LCIS Questions - Thanks in Advance

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FLhusband
FLhusband Member Posts: 6
edited June 2014 in LCIS (Lobular Carcinoma In Situ)

At the suggestion of responders to this post in Just Diagnosed I'm asking for more specific LCIS direction related to our recent diagnosis: 

My wife (we), was just diagnosed at age 54.  A mamo 6 months ago indicated some "suspicious" spots with a 6 month followup that recommended  Sterotactic (?) needle biopsy.  Pathology:

"Left breast microcalcifications":  Extensive pattern of ductal carcinoma in situ, solid and cribriform patters with focal central necrosis and calicifications (Nuclear grade 2-3/3).

No invasive carcinoma seen.

Focal associated lobular carcinoma in situ.

Background fibrosystic changes with microcalcifications.

Longest focus of DCIS measures 0.75cm.  Immunostains for smooth muscle myosin heavy chain were performed on both blocks and revealed positive staining surrounding the DCIS.  Immunostains for E-caadherin were performed and revealed positive staining on the DCIS and negative stainingon the LCIS.

 Hormon receptors and HER-2/NEU by Immunohistochemistry (IHC):

Specimen Source:  Left breast

Diagnosis:  Ductal carcinoma in situ

Estrogen Receptors:  positive 3+

Progesterone Receptors:  positive 3+

Her/2/neu oncoprotein:  negative

Estimated fixation time:  13 hours, 23 minutes.

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So, from what we can find so far:

1.  "good", we guess, that this is in situ?

2.  "good", we guess, on the positive horomones and negative HER-2

3.  Work done at hospital women's center on referral from OB/GYN.  Based on discussion at center and with OB/GYN we have two appointments set.  The general surgeon who "does most of the breast cancer surgery" in town, and the doc who heads the center who apparently specializes in reproductive cancers (fellowships in gyn oncology and breast diseases).

So, here's the range of questions I'd appreciate input on:

 1.  Additional diagnostics are coming we guess to better understand extent of involvement.  Understand lobular most likely in other breast?  Also assume that MRI, which was mentioned, is next diagnostic tool?

2.  Is further surgical investigtaion likely/warranted, i.e., excision biopsy as part of the diagnostic?

3.  Who should we look to for the best guidance...surgeon, oncologist?  Is there role for our family doc (internal med) in oversight?

4.  Any additional testing desired?

5.  Factors to weigh in considering surgery (lump vs mastectomy)

6.  Likelihood/desireability of medication, radiation, chemo?  Factors influencing either or all?

Enough questions?  If I've missed any please feel free to suggest.  Its early but we're a sponge right now.  No real panic....just obvious concern....and an interest in knowing what we're getting into so when we hear it we'll better understand.

Thanks to all in advance.

FLhusband

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Comments

  • leaf
    leaf Member Posts: 8,188
    edited March 2010

    Ductal carcinoma in situ is more 'serious' than classic LCIS.  (I assume they would have mentioned pleomorphic if it was pleomorphic LCIS.) Most LCIS is classic LCIS.  For classic LCIS and nothing worse, watchful waiting is an Option.  DCIS needs to be treated.

    'Good' is relative.  They haven't found any invasive cancer yet.  That is good.  There are people on the stage IV forum (the most advanced stage) that consider it 'good' when their cancer hasn't progressed.  (The best, of course, would be if they just found Boringly Benign things, but they didn't.)  

    They normally like to get clean margins (have no DCIS on the tissue edge) for DCIS.  For LCIS, they don't because LCIS is often multifocal (many spots of it) and less often but commonly bilateral (in both breasts).  For classic LCIS alone, they don't need clean margins (once they've excised) because a) they can never be sure of removing all the LCIS without a mastectomy and  b) the risk is in both breasts - even in the areas that are 'apparently normal'.  They do excisions after (LCIS and nothing worse) to make sure there isn't something worse in the area.  (LCIS is often found not at, but adjacent to, the lesion that prompted the biopsy.)  

    If they don't find anything worse than DCIS (i.e. if they DON'T find invasive cancer) on excision, then they don't do chemotherapy. (Chemotherapy is for systemic cancer.)   I'm not an expert on DCIS, so you may want to post on that forum.

    They normally start with a breast surgeon (or surgeon who does a lot of breast surgery).  The 'traditional' treatment for DCIS is mastectomy (if widespread or they can't get clean margins) or (excision + radiation).  Since she has ER+/PR+, she may or may not want to opt for anti-hormonal therapy after radiation.  Its good to check on the DCIS forum because I'm not an expert on DCIS; this is just my impression. I think the 'central necrosis' stuff implies it is relatively faster growing.  If I was in her shoes, it would be silly not to get this excised/remove more tissue.   I don't know if they normally do MRIs in this setting or not (before excision) - good to check on the DCIS forum (or if anybody knows here.)

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  • macksix6
    macksix6 Member Posts: 201
    edited March 2010

    I agree with leaf , good news is that so far there is no invasive cancer. DCIS must be treated and they want to get clean edges so either a lumpectomy or mastectomy are in order depending on the size of the area. You should also consider age. The younger the patient the greater chance of recurrence so a mastectomy may be in order. You need to go see an oncologist  and have an incisional biopsy to find out more. Work with both your breast surgeon and your oncologist.  Check out the DCIS board.There are wonderful options for breast reconstruction that you should research as well. Good luck!

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