close margins for both invasive and in situ tumors

ginafish

I've been diagnosed with invasive ductal cancer grade 3, stage II. Estrogen and progesterone positive, her2 negative. I just had a lumpectomy and the pathology reports indicate also ductal cancer in situ with very close margins (the closest being 0.8mm). The closest margin of the cancerous tumor is 0.6mm to the margin. This seems to close for comfort to me. At this point I'm wondering if it makes more sense for me to go back and just have a mastectomy rather then clean up around the lumpectomy. I guess I am afraid that if there were pre cancerous cells in this sample they could be elsewhere in the breast. Does anyone have any ideas, input or any information on my situation???

inks

I had close margins on my mastectomy (as well as bunch of other stuff) so I got radiation to take care all of that. Unless your surgeon thinks you should do another lumpectomy to clean up the margins then radiation should take care of whatever you have elsewhere in your breast. But if you decide on mastectomy ask if that would mean no radiation, since radiation may affect your reconstruction.

april485

I had to go back in and have my margins shaved BEFORE they would let me have rads. My RO said that the best results come with wide margins so I went back in and the BS shaved the close margin (1mm!) and in fact shaved around all of them and now all margins are over 1cm in size so am confident that I have gotten it all. The second lumpectomy was much shorter ad easier than the first one and recovery was faster. The only thing I didn't like was the size of the scar is larger now but for nice wide margins, it is an acceptable trade off.

Mastectomy is very serious surgery. Think about your options and then make the best choice for you.

Lou10

Tough decision. After reading Bessie's post (below), I've edited this to remove my friend's story as I certainly didn't intend it as a horror story. Bessie has provided some research information, which is helpful. I'm glad you're thinking about these issues, gathering information, and considering what is right for you. Good luck.

Beesie

gina, that fact that your surgery uncovered some DCIS in the area of your IDC is nothing to worry about.  About 80% of women with IDC are also found to have some DCIS.  This is because in most cases, IDC develops from DCIS.  So it's not unusual that there might be some DCIS left as part of the tumor, in addition to the IDC.

As for having narrow margins, this too is not unusual.  About 25% of lumpectomies require a re-excision to get clear margins or to widen the margins.  In most cases, the surgery is quick and easy and successful.  Of course there will always be exceptions and horror stories (as per Lou's friend) but you shouldn't make your decision based on what happened to someone else, and you shouldn't make your decision based on a 'worst case scenario'.  Because there are 'worst case scenarios' with mastectomies too.  You should make your decision based on what's right for you, and based on the advice and recommendations of your doctors. 

At this point, have your doctors said anything about the margins, or is this your concern, in advance of talking to your doctors?  The question of what is an 'acceptable' margin varies a lot, depending on the doctor.  It's a matter of opinion as much as it's a matter of medical science and medical research. Most doctors tend to want 1mm, some want 2mm.  But many are fine with smaller margins.  In fact an analysis of margin size research by the American Society for Radiation Oncology and the Society of Surgical Oncology has led to a recommendation that a margin should be considered acceptable so long as there is no ink on the tumor.  In other words, as long as the IDC or DCIS is not right at the edge of the removed tissue (the edge is marked with ink), the margin is fine.  So this would suggest that based on these guidelines, your margins are fully acceptable.  Your own surgeon and radiation oncologist might not agree, but those are the latest margin guidelines. 

Here is the write-up about this from BC.org: 

New Guidelines Say Lumpectomy Margins Can Be Small as Long as Tumor Has No Ink on It