New here- Surgery on Tuesday

Jen2222

Hi All. I’m new here and scheduled for a lumpectomy on Tuesday. Your stories and responses have been super helpful!!! I’m still learning and just curious if anyone had any special testing done other than the normal pathology, or had a second opinion pathology.

A little background info - my clip from the biopsy is useless because of a hematoma that moved it. All the genetic testing came back negative, but I am ER and PR positive. The biopsy report shows intermediate grade 2 dcis with a max tumor length of 2mm, and has a crib forming and micropapilary pattern. I don’t quite understand it all, but my doctor is not super concerned (as my surgery had been delayed almost 5 months since my biopsy because of the hematoma and a bleeding disorder was suspected). Radiation and tamoxifen are the plan of action after surgery.

One more question- how soon did you start radiation after surgery? I have an event that I really don’t want to miss and I have 10 weeks after surgery before the event. Hoping to be finished by then!

~Jen

SparkleTBD

Hi Jen!

I am in the same boat. DCIS grade 2, but bigger at 1cm. I had the hormone receptor test and genetic testing.

I did get a 2nd opinion and that MO gave me the same advice as my surgeon so I think the DCIS treatments are pretty standard.

My RO says that I can start radiation 6 weeks after surgery if my incision healing has been good. He planned for 4 weeks of RT for me, so that would put you at your event timing if you follow my same path. You would have to ask the RO to see what they have planned for your specific case.

Unfortunately I did not get good margins and have had two lumpectomies so far. I have another mammo and ultrasound this week to see if I need a third which is pushing out my radiation.

LivinLife

Welcome Jen2222! My situation is similar though different than yours - of course.... I was initially diagnosed with about 3 cm of DCIS on diagnostic mammogram. that changed to near 6 cm on MRI though a lot of that was non-mass enhancement. Mine was Grade 3 and with expansive comedo necrosis so quite aggressive. I could not have radiation due to having scleroderma so had to have a mastectomy, esp. given my age - I already made my mind up to have a BMX so that was not a problem... my surgeon told me a 58 year old woman could not have a lumpectomy without radiation....the Grade and comedo necrosis may have factored into that too? Anyways, the pathology after surgery showed 1.2 cm of DCIS, still Grade 3 and still expansive comedo necrosis. I also had the cribiform and micropapillary type. The remaining near 5 cm of stuff was a bunch of benign and pre-cancerous stuff....

Keep us posted on new developments... Best with lumpectomy and radiation when you get to that point.....

Jen2222

Thank you both for your replies! I am learning so much from your journeys. I even had to look up some of the terminology ;. I’m sure mine will have a new twist too. I thought dcis was supposed to be straightforward and easy to understand, but I’m learning it is not. I hope I will have an update to give you, but unfortunately they may not even find the area of dcis. The surgeon said she would not be able see it during surgery and without the clip she can only base it on previous mammos and make a good guess of the area to be removed.

Thank you again for taking time to respond. Every story I read I am shocked how many different versions of dcis can happen.

SparkleTBD

how did the surgery go? Im surprised the surgeon cant use a localization technique to find the lump via the same way it was seen(MRI/ultrasound/mammo)?

Jen2222

Surgery was much easier than I expected! And I was so lucky that I ended up being able to get the 2nd covid vaccine 2 weeks prior to surgery.

The area of dcis was along the chest wall and in an area that was hard to see on a mammo. After the clip moved (from the biopsy hematoma) they could not find the target area anymore, eluding to most of the dcis being removed from the biopsy. The doctor said that was good and bad - good if it’s gone but bad because she cannot say with 100% certainty that the lumpectomy was done in the right area (however, she felt pretty confident). I have not had an MRI and wonder if that would show more?

I meet again with the radiologist soon to discuss next steps - most likely will be the usual 4 weeks. Plus, I will be restarting tamoxifen (had stopped for additional bloodwork).

LivinLife

That's unbelievable Jen2222!!! Not heard that one before though I'm sure you're not the first or last.... Please let us know what the radiologist says.... Interesting about DCIS removed during biopsy... amount... My initial size of DCIS was 3 cm. Then 1.5 cm or so was removed during biopsy. Another 1.2 cm during surgery - so I guess my original size was the initial 3 cm. I probably should change the size in my subscript. I wondered about this for quite some time and what you say makes sense of this....

Beesie

Jen, if the DCIS was hard to see on the mammogram, I'm surprised that you were not sent for an MRI prior to surgery. Given that the clip moved and the surgeon was operating with no guide, I think an MRI now, prior to starting rads, would be advisable. Hopefully it doesn't find anything, but if there is more DCIS in there, you want to know.

What was the estimate of the size of the area of concern originally noted on your mammogram report? And how was the DCIS found? Did the mammogram show calcifications? I'm asking because it's unusual that a mammogram would be able to spot a tumor that is only 2mm in size. What does happen sometimes is that a tiny 2 or 3mm area of DCIS might be found in a larger area of calcifications, which turns out to be partly benign and partly DCIS. The 2mm sizing from the biopsy report of course only reflects what was retrieved by the needle during the biopsy, which for most of us is not at all reflective of the total size of the tumor or area of DCIS. However in rare cases with small tumors, the entire malignant area might be removed during the biopsy - it sounds as though your surgeon thinks that might have happened in your case. But still, I think an MRI to confirm (as much as any imaging can) that nothing is left would be a good idea.

With pure DCIS, size doesn't factor into staging and usually doesn't factor into treatment recommendations (although rads and/or Tamoxifen might not be pushed as hard when the area of DCIS is very tiny and the surgical margins are wide). But whether for DCIS or invasive cancer, the final tumor size is calculated as the sum of all malignant areas retrieved though all biopsies and surgeries.

Tudi

I am having a lumpectomy next Tuesday and there is a hematoma .9 cm at my biopsy site from having the biopsy almost six weeks ago. My DCIS is estimated 3 mm. Will the surgeon remove the hematoma or drain it first? Should the surgery be delayed until the hematoma is gone? Has anyone undergone a lumpectomy with such a large hematoma in relation to the size of the DCIS

eviec1

I had two hematomas at the time of my lumpectomy - one was quite large. Didn't delay my surgery at all and both taken care of during the surgery itself.

Tudi

Thank you so much for your response. I feel relieved knowing someone had the same issue as mine and the hematoma was removed during surgery with no problems. I am glad I joined this community today