Is DCIS always present with IDC dx

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patsfan
patsfan Member Posts: 72
edited June 2014 in IDC (Invasive Ductal Carcinoma)
Is DCIS always present with IDC dx
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  • patsfan
    patsfan Member Posts: 72
    edited September 2009

    Hi everyone.

    Couldn't seem to find an active thread that hit on this so decided to start a new one.  Just got my pathology report back yesterday and now am quite confused.  I have already done chemo and just had unilateral mx. My dr didn't go over my path report with me, other than to say it was great news, no node involvement and clean margins.  As i read it I see "DCIS and microinvasive ductal carcinoma without axillary metastases."  Since the beginning of this whole nightmare, I have had a mammo, an ultrasound, an MRI, chemo, another MRI , and then mastectomy. My drs recommended lumpectomy because the lump shrunk so much from chemo.  I opted for mx because I was hoping to avoid radiation.  Never once has anything said DCIS.  Could this be a spot that wasn't picked up on other tests or is DCIS always present with an IDC dx?

    Gayle

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  • KerryMac
    KerryMac Member Posts: 3,529
    edited September 2009

    I don't know but I had it. 10-15 % DCIS, the rest IDC.

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  • LRM216
    LRM216 Member Posts: 2,115
    edited September 2009

    Gayle, perhaps some one will come along and be able to fully answer your question.  I was diagnosed from my biopsy with a 1.2 cm IDC, triple negative cancer.  Had a lumpectomy and then two weeks later needed a re-excision for 2 clean margins, which on the surgical pathology they found DCIS in situ in those two unclean margins.  Had the re-excision on the April 8th and all margins were clean.  Didn't know about the DCIS until the dirty margins.

    Linda

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  • thenewme
    thenewme Member Posts: 1,611
    edited September 2009

    Hi Gayle,

    The way I understand it is that IDC is a progression of DCIS.   DCIS is ductal carcinoma in situ (located completely inside of the duct).  IDC is invasive ductal carcinoma (it has broken out of the duct and started to invade).

    It seems that when we have IDC, they don't always bother to mention the DCIS since it's a given.  If you have DCIS you wouldn't necessarily have IDC, but with IDC you would necessarily have DCIS - does that make sense?

    I'm sure someone will correct me if I'm wrong, but hopefully this helps!

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  • patsfan
    patsfan Member Posts: 72
    edited September 2009

    Thanks for all your imput.  I thought I had a pretty good handle on my dx and protocol.  But I guess this is just like the whole rest of the journey so far --just when you think you know what to expect, WHAM you get something else thrown at you!  So if you have IDC and a lumpectomy of the tumor, then what becomes of the DCIS?  My sister was diagnosed about 3 weeks after me with DCIS and they did a lumpectomy with radiation, but no chemo.  If I had opted for a lumpectomy as recommended, would I then have dirty margins and ended up having a mx anyway?

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  • thenewme
    thenewme Member Posts: 1,611
    edited September 2009

    I sort of picture it as a garden hose as the duct.  The DCIS starts as a spot inside the garden hose.  If they do a lumpectomy and cut out the section of garden hose where the spot was located plus a bit more for clean margins, it's good.  Some people have "multifocal DCIS" - multiple spots inside the hose, so the surgeon has to be sure to get them all, either with lumpectomy or mastectomy.

    If it has progressed to IDC (the spot inside the hose bursts out of the hose) like a golf ball attached to the hose, then they need to cut out the section of the hose as well as the golf ball.  Assuming they cut out the golf ball plus enough of the hose for clean margins - again it's good.

    Mastectomy chops the hose off way back at the faucet.

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  • LRM216
    LRM216 Member Posts: 2,115
    edited September 2009

    YOu would have had to have a re-excision to remove the dirty margins, or a mastectomy.  I had the re-excision and got clean margins; however, since a lumpectomy is breast saving surgery, there are just so many times they can go in to re-excise.  My onc said if she did not get clean margins on my first re-excision, she would only do a mastectomy after that.  Also, my onc described the dcis in the margins as resembling sand.

    Linda

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  • patsfan
    patsfan Member Posts: 72
    edited September 2009

    Thanks so, so ,much for talking me through this.  I think I am glad I opted for a mastectomy!  I had chemo before any surgery to try and shrink the lump as it was 4 cm.  The plan at the time was breast saving surgery.  My cancer responded so well to chemo, that my onc and surgeon thought I should have a lumpectomy.  I didn't want to do radiation, so I took a chance with a mastectomy, that my nodes would come back clean and not have to have rads.  No rads for me!!  I guess I am still wondering why my docs never told me there was more than one spot that had to be removed. 

    Gayle

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  • thenewme
    thenewme Member Posts: 1,611
    edited September 2009

    I had a mastectomy too, and am happy with my decision.  My lump was 5cm and I didn't have chemo first, so lumpectomy for me wasn't a good option.  I did end up having radiation too, but I'm okay with that too. That's awesome that your tumor responded so well to chemo!  

    When you say more than one spot, do you mean the IDC spot and the DCIS spot?  If so, I think it's because they really are one unit-the IDC is just the invasive extension of the DCIS, so they really aren't separate spots.  DCIS is the "seed" that IDC grows out of.

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  • Beesie
    Beesie Member Posts: 12,240
    edited September 2009

    Breastcancer.org has a great series of drawings that explain how DCIS progresses to become IDC.  This helps explain why DCIS is usually present when IDC is found.  But as thenewme explained, because IDC is the more serious condition and treatment decisions are based on the amount and grade of the IDC, often the DCIS is not discussed when you're told about your diagnosis (although it should be noted in the pathology report).  If you have both DCIS and IDC, the DCIS only becomes significant if it's right at the margin, as in Linda's situation, because in that case it needs to be surgically removed.  Other than that, whatever treatment you are getting for the IDC will be sufficient to address the DCIS as well.

    Range of Ductal Carcinoma in situ

    You can find this picture and others here: http://www.breastcancer.org/pictures/types/

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  • LRM216
    LRM216 Member Posts: 2,115
    edited September 2009

    Great post, Beesie.  Thank you.

    Linda

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  • patsfan
    patsfan Member Posts: 72
    edited September 2009

    Thanks for all your input.  I guess I was just a little freaked out when I read the pathology report and thought it was in more than one place. My only other pathology reports are from a biopsy and a sentinel node retrieval, so I guess that is why it was never mentioned.

    Gayle

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  • jillyG
    jillyG Member Posts: 401
    edited September 2009

    I had IDC 1cm lump, then had mastectomy.  The pathology came back that I ALSO had DCIS throughout the breast.  This had never been mentioned before and we would not have known about it had I just had the lumpectomy.  My surgeon said 'you made the right decision with the mastectomy because there was other areas of DCIS throughout the breast".  Scary.

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  • patsfan
    patsfan Member Posts: 72
    edited September 2009

    Both my surgeon and oncologist encouraged me to do lumpectomy.  I wanted to avoid radiation, and now I know that was the right decision.  I would have always worried that there was more there.

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