decision on lumpectomy vs bilateral mastectomy

oreo1231

I was diagnosed with dcis of cribriform type with intermediate nuclear grade. Woke up one morning with a 6 cm lump in my right axillary. And that was within 7 months of my last mamo. Biopsies done on right breast and right axcillary. I was told my cancer was very unusual due to the area in my breast was in situ but it "some how" found its way to the axcillary and it affected one lymph node under my collar bone also. I have necrotic tissue under my arm and is at a stage 3.  I have had AC chemo and now 8 more of taxol to go. My surgeon told me initially we can do a lumpectomy but am so anxious about what I should choose to do. Bilateral seems so aggressive but I have read so many reacurances in the same or other breast. Anyone out there have a similar diagnosis?

BarredOwl

Hi Oreo1231:

I was initially diagnosed with DCIS, and later upstaged to Stage IA, so my diagnosis was different. Due to widespread DCIS, mastectomy was indicated in my case.

It sounds like you were diagnosed with DCIS plus an occult primary cancer (malignant cells in nodes, but no underlying invasive disease located), and the occult primary was then determined to be an occult invasive breast cancer?

Occult breast cancer presenting with axillary metastases is an unusual presentation per NCCN guidelines. If you don't get any responses here, you may try posting in this thread also:

https://community.breastcancer.org/forum/137/topic...

It may be helpful for you to think about the DCIS separately from the occult disease.

Please consult your medical oncologist and breast surgeon and ask them to explain what the current National Comprehensive Cancer Network (NCCN) guidelines provide as reasonable treatment options (or recommend, if applicable) for a patient with occult breast cancer of your stage, nodal status, and presentation, who has received neoadjuvant chemotherapy.

Of course, it may be medically appropriate to depart from the guidelines in a particular case. If that occurs, be sure to ask for the reasoning behind it.

You may wish to ask about the relevant studies in occult disease that are applicable to your particular situation (having received neoadjuvant therapy) and that address your question. What regimens were studied? How many patients were included? Did they measure recurrence rates and breast-cancer specific survival? What was the length of follow-up? This kind of information may help you to understand the strength of the data behind any recommendation you receive for lumpectomy or mastectomy, as well as your level of comfort with the options.

With an unusual diagnosis like this, it would be more than reasonable to seek a second opinion on the next steps of your treatment plan.

I wish you all the best.

BarredOwl

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Age 52 at diagnosis - Bilateral breast cancer - Stage IA IDC - BRCA negative;

Bilateral mastectomy and SNB without reconstruction 9/2013

Dx Right: ER+PR+ DCIS (5+ cm) with IDC (1.5 mm) and micro-invasion < 1 mm; Grade 2 (IDC); 0/4 nodes.

Dx Left: ER+PR+ DCIS (5+ cm); Grade 2 (majority) and grade 3; isolated tumor cells in 1/1 nodes (pN0i+(sn)).