All cancer removed in biopsy....how do I know how big it was???

eveldon

I had my second visit with my medical oncologist today and she recommended no chemo.  She could tell I wasn't completely comfortable and referred me for a second opinion.  I am fortunate in that there was no cancer found in my lumpectomy at all--just DCIS--but the original pathology was not pretty.  Grade 3 KI>65%. I am trying to gauge how they can define whether it was microinvasive or not.  I have the original pathology and it is not specified as a percentage.  It was mixed IDC and DCIS along with fibroadenoma.  There were 14 cores taken and each had a diameter of 0.2cm so that is 2.8cm of tissue removed then along with another 1.5cm at the lumpectomy. I am happy to get more oncology opinions but I hate being in this gray area.  I feel crazy for wanting chemo/Herceptin but I know I have only one shot at knocking this out.

dlb823

I don't have your dx, but absolutely get a second opinion, preferably at an NCI-designated cancer center, where they see the most breast cancer, so logically have the most experience to draw on for any given subset of patients.  Here's a list of NCI-designated cancer centers:  http://www.cancer.gov/researchandfunding/extramur...

Good luck!   Deanna

eveldon

I don't know why my dx isn't showing because I did make it public...

lintrollerderby

For some reason, signature profile lines never show for the very first post in a thread. They will show if you post in the subsequent posts. I think it's a glitch.

lintrollerderby

I agree that an NCI Cancer Center or Comprehensive Cancer Center is the way to go. I was treated at one and wouldn't have had it any other way.

If the invasive component is smaller than 5mm, chemo and Herceptin is not usually recommended. I don't know how large the invasive portion was, but maybe that's a question to ask.

Moderators

lintrollerderby,  You are correct - signature profile lines do not show up in the first post of a thread. It is a glitch and our tech team is aware of it. Thanks for the clarification. eveldon as you can see your diagnosis did appear in your signature line in your subsequent post. The Mods

lintrollerderby

Thanks, Mods!

Ridley

eveldon. Has your surgeon gone over your path results with you?  The reason I ask is because I'm wondering if all of the samples showed cancer, or just some?  I would think they should be able to give you some idea of higher size of the invasive component.  I agree with a second opinion - I had my pathology reviewed by a second hospital. Was  helpful to me.

Good luck

kcat2013

eveldon  My surgeon had a second opinion done on my surgical pathology because the first report didn't show the IDC that we knew was there from the biopsy.  It only showed DCIS.  Second path report did find the IDC.  

Kendra

eveldon

Just to update...thanks to all for the kind responses. My future visits are going to be with the center associated with NCI. My surgeon (who I loved) was at another hospital and the first oncologist was there as well.  

I really liked the second oncologist more than the first.  She was much more clear and was interested in my questions.  When I asked her how they knew how big the original invasion was she kind of chuckled and said "well we don't". Which is exactly what I was thinking.  She then explained that the tissue missing from the lumpectomy due to the biopsy is never considered when making staging decisions.  That made total sense to me.  Didn't help me at all with my decision but at least I understand the process better.  I am going to see one more oncologist.  I am anticipating another no to chemo.  I have an appointment with a rad onc the next day and expect to be proceeding down that path by the end of the month.  

@ Ridley--I am going to do what you recommended with the next oncologist.  She is at the center where the original pathology was processed and I think it will be easier for her to access the info.

sandee107

I was in a very similar situation as you six years ago. They also did not find any cancer in my lumpectomy. The size of the cancer in the biopsy was less than a cm and was also mixed. DCIS & IDC. I had radiation and was on Femara for 5 years. My onc did not recommend chemo or herceptin. I recently read a study of very early small Her2+ tumors showing a low risk of recurring if no chemo/herceptin was given. I just cant remember where I saw it. Maybe a web search will find it. Good luck whatever you decide.

Sandee

pattij

i was just borderline for the Herceptin and chemo treatment, stage 1, grade 3 nottingham grade 9 k67 score was 87%, 4 sentinel lymph nodes negative, no lymphovascular invasion, 0.5cm idc (5 mm), 0.1cm dcis (1 mm)...  just made it to the 0.6 cm size recommended fro treatment, i am very glad i got the treatment the aggressiveness of this cancer scares the hell out of me....just finished round 6 of TCH chemo treatment now i have the 9 months of herceptin alone and finish up reconstruction

Coblndie

So basically you had a biopsy, they informed you that you had cancer, went in for a lumpectomy and none more was found? Is that right? 

eveldon

Yes.  That is exactly what happened.  I finished radiation on 9/8.  Saw three oncologist and all recommended no chemo so that is what I am doing.  Its a little nerve wracking now to be done and worried that I am not actively doing anything.  All good tho so far.