Mom Just diagonsed...

dcramirez1

Hi All. Just got back from oncologist to go over core needle biopsy results for two lesions in my mom's left breast (both .6cm).. came back with:

FIrst Lesion:

• apocrine DCIS, nuclear grade 2-3 with luminal necrosis.
• calponia and p63 utilized for interpretation
• ER,PR,AR, and K1-67 pending

Second Lesion:

• apocrine DCIS
• can not exclude mico-invasion

Not entirely sure what all of this means and how it it affect her treatment options. Onc would like to do lumpectomy with no chemo/radiation. Any info would be greatly appreciated.

Thanks so much.

Annette47

Essentially, based on what I’m seeing, there would be no reason for chemo, and depending on her age and other factors a lumpectomy without radiation might be fine (radiation would almost certainly be recommended in a younger patient, but with older women it is more acceptable to skip it). The only thing is that the core needle biopsy only takes a tiny sample, and in some cases there is more/different there than shows up on that. For example, if there is a larger invasive component than was identified by the initial biopsy, that might change things, but that doesn't happen all that frequently (I believe it's around a 20% chance). If the diagnosis remains DCIS, even with a micro-invasion, then chemo would not be recommended.

The only other issue that might preclude a lumpectomy would be the location of the lesions and whether it would be possible to remove both with large enough margins and still have an acceptable cosmetic result. My mother had a similar diagnosis (although she did have confirmed invasive cancer in one of the lesions), but due to the location of the two lesions and the fact she was not well-endowed to begin with, a mastectomy was recommended as it was felt that a lumpectomy would not leave enough breast tissue for an acceptable result. She did not have to have any further treatment though.

magiclight

As you can see from my description of surgery I had BLM however, after the MRI biopsy showed IDC in R breast, when they did the mastectomy there was no evidence of disease. Looks like the biopsy removed the entire cancer. What a surprise and I sure wish I had could have know that prior to surgery. It seems one must be prepared for a myriad of events.

Annette47

Magic light - I had a similar experience. No residual cancer was found during the lumpectomy - the core needle biopsy had gotten it all. It can definitely go either way (it gets it all or it gets only a tiny portion of it). There’s really no way to be sure until after the surgery.

dcramirez1

Hello. Thank you both for your responses and insight as it was helpful.. I hope you're both recovering well!

dcramirez1

Hi again. So my mom's initial biopsy came back with DCIS but micro-invasion was not ruled out. When do doctors test for mico-invasion? And if it turns out that there is micro-invasion, will doctors test sentinel lymph nodes? Thanks for any help in advance once again.

mustlovepoodles

Yes, they will very likely test a sentinel node or two. They won't know anything further until they get the tissue out and look at in in pathology. Usually, that will occur with a lumpectomy. Sometimes DCIS will require a mastectomy if it's widespread. But since DCIS isn't invasive, a lumpectomy will likely be the course of surgery.

dcramirez1

thank you for your reply!

dcramirez1

Does anyone reading think it would be a good idea to get a sentinel node biopsy done along with lumpectomy? I believe they did a mammography on my moms axilllary lymph nodes and it was clear. If my mom's margins aren't clear enough, will they recommend SNB?

MTwoman

Margins wouldn't be the reason that they would recommend SNB. They would recommend re-excision to get good margins. I had my SNB along with my lumpectomy just so that we could avoid another surgery if possible. (turns out avoiding additional surgeries was not an option for me, but it wasn't due to going back in for nodes ) Although it could show potential problems with them, mammography wouldn't be able to give a definitive "clear" on nodes. DCIS, however, if it is pure DCIS, does not require lymph node evaluation as by definition, it stays within the ducts. If your Mom happens to have invasive disease, that is discovered by pathology of the tissue removed during lumpectomy, then it could be recommended to actually take out the sentinel nodes and also send them to pathology. I think that is could be smart for her to talk about this in advance with her team and get their input.

PNWBCHgirl

I had mine with my lumpectomy

Annette47

While some surgeons do them with a lumpectomy, there is no need to unless invasive cancer was already found via biopsy (as in my case which is why the SNB was done at the time of the lumpectomy). It comes down to whether the extra risks (another much more painful incision, increased risk of lymphedema) of the extra surgery are worth not having to possibly go back in another time.

With a mastectomy for even what is thought to be pure DCIS the SNB is done at the same time because once the breast is removed, there is no way to identify the sentinel node. With a lumpectomy, if invasive cancer is found, they can go back and do it as a separate procedure.

dcramirez1

Thank you all for your responses. We have an appointment with a breast surgeon today so this is really helpful.

dcramirez1

Hi again. Reviewing my mom's blood work and her CEA is "high." On 12/8 it was 3.8 ug/L and on 2/7 it was 4.3 ug/L. Standard range says CEA should be 0.0 - 3.0 ug/L. Should we be alarmed at this? From what I was able to research on the google machine is that CEA is primarily used to help diagnose intestinal, rectal and breast cancers.

Also, Ki-67 tumor cell proliferating index came back as 7%. Is this good? Thank you in advance for all the help and support.

dcramirez1

Hi Everyone. It's been a little bit since I've posted. So, my mom went ahead and got a simple mastectomy w/ sentinel node biopsy. Three sentinel nodes were pulled and they came back clear. Pathologist was a little worried about some weird cells in one of the nodes so he did staining test and it came back clear . Got off the phone with the surgeon today and the breast had other areas of cancer but all DCIS with no invasive component.

Just had a few questions.... what happens next? Should she follow-up with her oncologist?

MTwoman

Hi dcramirez, glad your Mom's nodes were all clear and there was no invasive component to her DCIS, that is great news! There are architecture types of DCIS that are more prone to be multi-focal (mine was too) and mx is then recommended, but since your mom went ahead and did that anyway, she should be done with surgery (except for any reconstruction). The next step depends on whether her DCIS was ER+ or PR+. There are options of Tamoxifen or an AI if her cells were receptor positive. If they were receptor negative (like mine) then she would typically be finished with her treatment phase. Radiation is also not typical, when the final pathology is DCIS with no micro-invasion and the surgical intervention was mx. There is usually increased monitoring (every 6 months instead of annually) of the remaining breast tissue (if she got umx instead of bmx), for several years. Hope this answers your questions! ((hugs))

dcramirez1

thanks so much

kate_ostin

I am very disheartened about the news. I wish you to overcome all the problems.