Two Positive margins after mastectomy and neoadjuvant chemo

Marmotka

Hi everyone,

I had 5 months of chemo with an excellent response on my multicentric tumors and lymph nodes prior to my mastectomy and SNLB. However, the pathology report came back with two margins positive for IDC (towards the collarbone and flank) in the breast specimen. But the main surgeon told me she has taken out all she could...I was a bit taken aback so didnt ask the logical questions. Not sure whether it means I have to live with this? I know I will be getting radiation as I had 3 of 9 positive lymph nodes but is radiation also the only solution for positive margins? I'm really afraid this means I will be at a very high risk of recurrence.

My MO and RO dont seem to be in a hurry to discuss this as I'm recovering from my MX but it's hard not to be really worried.

I would appreciate knowing from similar cases as mine. Thanks!

MinusTwo

Marmotka - I think it's time for you to take all your reports & images and get a second opinion. Sometimes they can do a re-excision.

Since I didn't have a pCR from neoadjuvant chemo, The tumor board at my hospital determined it would be beneficial for me to have another batch of a different chemo after surgery before rads. Even though the surgery showed clear margins. I don't know if that's common & I sure didn't like more chemo - but it's letting me sleep more soundly.

MSS_27_72

Hi there! Misery loves company! I am 5 mos s/p bilateral mast for ILC left breast- 2.6 cm with two positive deep (chest) margins in my left breast after mast 02/2020. The surgeon said cancer was old- missed for years on my yearly routine mammo/ULS for dense breasts and location 3 fingers below my L clavicle. The pathology was also positive for multi focal and LVI and given my pre- menopausal status I was put before two tumor boards (MSK one of them) and both recommended Left PMRT clavicular/axillary/mammary nodes for 8 weeks which I completed May 8. I am going for tubes/ovaries removal and expander to implant switch out next month. I was 47 when dx Dec 30, 2019 (worst holiday ever and had “all clear” mammo and ULS Sep 2019) and have two kids- 12/14 and am a single mother; head of household pharma executive. My oncotype was 13 so no chemo recommended as 100% ER/PR + and HER 2 neg; KI-67 20. I am on Tam since May 8th and will remain on this even after salpingoophrectomy for further assurance of estrogen elimination. I know our biology is different as I am ILC vs your IDC and LVI (which is perceived = to lymph involvement) but positive margins very rare s/p mast; less than 5% have positive margins so no good data to guide; but in my mind, our cancer was “unresectable” as margins involved so we still have cancer and idea of being “cured” is a stretch for me. I think we need to stay ahead of this with meds/science just like our sisters but with a bit more worry. I’ve read a lot of good pub med studies (mostly observational from Sweden) that support positive margins NOT being as big of a poor prognostic indicator for overall disease free survival as you would think; but I am glad I did the PMRT- skin burned but healed fine and have additional peace of mind in sterilizing these areas. Keeping you in my thoughts and prayers - please if anyone else positive margins s/p mast— share your experience as I would be grateful to hear. Hugs to all xx