Anyone have close margins with DCIS and go back for re-excision?

caligirl76

I am 38 and was recently diagnosed with Stage 2 invasive ductal carcinoma and DCIS (both are high grade) in the left breast. I had a lumpectomy three weeks ago. My margins came back negative in both areas and my lymph nodes are clear. The pathology report said the margins were .1 cm for the DCIS and .2 cm for the IDC. I got a 2nd opinion from a surgical oncologist and she felt my margins for DCIS were less than acceptable. I sent my slides to their lab and they found the margin to be less than .1cm.

Now I don't know what to do. I thought I was done with surgery and about to start treatment and now I feel like i'm back to square one and might need more surgery. I have an appt with my surgeon and radiation oncologist to discuss the new findings but I have no idea what they will say.

Anyone have a similar experience?

april485

I went back in for a re-excision for a "close margin" of less than one mm. My RO said she would not allow me to enter the clinical trial I signed up for (partial breast rads) if I did not have larger margins of at least 5mm each side so back I went. It was fine..just a pain in the butt really. Now I have nice large margins with closest being 10mm and that is a very very good thing as margin size can predict recurrence sometimes. Best to you whatever you choose to do. 

Nancy2581

interesting - one if my margins was very close - .8 mm and I did not have to do a reexcision. My pathology said margins were clear

Nancy

april485

Nancy, .8mm is a good sized margin actually. Had mine been that, she would not have re-excised me. The RO likes .5mm, but would accept anything over .4mm but mine was less than .1mm!

Edited to add tha my tiny 1mm margin was also clear...just too close for comfort for the partial breast rads trial cause they pin point the rays and give me very high doses 2X a day for a week so it had to be big enough so that the rays got it all since it was not whole breast rads.

Nancy2581

oh thanks April because I always thought .8mm was awfully close, but I guess not.

Jelson

there has been new guidance on the issue of margins - essentially size doesn't matter as long as there is A MARGIN. this piece on BCO explains and references the studies.

http://www.breastcancer.org/research-news/20140402

molly52

Sorry to hear that. Same thing happened to me. Just when you think you are moving on, they throw a wrench in your plan.

I am 9 years out from my diagnosis. I did have the second surgery and got clean margins.

In the short term it is hard to hear, but 9 years later the only thing that really matters is being whole and happy.

I think "clean margins " is subject to "professional opinion ", so does vary amongst medical professionals.

In my opinion, it was worth it to follow my surgeons opinion, so I could know I did everything I could. Like carrying an umbrella so it won't rain.

MoJim

I was just diagnosed w/ DCIS about a month ago. My yearly mammogram picked up the clusters of micro-calcifications & a stereotactic needle biopsy confirmed cancer. My lumpectomy is scheduled for Nov. 19.  I, too, am worried about getting clean margins as I don't want to go back for a 2nd surgery. I have heard numerous women on another site that had this happen to them. I don't know my stage or grade at this time. Does that come after surgery & the pathology report comes back? They've already told me I will require 6 to 7 weeks of radiation post-op.  My husband has 4 different cancers, so this was one more cancer we didn't need.....

Moderators

MoJim, so sorry that you are confronted with another cancer in your family

We are just adding in a link to a section on the pathology report Pathology Report

Some tests are done after the initial biopsy, and others after the lumpectomy. Typically, and unfortunately, you'll have to wait for some of these tests.

This page may also be helpful to guide you: Diagnosis

We're all here to help guide you through the process.

Gentle hugs,

The Mods

PoohBear-61

Hi caligirl.......

I was 46 at diagnosis ...

. I was not recommended for a re-incision with a 0.4MM margin after my lumpectomy. According to my surgeon this is a clear margin and no reincision was recommended. Apparently the new margin rules ARE "If nothing is touching the inked edge ...its a clear margin" . I found a few articles...that i will attach that discuss this subject.

http://www.breastcancer.org/research-news/20140402

http://thecancermd.com/2012/02/01/second-breast-cancer-surgery-required-for-positive-margins/
http://www.nytimes.com/2012/02/01/health/repeat-breast-cancer-surgery-guidelines-found-unclear.html?_r=0
http://www.cancerworld.org/pdf/9184_pagina_12-16_Cutting_Edge.pdf

http://www.cap.org/apps/cap.portaL?_nfpb=true&cntvwrPtlt_actionOverride=%2Fportlets%2FcontentViewer%2Fshow&_windowLabel=cntvwrPtlt&cntvwrPtlt%7BactionForm.contentReference%7D=cap_today%2F1012%2F1012b_lumpectomy_surgical.html&_state=maximized&_pageLabel=cntvwr

proudtospin

I do not know my actual numbers but did end up with 3 lumpies till the surgeon and my RO were cool with the margins
but all is fine and I am 6 1/2 years out and all fine

DCIS with some microinvasion but I did have one of the best BS in the state~~

canuckgirl

Hi Caigirl -

I am 49 at diagnosis with 9 mm DCIS Mixed Grades 2 and 3.

I also had close margins which were clear.  Closest was 1 mm and even though my surgeon gave me the all clear, my RO said hmmmm ... maybe larger margins would be better!  So I decided to listen to my RO and went in for re-excision.  The surgeon took out a further chunk that was 3.5 cm x 2.5 cm x 1.3 cm and path report came back stating:  benign breast tissue, negative for malignancy.  I'm about to start rads in 10 days ..... second surgery was a breeze - I highly recommend doing it if it will ease your mind as it has mine.

Dogsneverlie

Hi MoJim,

I had two stereotactics (one was close to my chest wall); it's challenging with the type of DCIS you and I both have because mine was not a "LUMP" but clusters like you describe. Most likely they will use the wire to guide for the surgery but yes, my margins did not clear and I went in for a second lumpectomy and then 30 rads.

I have found personally, the best way to work thru BC is one step at a time. If you get too far ahead of yourself, you will drive yourself crazy. Focus on health and your upcoming procedure/doctor appointments and try not to think past them.

Wishing you all the very best - please keep us posted and remember we are all here to support you and your decisions.

april485

Dogs, about 99.9% of all DCIS is microcalcs, not a lump (once in a blue moon it is a lump) so the majority of DCIS is a blind surgery which is why they make us have the wires put in so the surgeon has a place to cut! But, even though I had those clear margins, with my type of rads, they needed good sized ones so they could literally pin point the rays cause I had partial breast rads only in the area of the lumpectomy so it was imperative they did it again. I think Rad Oncs like larger margins period as evidenced by so many re-excisions. But my margin was for sure too close for my type of rads.

AndreaJ50

Hello. Welcome to the club no one wants to join.

I find it interesting to hear how the guidelines for margins have changed.

I had my first lumpectomy Dec 2013, but had two reincisions in Feb 2014. I am glad they didn't settle for less than the 2mm guideline at the time because they found multi foci malignancies in the second surgery.

I was able to have a third reincision (that came back clear) because as I put it "I have plenty to work with".

The initial lumpectomy (and lymph node removal) was the hardest of the three surgeries by far. The last two I insisted on twilight sedation (propofil) because of my severe reaction to general sedation.

Looking back, nearly a year later I am so glad I had larger margins.

Wishing you all the best!

Take care,

Andrea