Lumpectomy for IDC but DCIS left

Hi abcd -  I'm sorry that you are having to worry about this.  I also had IDC + DCIS with the DCIS component being .3 mm. from the chest wall.  That's one-third of a millimetre which seems like nothing essentially. Like you, I was very worried about this.  My docs said that 1) they had removed all the breast tissue and DCIS needs breast tissue to spread, 2) the chest wall acts as a natural barrier, and 3) they would do radiation boosts to that area to zap anything that may be left.  They did not seem particularly concerned about that close margin.

I'm wondering how there could be DCIS left if they have removed all the breast tissue to the muscle. Did your doc say you would be receiving radiation with boosts? I hope the MDT will give you an explanation and treatment that will ease your mind.  All the best.  Please keep us posted.

abcd- Typically, if you have a lumpectomy and they do not get clear margins they will recommend mastectomy possibly with radiation.  During the mastectomy they would probably also do a sentinel node biopsy (SNB) and test a few nodes.  If the nodes are positive for cancer they would recommend chemo.  Like others have said they don't just leave DCIS in there as it can become invasive.  Is it possible you misunderstood?  Also, you cannot get breast cancer in your pectoral muscle.  Breast cancer is in breast tissue which would all be removed during a mastectomy.  Breast cancer can appear else where if it has metastasized but I have never heard of this happening in muscle.  It's usually bone or the lungs.  I am glad you are having a meeting with the multi-disciplinary team.  Make sure you write down all your questions, take someone else with you if possible and if you don't understand something ask them to explain it again.  Also, ask for a copy of all tests you've had done and the results and review them.  This all can be very confusing, and by the time you're done you'll probably feel like you've earned your medical degree, but you need to take charge and educate yourself as much as possible so you can make treatment choices.  Because ultimately they will leave it up to you to decide how you want to proceed with treatment and possibly reconstruction.  I know how overwhelming it can be at first but once you have a plan in place it gets much better. Good luck to you.

Hi abcd - Our situations sound very similar.  As I mentioned in a previous post, the DCIS component of the tumour was 1/3 mm. from the chest wall.  You will likely get radiation therapy that consists of whole breast treatments and "boosts", i.e. radiation that is targeted to the tumour area.  I had 16 whole breast plus 8 boosts.  I did not find radiation bad at all.  My skin turned somewhat red and it was itchy, but no blistering.  It was pretty easy overall.  The worst part was going there and waiting around every day (so take a good book lol).  I had my lumpectomy + SNB on Sept. 17th and radiation started on Dec. 1st.  I think you will feel much better after your meetings with the doctors when you get things explained.  I now take an estrogen blocker as well.  All the best.  Please let us know how you are doing.. 

Hi Allenan - Try not to worry too much.  I think what you are going through is common.  The small IDC tumours and the DCIS are not not visible to the naked eye, so the surgeon cannot tell for sure whether he/she has got it all until it is checked by pathology.  While this causes you to worry right now, I'm sure they will get it.  Are you definitely having chemo?  I have very similar stats to yours and my onc was adamant about no chemo, although I did not have an Oncotype test.  With your stats you have a good prognosis.  Don't worry, this will get taken care of and you will be able to move on. Take care.

Thanks Kate,   I sent you back a reply.  Thanks LittleMellons.   After reading your posts, I feel better.  I still need to do my homework though.  I see the medical oncologist on Wed 6/22.  I made an appt to see my gyn also.  They gave me an appt for the radiation oncologist for July 26 and I am thinking that is a long time to see the radiation oncologist.  I will try to call and see if I can move it up.  It seems that doctors are going on vacation --thus the delayed appts.

Anyway, I am having my re- re-excsion this Friday and trying to get myself mentally ready.  The actual re-excision is never the problem.  Its the week to 10 days waiting period for the pathology to come back.

Hi abcd -  I am in Toronto Canada.  It's good that you and the docs know that the chemo was effective.  My radiation oncologist, who specializes in breast cancer, said the raidation is very effective.  In Canada we seem to get fewer treatments than our American sisters. I had 16 whole breast plus 8 boosts to the tumour area.  I'm not sure if the radiation dosage is different than in the States where more treatments are given.  I'm not sure how things are in the UK. You will receive detailed information about how to care for you skin, creams to use, mild soap, no deodorant, etc.  I did not have chemo, but people have told me that radiation is much easier than chemo for most people.  Take care and let us know how you are doing.

 Allenan -   You will feel better after seeing you med onc tomorrow, is it?  If you are having chemo, you will get that first then radiation, so July 26th to see the rad onc is not bad.  If you are not having chemo, then I would push for an earlier appointment with the rad onc.  My radiation was delayed due to a lost referral, and I had to get a little pushy to get it going.  All the best.

Hi Allenan -  Sounds like you are making progress and it's great that you like your Onc. that helps a lot.  I did not get an Oncotype test as I live in Ontario and it is not routinely done here.  I asked my Onc if it could be done and he said it would not change his treatment plan, so would not order it. Your Onc is probably leaning toward mild chemo (CMF) because you have no positive nodes and an intermediate grade.  I hated the idea of chemo in the beginning because I was scared of the SEs and didn't want to lose my hair.  However, by the time I saw my Onc I actually wanted it to really do all I could, but my Onc was adamant about no chemo.

I would recommend that you post your situation on the Chemotherapy forum.  I'm sure lots of people will come on and give you information there.