How big does margin need to be?

knittingPT

Hello all! I recently read the guidelines from ASTRO and SSO which say that as long as there are clear margins, no further surgery is recommended (i.e. size of margin not really indicative of recurrence rate). However, that was for Stage I and II. I am Stage III with lymph node involvement. I had margins 5 mm or greater around most of the tumor but the anterior margin is only 1 mm. I will be having radiation (and had chemo prior to surgery) The breast surgeon is recommending a re-excision to get a larger margin. I asked her about the above recommendations and she kind of hemmed/hawed and couldn't really cite any other info to support her recommendation. I will be discussing with RO and MO at appointments next week. I would love to hear what your docs have said and if you know of any other info that I could read ahead of time to help me understand. Obviously, if taking more out decreases my risk, I am willing to do it However, if it changes nothing, then I don't want to do it.

Hopeful82014

Hi, KnittingPT - I understand your concerns and this does seem to be an area of evolving standards. My surgeon goes for a minimum of 5mm on each side (which is going to be challenging on the side that's close to the chest wall....) I have read, however, that studies have shown that as long as no tumor cells are present on the inked margin that is sufficient. I can't find the bookmark for the article but there was a professional discussion of the issue within the past few months that you might find if you google enough. I don't recall whether that applied to Stage III, either.

I think a long, thorough discussion with all of your doctors is probably the best place to start, armed with your own research of course, and hopefully their statements will be supported by research, not just their preferences. Good luck with this.

knittingPT

Thanks, hopeful! Yes, the inked edge thing was what I was referring to. I think it is the ASTRO/SSO guidelines for Stage I and II breast cancers with lumpectomy and whole breast radiation. My surgeon said that it is evolving everyday and that when she first started as a surgeon, they went for at least 1 cm, then changed to being 5 mm, and that there is still a lot of variation surgeon to surgeon. I guess my concern is that I'm stage III so I'm not sure if those guidelines are really appropriate to guide my decision. I also had 5/10 positive nodes and from what my MO has told me before, I'm more likely to get recurrence outside of breast than in it. I hate making decisions.

GoodConstitution

Hi knitting PT, I have intermediate grade DCIS and have greater than 10mm margins on all sides except the posterior which is .5mm. My surgeon suggests after the third lumpectomy that a fourth to get better margins is advisable but is afraid I won't like the cosmetic outcome. I am a B cup. She recommended that I talk to a plastic surgeon for skin sparing mastectomy. However, two other surgeons said I was good to go to radiation. I have a second opinion scheduled for next week. I think they will leave it up to me based on the level of risk that's comfortable for me. I'll look forward to hearing your thoughts. My DR friends tell me to be aggressive because cancer is all of that! All my best to you.

GoodConstitution

Hi knitting PT, I have intermediate grade DCIS and have greater than 10mm margins on all sides except the posterior which is .5mm. My surgeon suggests after the third lumpectomy that a fourth to get better margins is advisable but is afraid I won't like the cosmetic outcome. I am a B cup. She recommended that I talk to a plastic surgeon for skin sparing mastectomy. However, two other surgeons said I was good to go to radiation. I have a second opinion scheduled for next week. I think they will leave it up to me based on the level of risk that's comfortable for me. I'll look forward to hearing your thoughts. My DR friends tell me to be aggressive because cancer is all of that! All my best to you.

GoodConstitution

This link talks about margins for DCIS so do you extrapolate that it applies to invasive cancer? I don't know but it's an I teresa study on margins:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1246064/

art15

My wife had a IDC with(ILC) Lobular Invasive Carcinoma/ or "Infiltrating Lobular Carcinoma" lump. I talked to the surgeon before and after, it's a good idea if a spouse or significant other is there, but I am not preaching...this was at Kaiser Perm San Diego/ Dr Herman/ he said when excising lymph nodes or cancerous tissue it's " mainly on feel... it's like an apple with a rotten spot, ... he said he "feels" the lymph nodes (they are in tissue)(after all the radiology, and a great "nuclear dept, which uses a redioactive iv to locate problems...)) as it is not clear where the surgeon "sees" , ...this is not an exact science by any means, Dr. Herman tried to take enough margin(lumpectomy) which was excessive because it was/is lobular(ILC) cancer... my wife calls him a butcher... surely he is/was NOT because she has not had a recurrence in that side- same breast...or on the excised margin... Dr. Herman told me(in waiting room after) if my wife did not want a mastectomy, he would do a lumpectomy, which he called "breasted conserving surgery" but these are choices we are faced with again after 7 years , but i think it is valuable to not only ( have a friend or spouse) to talk to these medical professionals, they are receptive, they want to put you at ease, they will explain why they have resolved to do a certain surgery this is my experience, but I have been semi-retired and now retired, so my acute understanding of our situation is probly not available to some people, this takes time, lots of time... hope this helps .. Art

knittingPT

Thanks all for your responses. Here's an update. Both my radiation oncologist and medical oncologist agreed with me and do not recommend any further surgery. So, I'm waiting to heal up a bit longer and then will start my radiation