Just diagnosed with Stage IIb

rleepac

Hello all! My first post here so I'll introduce myself. I'm 42 y/o (oops...43 today) and was diagnosed 3 weeks ago with Stage IIb IDC. I'll try to summarize my story and findings...I felt an abnormal lymph node in my right axilla back in October. GP sent me for mammo and ultrasound. 2D/3D Mammo didn't catch anything. Ultrasound found the lymph node and said it was normal size but didn't have a fatty hilum (suspicious). Radiologist recommended US guided needle biopsy. I happened to be seeing a hematologist/oncologist for low iron and I asked him to feel it. He had some choice words for the radiologist and instead recommended an excisional biopsy. General surgeon did an excisional biopsy and found a mass next to the lymph node so he removed both and it was a 2.1 cm malignant tumor with a micrometastasis to the lymph node. He ordered bilat breast MRI which showed nothing on the left. On the right there is another small bi-lobed mass in a different location with suspicious kinetics (rapid uptake with washout) and evidence of remaining carcinoma at the initial excision site - this matched the path report. The pathology report showed that he did not get clean margins, infiltrating ductal carcinoma with a modified SBR score of 7/9 (Grade 2). It was ER+, PR+, HER2+ with a Ki-67 of 40% (high). Surgeon says at minimum, he needs to go back in and get wider margins, grab a few more lymph nodes, and biopsy the mass found on MRI. But, having read everything I can find and being a healthcare provider myself (I think I know too much and it's hard when you're the patient!) - I believe the mass found on MRI is very likely malignant and he will end up recommending MX anyway.

Whew...that's a lot to take in!

I am 98% certain that I want to do a BMX with reconstruction. I don't know for certain but I believe I am of Ashkenazi jewish ancestry. I really don't want to do radiation but I'm hearing and reading that with any nodal involvement it's pretty much a given. Plus I don't know if there are any other nodes involved until they go back in. I already have implants which will have to be replaced with TE and then implants later but one doc has already said that having an implant 'pocket' already there should make the TE easier.

I don't really have a specific question but I'm just curious if there are any others out there with similar stats and maybe you could share/explain your choices? I have an appointment at a large teaching hospital with an impressive Breast Cancer Center on Friday so I'm hoping to have as much information and ammunition as possible before I get there!

ElaineTherese

rleepac -- I'm sorry that you've been diagnosed with BC. If I were you, I would wait for the MRI report and talk to your doctors before making any definitive decisions. For example, you note that you are triple positive (ER+/PR+/HER+). Typically, that means that you will undergo some kind of targeted therapy (Herceptin/Perjeta), and may have to undergo chemo. As for whether or not BMX + reconstruction is appropriate for you, only you can decide that. But, you will probably have to fit your BMX + reconstruction in with other treatments like chemo, targeted therapy, and/or rads.

I was diagnosed with a Grade 3, triple positive IDC that was considered locally advanced (5 cm. + one node tested positive for cancer). I underwent neoadjuvant chemo, which shrunk my tumor and allowed me to have a lumpectomy with no reconstruction. Because one node was compromised prior to chemo, I ended up having all Levels 1 and 2 lymph nodes removed. In February/March, I will have radiation for six weeks.

Good luck!

rleepac

Thank you Elaine!

I'm taking it one day at a time. So far, they are telling me surgery first and then off to the oncologist. However, that was from a local general surgeon. I'm going to a Comprehensive Cancer Center on Friday so they might say something totally different. Thanks again and good luck with your upcoming radiation!

vlnrph

Good job on getting yourself to a specialty center. I agree that it is difficult for a person in health care to be objective about their own treatment. At least we have a degree of comfort with the lingo/terminology!

Perhaps there would be an opportunity to get a genetic consult & fast BRCA test (I think some labs that don't do a full panel but focus on the most likely mutation can obtain results in a couple of weeks or less) and use that information to help confirm your decision.

Sounds like you already have a plastic surgeon: would free flap reconstruction be an option for you?

The primary similarities in our situations are that my IDC was not seen on mammogram - MRI picked it up and with another tumor, mastectomy was a given. My sentinel node looked clean during the procedure so I had DIEP. Upon completion of pathology where micromets were found, my doctor insisted on full axillary dissection. I escaped radiation because of the transplanted tissue which would have been damaged.

You are younger than I was at diagnosis: Happy Birthday Hopefully by this time next year, you'll be looking back and maybe logging on to share your experience with those who follow after us.

LizA17

I was triple positive node positive and MO & RO both agreed no radiation.

rleepac

vlnrph - Thank you for sharing.  Tissue transfer or flap reconstruction isn't really an option because I'm very thin and don't have much to spare.  Plus, I already have implants that I got in 2008 so there is already an implant 'pocket' there.  According to the first PS I saw, that will make the TE process a little less painful.  I'm waiting to see what the CCC PS has to say.   I'm praying that 'direct to implant' might be an option but I'll go with whatever the PS thinks is the best route to get the best looking fake breasts I can get.

 

LizA17 - Your stats look very similar to mine except I don't know if there are more nodes involved yet since they only took out the one that was right next to the tumor.  But that's nice to hear that you didn't have to do radiation!  For some weird reason, I'm more opposed to radiation than I am to the BMX...bizarre but I guess it's just how my mind works.

formydaughter

I went for BMX. My surgeon, PS and MO all agreed this was the best plan, given my age (40 at DX), the tumor being grade 3, the aggressiveness of the cancer, to achieve better cosmetic results (matching) with reconstruction, and to give me better piece of mind. I had BRCA testing immediately too. Ended up negative (thankfully), but played a huge role in ovary decisions. Knowing I had to have chemo for Herceptin, I opted to not have radiation. The docs were in agreement and PS glad this was an option since reconstruction after radiation is tough and sometimes can't be done. I did not have node involvement. This may be why radiation was not needed. But my understanding is that chemo gets all the cells everywhere. So I figured it would help prevent local recurrence. I'm not sure why they double it up with chemo for anyone having MX. Would love to know!