Diagnosed with DCIS ER+/PR+...need suggestions..

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  • Beesie
    Beesie Member Posts: 12,240
    edited April 2010
    Good that you are going for a 2nd opinion.  I agree with sweatyspice that there seems to be info missing on your pathology report - it definitely should say what your margins are. Given that it doesn't, I'd recommend too that you ask to have your slides reread, as part of the 2nd opinion process.  I don't think sending over the report is enough, since the report seems to be incomplete.
  • sweatyspice
    sweatyspice Member Posts: 922
    edited April 2010

    BTW - I just noticed that SHARE in Manhattan has a program called Young Women and Breast Cancer: The Empowerment Series.   http://www.sharecancersupport.org/services/educational_programs/young_women_and_breast_cancer_th/?lang=en

    Last month, (oops, too late!) it featrured Dr. Tessa Cigler, an oncologist at Cornell, who talked about hormone therapy and young women.

    Here's her bio page if you want to contact her for a consult (and another opinon):  http://www.weillcornell.org/tecigler/index.html 

    You might be interested in that or the other programs at SHARE, or Gilda's Club NYC (in the village) or the Young Survival Coalition.... 

     SHARE main page:  http://www.sharecancersupport.org/  - there are specific support groups for for Young Women w/BC:

    http://www.sharecancersupport.org/services/support_groups/you_wom_s_con/

    and also for DCIS:

    http://www.sharecancersupport.org/services/support_groups/dcis_support_group/

     Gilda's Club NYC and/or Northern NJ:  http://www.gildasclubnyc.org/  and http://www.gildasclubnnj.org/  (Hackensack)

     Young Survival Coalition - also NYC and Northern NJ   http://www.youngsurvival.org/   there's a message board, etc. on the main site   http://www.youngsurvival.org/newyorkcity  and  http://www.youngsurvival.org/northernnewjersey  (office in Paramus, they also co-sponsor a monthly meeting with the Hackensack Gilda's Club, held at Gilda's Club)  I know some people from this site who are also involved with YSC in NYC.

  • NK1
    NK1 Member Posts: 17
    edited April 2010

    I want to ask one more thing. when my BS told me that I had DCIS. She only told me my 0stage. At that time I didnt know anything. She only said that I had wide margins. Yesterday I met Medical Oncologist, I asked her about my margins. She said that they mentioned only negative margins with grade 1. Is it posibble they dont mention margin size in pathology reports?

  • dsj
    dsj Member Posts: 277
    edited April 2010

    DCIS is always stage 0.  this means that it has no invasive component--it's only in the ducts and can't go somewhere else. It can,however, turn into more serious invasive cancer (stage 1, 2, 3, or 4), so this is why it's important to get it out. 

     DCIS is divided into 3 grades (how normal/abnormal they look and how fast they're growing).  1 is low-grade (the cells are the most like normal cells and probably less like likely to turn into invasive cancer); 3 is high grade (most abnormal); and 2 is in between. 

    So with DCIS (always stage 0) and Grade 1 (least worrying), you've got the best pathology you can have and still technically have breast cancer.

     The margin is the amount of healthy tissue around the DCIS in the part they excised (took out).  The wider the margin, the more likely it is they got all the DCIS out with the surgery.  The smaller the margin, the more possibility some DCIS may still be there (residual DCIS).  So the size the margin is really critical in determining what kind of further treatment you might need.

     It's hard for me to imagine the pathology report didn't include the size of the margin, but I am not a doctor, so who knows.  But if it were me (and it is me), I would want to know how large the margin was.   I think this is something you should ask the doctor at Sloan Kettering about.  

  • sweatyspice
    sweatyspice Member Posts: 922
    edited April 2010

    I suppose it's possible that at your hospital they don't mention margin size with Grade 0 disease (DCIS and LCIS) other than saying the margins are negative.  Apparently there's no national standard for how to write a path report, so I guess they can do it however they like.

    BUT - I think that's a bullshit approach and that you should have someone else look at your slides and tell you what your margins are. 

    I'm with dsj on this one, too.

  • NK1
    NK1 Member Posts: 17
    edited June 2010

    Hi everyone, I am back after consulting two more doctors. He recommended re-excision. After that there are very less chances of radiation. But I have to go to a different breast surgeon. I live in saddle brook, nj. Please give me some sugestion about good breast surgeon. I wud be really grateful. Thanks

  • NK1
    NK1 Member Posts: 17
    edited June 2010

    Hi, please give me some sugestions...I am very confused these dayz. I had my lupectomy march 18th,2010. I dont want to go for radiation. I went for the second opinion at newyork kattering hospital. They also suggested radiation because pathologist didnt give size of margin. Then I consulted dr. lagios. he is recommending re-excision to get better margin. After that if results are clear. I dont have to go for radiation & chances of recurrence will be 5%. I talked to my breast surgeon & newyork hospital but nobody seems to support my decision. I dont know what should I do? What do you think abt my case. I have one more thing to clear. My operative side is very hard. I feel pain in n around the operation site. Is it normal? Thanks

  • wyldblumusic
    wyldblumusic Member Posts: 59
    edited June 2010

    Hello.

    I'm sorry that you're having such a difficult time.  I see that you have had second opinions, but did you have a second opinion on the actual pathology slides?  Even though your surgeon said that the margins are clear, I would not trust that information unless it was confirmed in a pathology report.

    Unless you have this information on a pathology report, you cannot be entirely certain that all of the DCIS was cleanly removed.  If you do not want to have your slides evaluated again, I would strongly urge you to consider the re-excision or radiation at a minimum.  I had both.  I won't call this process easy, but it is doable.

    Also, I am angry that anyone has to go through this situation.  Sweatyspice is right; it is BS!  I cannot believe that your pathology report is incomplete.  We cannot possibly make informed decisions when we are only given minimal information.

  • NK1
    NK1 Member Posts: 17
    edited June 2010

    @wyldblumusic....I did go for second opinion n also for third opinion because of uncertain margins. I also sent my slides. They said that it is DCIS but they cant give margins. It should be done by the first pathologist. They are considering it more than 2mm. Now I am in middle of re-excision & radiation. No doctor is supporting our decision of re-excision.

  • NK1
    NK1 Member Posts: 17
    edited July 2010

    can someone suggest me a good breast surgeon in new jersey(saddle brook). I want to go for re-excision. plz help.

  • sweatyspice
    sweatyspice Member Posts: 922
    edited July 2010

    Not sure how far this is from Saddle Brook, but maybe Laura Klein at Valley Health in Ridgewood?

    http://www.valleyhealth.com/BreastCenter.aspx?id=2032 

  • Roberto487
    Roberto487 Member Posts: 20
    edited July 2010

    I don't know how far you want to travel but Doctor Michelle O'Shea of Summit Breast Care, in Sparta, NJ is a good doctor. Very personable.  Her number is 973-729-6517.

  • hurleygirly
    hurleygirly Member Posts: 157
    edited July 2010

    NK1, I am 35 (clock is a ticking) and I was in the same predicament as you when I first got diagnosed back in March. Honestly, I went over all options with two oncologists and what I decided to do to avoid the Tamoxifen was to get a bilateral nipple sparing mastectomy. My final implant exchange will be scheduled at the end of August and as soon as I am healed, I have the go ahead to start trying. Feel free to pm me as I am so happy that I did decide to go this route which may sound extreme.

  • NK1
    NK1 Member Posts: 17
    edited August 2010

    Here I am again...I met a gud BS yesterday. She is ready to do re-excision. As I stated earlier that I am not going for radiation. She also suggested one more alternative & dat is Mastectomy. I think dats the same wat hurleygirly wrote. I have to take my decision between re-excision & mastectomy. I want to know what are the pros & cons of mastectomy? Would it be lil extreme for DCIS? She said that I wud not have to worry abt screening n all those mental trauma. Please share ur point of views. All those who had done the same might have something to share.

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