Large area of DCIS & possibility of microinvasion

jammie,

I just 'bumped" a post from a very knowledgeable poster named "Beesie" on understanding DCIS.  If you haven't read it yet, it is excellent.  She herself had a 6 cm DCIS and after pathology did have microinvasion.   Hopefully you can connect with her on these boards.....but I'd try not to panic. I had a single mastectomy 2 yrs ago for 4.5 cm DCIS, some grade 3, and turned out to have pure DCIS after the surgical pathology was completed, so hang in there.   

Hi jammies,

I'm new here too and recently diagnosed with DCIS when 3 areas of microcalcifications (right breast) where found on my very first mammogram. I only had one of the 3 areas biopsied and the result I was given was an extensive area of low grade DCIS. I opted to pass on a lumpectomy and go straight to MX. I will be having a MX and SNB on the 28th of this month, all being well.

From what I have read here and know from a friend who also had DCIS, they can't really be certain what 'lies beneath' until the final pathology following MX. My friend was initially told after core biopsy that there was only a small area of DCIS but they couldn't get clear margins following a lumpectomy and she had to have an MX. The final pathology found 4.5cm of high grade DCIS but thankfully no microinvasion or lymph involvement. So like you jammies, I will have to wait until the final lab report to get the full picture and yes I know exactly how you feel, it is a very anxious wait.

Hugs,

Aggie

Hi,

I had a relatively small area of DCIS.  My excisional biopsy discovered low grade DCIS and 2 tiny invasive areas....1mm and 4mm so I was lucky that it was caught so early.

My treatment was another lumpectomy to clean margins and SNB.

I did radiation and tamoxifen...so far on tamoxifen for 3 years and still hating it.

My tumor was grade 1 and chemo was not recommended due to tiny size and grade.

Hang in there - you won't know until they take it all out.  Once you do know you will have an action plan and will feel better!

Hugs...Kosh

I found out about the invasion one week post mastectomy, when I received my final path report. You should also get the news when you get your final pathology. Your doctor should be able to give you a sense of when you will get the report.

To reassure you, a micro-invasion is usually not a big deal. It is small enough that you shouldn't require any change in your treatment, and it wouldn't have much affect on your prognosis. Your staging would change from 0 to 1, and you would have a slight (like 1% or less) chance of things spreading, but in general things would be  the same as if they just found DCIS.

In terms of treatment, you might get radiation if your had poor margins after surgery, regardless of type of cancer near the margins. You might get chemo if they found a large invasion or possibly an invasion that was HER2+, or if they found cancer in your nodes. Micro-invasions are 1mm or less, and well below anyone's criteria for chemo.

I was diagnosed with DCIS in May.  Multi focal, >6cm, grade 2 and 3 with necrosis.  I am also small breasted so a lumpectomy was not possible, I chose to have bmx with te done on June 8th.  I also was fearful of microinvasion.

My final pathology report ended up showing 7.6cm of calcification and no microinvasion.  3 sentinel nodes lit up, removed and they were clean too.  I am cancer free.  No chemo, no rads, no tamoxifen. Keep your chin up.

mycinnamon, it depends. Most doctors use the Van Nuys Prognostic Index www.theeffectivetruth.info/wksht1.html to determine whether radiation is needed for a DCIS case. It looks to me that you're at least an 8, which would mean that radiation would be recommended. Here's the decision chart: www.theeffectivetruth.info/brcavnpi.html

I had 2 lumpectomies with unclean margins so I went for a BMX on 3/28/11.  Cancer was only on the left side but I was tired of the whole process.  I do not regret my decision.  Currently have TEs.  I did have 2 areas of microinvasion but I have been seen by my oncologist and Duke University.  I also consulted with John Hopkins.  All have agreed that my microinvasion was so small (less than 1mm) that no chemo/herceptin/tamoxifen recommended.  My margins were clean after BMX so I did not need radiation.  Now I am just waiting for exchange surgery.  Good luck to you.  Getting a second opinion did help put my mind to ease on what I should do. 

Others can probably explain in more detail about clear/clean margins, but basically it just means that you have no areas of cancer remaining after they remove the breast tissue.  I still had areas of cancer after my lumpectomies so I had no choice but to have a mastectomy.  I did decide to have both breasts removed even though I only had a problem on the left side.  Hope this helps

Praying for a quick recovery!!  Hugs, Lynette