'll deal with it then.

Best of luck. When is the lumpectomy scheduled for?

Annette47

Just to add what the others have said, the fact that your DCIS is low grade actually decreases the odds of any IDC being found ... Although mine was eventually decided to be grade 2, that was more of a compromise as there were some high-grade features (comedo necrosis etc) mixed with less threatening stuff. And yes, I am one who had a tiny area of DCIS with a micro-invasion of IDC, but I am told that is pretty rare. The only things it changed for me was to make me officially Stage 1A rather than Stage 0, and for them to do a sentinel lymph node biopsy along with my lumpectomy (the IDC was found on the stereotactic which actually removed all of both the DCIS and IDC). Nothing else about my treatment plan was changed by it, and the difference in my prognosis between pure DCIS and this is miniscule.

ballet12

Hi Annette, you were the one I was referring to when I stated there was someone with a small amount of DCIS with a small amount of IDC. I didn't realize that yours was considered "microinvasion". I did also recall reading that low grade DCIS makes it less likely that there will be microinvasion, but wasn't sure enough about it to post it. My surgeon told me, after I had the first excisional biopsy where 4 cm's were taken out, that it was unlikely that they would find IDC in subsequent re-excisions (although my previous surgeon--who had done the first surgery thought there could be). Anyway, there was no sign of microinvasion. I would guess that people feel that much more vulnerable if the cells have made that genetic change to invade, even in a small way (I know statistically there is a very very very small chance of mets from that diagnosis).

percy4

Thanks all.  Ballet; have not scheduled lumpectomy, as I was told I could wait 1 or even 2 mo.  As I said in my other thread, I am seeing oncologist, breast specialist 2nd opinion, and radiation oncologist before deciding treatment plan, not in the flurry of emotions and pushed treatments after lumpectomy.  I'm a planner.  I've read that how this is initially treated makes all the difference in further treatment, possible recurrances, etc.  I'm trying to gather, from all I read, what to ask for in the lump path report; molecular biology of my tumor, etc., etc., to get MY chance, not just the chance of recurrance,  which will help me decide what other treatments to accept, or not.  It's like a full-time job doing all this, but I have to do it right.  Have pages of notes to re-write, and too much info to remember everything, but will try.  Was not pleased that my biopsy had to be sent on to SF to rule out micro-invasion, less pleased that they said this "abnormality" was likely introduced by the biopsy itself (but honest).  They ruled it out for now, but only by saying "no uniquivacable IDC  was found".  Not reassuring, as that sounds like it's suspected, just not confirmed.  So do know I need to get this out of me sooner rather than later.

Beesie

Percy, I'm a planner too so I know exactly what you are going through. A tiny little spot and all of a sudden you are immersed in the whole new world of breast cancer and DCIS.

Don't worry about the path report saying "no unequivocal IDC was found". That's just typical CYA pathology (and imaging) wording. They often use wishy-washy wording. The important part to take away from that is the "no IDC".

As the others have said, with a small amount of low grade DCIS, the risk that surgery will uncover some invasive cancer is really low. You have to consider that the 20% likelihood of an upgrade to IDC after surgery is an average for everyone diagnosed with DCIS. That average includes lots of cases like mine, where there are large amounts of very aggressive DCIS. From what I can find, with my type of diagnosis, the risk of upgrade is probably more in the range of 40% - 60% - and sure enough, I did have a microinvasion hidden in the middle of all that DCIS. So if the average for everyone is 20%, and it includes cases like mine, that means that women who have a diagnosis that puts them at the other end of the spectrum, as yours does, must have a much lower risk than that 20% average.

Of course, anything can happen. But your imaging doesn't show anything other than this small area of DCIS, so even if some IDC is found, it's likely to be very tiny, no larger than a microinvasion. And as Annette said, that doesn't change much at all.

percy4

Thanks, Beesie, and all of you.  Helps me to not let my mind run rampant; keeps me grounded in this situation.  Can't really help anyone yet, as I don't know much, but really glad about the time coming, when I will know a lot, and can pay it forward to other women here. - P.