Invasive Ductal Carcinoma AND DCIS in same breast

Hi WordDoctor,

My case is the opposite of Marie's.  I was initially diagnosed with DCIS (I found the lump with a self-exam), then the MRI found multifocal IDC that did NOT show up on the mamogram.  Due to the mutlifocal nature of my cancer, I needed a mastectomy.  I chose a bilateral mx, although cancer was only on the left side.

Hi there,,,

I was first diagnosed with low grade dcis.  After an excisional biopsy they discoved a 4mm idc and a 1mm idc.  I had a second surgery to clean up the margins and had radiation treatment.

My last 2 breast mri's were all good.

Trust your surgeon!

Kosh

I had both Extensive DCIS and Multifocal IDC on my left breast. My PS and BS told me a lumpectomy would leave me disfigured because too much tissue had to be taken out. I chose a mastectomy on the left and right breast even though the right breast was healthy. This is such a personal decision. I have no regrets in choosing to have a bilateral mastectomy. I knew when they had to go back in to get clear margins a week after the mastectomies that I made the right decision for me. Good Luck.

I had breast cancer soup, DICS, LCIS and IDC (1.2 cm and .8 cm) in my right breast. After an inital lumpectomy, excisional biospy and snb, I wound up having a bilateral mastectomy after an MRI detected the second IDC, I had a bilateral because I didn't have recon and I wanted to be balanced.


A mastectomy was my only surgical option at that point because my cancer was multicentric. I wish I could have had a lumpectomy and kept my breasts, so my advice to you will biased.



I presume you have had a biopsy that has confirmed the area with DCIS. If so, I think you should talk to your surgeon about the cosmetic outcome if you had the two lumpectomies. In my case, I was very busty and my breast looked okay after the lumpectomy and excisional biopsy. You should also talk to your oncologist about the medical outcome of the multiple lumpectomies, if one surgery or the other is better from the point of view of your survival or recurrence rates.



The thing is that I think it is worth while to try and keep your breasts and the sexual sensations you get from them. Remember that one you have had a mastectomy you don't get a do over. Reconstruction may give you something that approaches a natural breast, but it is not the same.



It is a hard decision to have to make and one you have to make for yourself. Take the time you need to make your decision; don't rush into it, even if it means delaying your surgery.

I was initially dx'd with IDC, DCIS, ADH and LCIS but supposedly all in the same quadrent.  I desperately wanted a lumpectomy, so did MRI-guided core biopsies to be sure I could take it all out in one swoop.  It came back as multi-focal and my surgeon met with a tumor board to discuss my case.  They all unanimously decided that a mastectomy was my only logical option.  Lumpectomy would have removed more than a quarter of my breast and given me an unacceptable outcome.

My left breast is clear so I'm leaving it alone.    Surgery is tentatively scheduled for 10/19.  

Good luck in your decision - I know it's not easy.

Hi, Kat!  I'm waiting for the official, but my surgeon says yes, and I called my ins company and they said yes also.  But...I'll believe it when I get the approvals.  I cant do it until prob June 2010 because I have to heal from rads, so I guess the answer is...I think so?  I hope so!

As you can see, I think this dx is fairly common. I was originally dx with a 2 cm IDC tumor - mammogram, ultrasound and MRI all showed the same thing. After lumpectomy, two ducts of DCIS were discovered - another lumpectomy to clean up the margins showed another .7 cm IDC tumor and DCIS still up to the margins. I then had a unilateral mastectomy with tissue expander reconstruction. Had my exchange surgery to a silicone implant almost exactly one year ago.

Best wishes to you as you deal with so many decisions.

Hello,

I was DX with 3 cm IDC grade 3 and high grade DCIS, my surgeon said that the survival rate was the same with a lumpectomy/partial mastectomy with radiotherapy as a mx. I went with him. Figured he wouldn't recommend a more costly operation if he didn't think it was right and also wants the right sort of statistic. He's of the opinion that some DCIS never leaves the area/ change from stage 0 and that some women have, in his opinion, unnecessary ops.

Had to have a re-excision as margins were not clear, told v v aggresive tumour. If it comes back (expected possible in next couple of years) then I will have breast tissue for it to go in to otherwise it will go in to my chest wall which would be harder to deal with.

My surgeon is a breast recon specialist with an excellant reputation, he has done a wonderful job. Even though I have lost a small orange from my boob (32 D cup) you can hardly tell and I'm happy that my body looks almost normal - for a while at least - he's given me time to get used to the idea.

That's me.. I believe you should listen to your surgeon it's his job to do the best for you but you should also go with your gut feelings. You know you and you must be comfortable with what you decide . 

Good luck

Katie 

I too was first diagnosed with DCIS in 2005.  I had a mastectomy, but have been just diagnosed with IDC in the remaining breast tissue.  From what I understand now there is always some breast tissue left, had I known that then I would have checked my breast with the mastectomy.  I never did and neither was it checked at any of my mamograms.  I am a little confused by that.

Good morning all,

I am glad I have found a thread that is of personal interest to me.  Here is my history.  I found a huge "thickening" at 7:00 in my right breast.  Although it never showed on a mammo, even after it was confirmed by u/s, I was diagnosed with IDC, 3.5 centimeter tumor.  Three weeks after discovering the lump I had a lumpectomy with clean margins, no node involvement and no tenticles. 

My oncotype dx was 17, so I was heading toward treatment of radiation and arimidex, no chemo.   Then I asked for a breast MRI just to make sure the other breast was ok, since my 23 year history of mammos had been clear and we now knew I had a large tumor.  Results of the MRI showed "something" in both breasts.   After another surgery, we found atypical cells in the left breast and another primary in a different quandrant of the right brest, 11:00.   The new cancer was mostly insitu, only 10% had invaded and I think the tumor was 7mm.  

Now what to do???????????????  After seeing my oncologist, my radiation onc and my second opinion onc at Moffitt CC center it was agreed that going with chemo, rads and arimidex would have the same survival rate as doing a mastectomy.  My breast still looked "okay" so I decided to go that route.  The rad onc even said that if  I hadn't had the MRI, the other cancer would have been destroyed by the radiation and we would not have even known it was there.  My med onc at the time still said the mx was an option, but he said it was to take future worry and stress off my plate.  I decided to go forward with treatment and give myself more time.  I was fortunate that my chemo and rads were very doable and so far (6 months) I am ok on the arimidex.

Now, fast forward a year later.  Infact I started my chemo a year ago today...............happy anniversary to me.  I feel great, I look great and I am healthier than ever.  But now my med onc has brought the mx up again saying it would decrease my risk.  I went for other opinions and I am back to square one.  I am not having the mx and recon, at least for now.  If the stress gets too great, or worse I am diagnosed in the future, then I will go with the mx and recon.  I have read in the last few days the posts of all the recurrances and new dx after mx's.   There are never any guarantees.

So, the point of this long post....................................each of us has to make what we think is the best decisions for our lives.  I try not to second guess and just go forward.  I am trying to get a space on that line of women who never have to deal with cancer again after the first dx and treatment.  Hopefully I can get a space.

Healthy prayers for all of us.

Caren

I had lumpectomy for my IDC last week and received the pathology report today.  My surgeon didn't mention it but as I read it now, it says intermediate nuclear grade ductal carcinoma in situ in addition to the IDC.  I had clear margins so no more surgery is expected.  My surgeon says that the purpose of radiation is to take care of any additional cancer in the breast.  Still I would have liked him to mention this new finding.  Have appointment with medical oncologist in two days so will discuss with him. 

The "D" stands for "ductal."    IDS=Invasive Ductal Carcinoma  

I never felt a tumor either, rather a "thickening" of tissue (such as Caren mentioned, above) and only felt it after the ultrasound tech pointed it out.   Actually, it wasn't until she had me feel both breasts at the same time did I feel anything different on one breast.   I've always felt for lumps or bumps - never this odd thickening....

Dear WordDoctor,

You are right that waiting for the report from the lumpectomy and node biopsy is the hardest. Do ask the surgeon to tell you results from "frozen section" of the nodes if possible. They are available right after surgery.

I want the degree for here, not to go (upstairs!) :-)