Who recommended rads to you?

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CoolBreeze
CoolBreeze Member Posts: 4,668
edited June 2014 in Radiation Therapy - Before, During, and After

I had very close margins after mastectomy.  Under 1 mm according to my pathology report.  I saw my surgeon for the follow-up, but completely forgot to ask him if I needed rads.  He didn't mention it.

I will be doing TCH - should I ask the onc?  Who is the one who decides that?

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  • Mazy1959
    Mazy1959 Member Posts: 1,431
    edited November 2009

    Hi cool,

    My surgeon and med onc said I would probably get rads but the decision was actually made by the rads onc. Hugs, Mazy

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  • CoolBreeze
    CoolBreeze Member Posts: 4,668
    edited November 2009

    Thanks Mazy.  When did you find out?  I've never seen a radiation oncologist.  I can ask the onc when I see him next, I guess. 

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  • lexislove
    lexislove Member Posts: 2,645
    edited November 2009

    Everyone said I would need rads..lol

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  • CoolBreeze
    CoolBreeze Member Posts: 4,668
    edited November 2009

    I'd as soon skip it - maybe I'll let it get lost in the shuffle.  :)

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  • cbm
    cbm Member Posts: 475
    edited November 2009

    Hi, Ann.  My oncologist told me I didn't need radiation, so I guess he's the one who'd have said so if I did.  And I was opposed to radiation, so I was okay with that.

    Fast forward to the present.  I wish I'd had more of a debate over it.  I had one big lymph node, and those with one to three nodes who elect mx usually didn't used to get rads; lumpectomy with any nodes did.  Now, there is some thought (esp. among rads oncologists) that this hair splitting might be arbitrary.

    I know you had no nodes, and I don't mean to trigger a suggestion you didn't ask for.  But if it were me, I might ask for a consult just to see what the radiation oncologist might say he or she could do for me, and not do to me, and how, when and why.  You don't have to do anything with the info.  And your oncologist might benefit from the dialogue.

    You can get a lot of info on PubMed doing a search on mastectomy, radiation, nodes and a few other terms.  Nodes and margins are definitely two different things but I suspect your instincts are to make sure the discussion doesn't get lost.

    Warmest,

    Cathy

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  • bluedasher
    bluedasher Member Posts: 1,203
    edited November 2009

    My bc surgeon gave me a referral to a medical onc and a rads onc at the same time. I don't know if he would have done that if I'd had a node negative mastectomy. I think that either the surgeon or the med onc could give you the referral.



    Since the medical onc normally follows the patients longest, yours might also have an opinion on whether rads would be advisable in your case.

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

    Coolbreeze,

    For me - we didn't really discuss rads until near the end of my chemo.  Then the med onc referred me to the rad onc, who made the final recommendation for rads.  I had rads because my tumor was large, triple negative, and I had a suspicious IM node.  There seem to be varying philosophies about getting rads or not, but please don't let yourself get lost in the shuffle!  After chemo I think you'll finds rads much easier, but whatever you choose, be sure you understand and agree with the recommendations for or against it.  Hang in there and let us know how you're doing!  Take care! 

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  • cakeisgreat
    cakeisgreat Member Posts: 660
    edited November 2009

    I'm with Lexislove--everyone told me I needed rads.  When I had close margins, before my onc saw that the surgeon did do a re-excision to get better margins, she said, "now we have to depend solely on the rads killing anything else in there," so I think for me the rads were important.

    HTH!

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  • CoolBreeze
    CoolBreeze Member Posts: 4,668
    edited November 2009

    Thanks everybody, you have cleared it up. I had a mastectomy, and as Cathy noted, no nodes.  However, the path report did say:

    No intraductal carcinoma indentified at margins, although intraductal carcinoma is noted very close to deep margin (within 0.5 cm, and somewhat close to anterior soft tissue margin (within 1 mm)

    I don't know if that is something chemo will take care of or not, or if because it's DCIS and not any of the invasive tumors they found in me,  if it's necessary to consider radiation. I don't know waht an acceptable margin would be.

    I'm only concerned about rads because I am doing reconstruction.

    Next time I see the onc I'll discuss it with him.

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

    Do you already have tissue expanders?  Have you discussed it with your plastic surgeon? I have expanders in, and did radiation with them.  I finished rads in early July, and so far so good.  The bummer for me is that my PS wants to wait an entire YEAR from rads to do the exchange surgery, just to be sure any tissue changes/scarring/contracture is stable before the final exchange.  I hate the though of having these expanders in for so long, but it's really not that terrible, and it's better than rushing it and having complications later. 

    I bet you'll feel reassured when you talk with the rad onc.  They have some pretty nifty programs where they input your specific information and give you a personal risk vs benefit assessment. Plus, after your chemo they may do more testing/imaging that may give more information to consider.  For me, they did a pet scan that identified the IM node, so that made my decision more clear.  

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  • bluedasher
    bluedasher Member Posts: 1,203
    edited November 2009

    I don't think that the issue of whether chemo will take care of it or not is based on whether it was DCIS or invasive. What I've read before is that surgery can have disrupted the circulatory system near where they operated so that area doesn't get as good a dose of the chemo as the rest of your body. They do radiation to target that area.



    Did you mistype 0.5 cm instead of 0.5 mm above? Half a centimeter would be good margin and since the text says it was very close it sounds more like half a millimeter.

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  • CoolBreeze
    CoolBreeze Member Posts: 4,668
    edited November 2009

    I had to check the original path report, and no, it apparently wasn't a typo, it did say 0.5 cm.  However, as you astutely noticed, the wording is suspicious because it did say "very close" with the 0.5 cm and "somewhat close" with the 1 mm statement.  Now I'm wondering if THEY made the typo? It makes no sense, unless certain areas have different criteria for close margins.

    Great.  How do I find out if it's an error or not?

    Now I feel like I better bring it up quickly, while the slides or whatever are still around.

    Oh and yes I have the expander in already.  I begin expanding next week. If I need rads, that will change when I get my implant.  Which, as you understand, is why I hope I don't!

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  • Mazy1959
    Mazy1959 Member Posts: 1,431
    edited November 2009

    After I was finished with chemo, the med onc's office made the appt for me to see the rads onc. That was all there was to it. Hugs. Mazy

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