newly diagnosed with DCIS
Hi all. Moving over here from the "not yet diagnosed boards". Just received word from my doc yesterday that I have DCIS. Here is the path report:
Final Diagnosis:
DCIS, intermediate nuclear grade with comedo necrosis and coarse calcification; extent of lesion at least 2.0 cm in maximum extent; no invasion identified; ER - 100% positive; PR - 100% positive.
Microscopic Description:
Sections have extensive ductal carcinoma in situ filling much of these cores. There is no definite invasion identified. There is moderate to focally marked nuclear atypia with occasional mitoses. There is calcification with comedo necrosis.
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My current doc has advised lumpectomy with sentinel node biopsy, followed by radiation. I have an appointment set up for Monday for a second opinion. Everything I have read has suggested that I do that. I am fortunate that I live near an NCI cancer center here in Birmingham, AL. That's where I am going for a second opinion Monday.
Not sure what my questions are right now...just taking it all in still. So glad this board is here.
Comments
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Sounds like you are on top of things. Good luck to you!!
Foxy -
I was where u are right now in February 2011. Sounds like u r in a good place physically and mentally. One day at a time. I'm prepping for my final surgery in Sept...nipple creation. And I just returned from an adventure vacay in Colorado! Even tent camped on a mountain top! Made me feel stronger than I've felt in months! All the best to you~~~
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Hi dancetrancer...followed you here from the motherboard. I'm sorry your results came back as they did. Your heart just stops when you get the news and you feel like you're on a scary roller coaster ride. First of all...you're probably going to have the strangest emotions the next few weeks, and that is completely normal...let yourself go and have your time with this. I have to say, your diagnosis is very promising in that your treatment will likely be very successful and you may be able to avoid chemo at this stage depending on your sentinel node biopsy. But very good sign that it doesn't appear to have invaded the surrounding tissue and that it is confined to the ducts. The fact that you are 100% positive for estrogen is great because you will respond very well to hormone treatments. This also means it is important for you to avoid putting estrogen in your body...birth control pill, plant based estrogen foods like flax seed oil, soy, etc. Your docs treatment plan seems right on target.
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Thank you soooooooooo much everyone! This board is such a huge help to me!!!
A question I have as I look at other's sig lines - how do you know the stage and grade - do they not know that until they do surgery? (Nothing like that is in my path report.)
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Ah, good, dancetrancer ... You found it! Lots and lots and lots of help and support and care here! I'm sorry you are here, but glad you will get the support and help we all need!
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Mouse - by hormone treatments, do you mean Tamoxifen? Still an infant in my learning stages here! Thank you so much for your encouraging words. It means so much to me and DH (I read the posts to him). Guess I'll stop my BC pill...I was wondering about that!
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Yes...tamoxifen is an estrogen blocking medication, and there are others as well. Sorry I'm not well versed in the different medication names because I'm er neg. As for staging, they will wait until after your snb to stage you because if it happens to be in your nodes, which I hope it is NOT, you would be stage 2. Your grade was intermediate nuclear which means grade 2. Not the most aggressive type, so that's good news! There is different terminology on path reports so it can be confusing. Have they scheduled your lumpectomy and snb yet?
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I am scheduled for lump with snb for Tuesday, but I am getting a second opinion on Monday, so I will probably delay the surgery for a few days. Everything I've read so far suggests getting a second op on the path and tx plan, so hopefully it's ok to delay the surgery a bit.
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Delaying for a few days is not a big deal at all. It's important to feel confident with your treatment plan, which is what a second opinion will do.
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Thanks for all the support guys. I am feeling much more hopeful since hearing your comments and encouragement.
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Dancer,
I see you found this forum. The ladies here will help you navigate this journey. If you scroll down a bit on this forum you will see a thread started by the lady I told you about, Bessie.
It's called "DCIS facts and misconceptions". I think you will find it very informative as you make the right treatment options for you.
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Found it Marie! Thank you!!!
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dancetrancer;
(((((HUGS)))))
All I can say right now after reading your posts when I got on this morning is..........CRAP

I'm sorry your call was not what we were all praying for....On the good side, you are exactly where you know you have a ton of support and plenty of people to walk with you on this journey.
I am sure you have a ton of reading to do so I will keep my post short for now. Hang in there.
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hi dancetrancer. Welcome to the club that we don't want to be part of but the support here is AWESOME. If I had one piece of advice it would be to bring a notebook and take notes as the docs are speaking to you. Helped me tremendously as I made my way through different appointments. Good luck to you and ask as many questions as you need to!

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Thanks DeeLJ. I do just that, plus so far I've been lucky enough that DH could join me for all my appointments. 4 ears are much better than 2! DH has been so amazing through all of this. I am so lucky to have such incredible support from him and all of my friends and family and this group!
I had my second opinion Monday. The cancer center at UAB is fantastic. I feel like I am in much better hands - just so much more comprehensive in their team approach. Here is what I found out:
1. Since I have very dense breast tissue, doc wants to get a breast MRI (after insurance approval, hopefully) to make sure nothing invasive is hiding in there. Says there are more calc's on the mammo that are deeper and weren't caught in the biopsy. I'm also scheduled for another mammo and an US tomorrow...worried about the mammo...I'm only 1 wk post core biopsy today. It sure ain't gonna be pleasant. :-( Oh well, I'm a strong one! You do what ya gotta do.
2. Doc does not want to do surgery until tests are all done, their radiologist review all films, etc. They are getting my actual films from the last 3 or 4 years of all of my mammo's I've had done. I'm surprised at how thorough they are - pleasantly! After all these tests are back we will decide if lumpectomy or mast is the appropriate option for my case. If mast is recommended, I will have an appt with PS to discuss reconstruction options before surgery.
3. Their path will do second opinion on the slides from my biopsy
4. Since I have two aunts that had BC, she is having me get genetic counseling and testing (BRCA).
5. When we get closer to radiation time, I will have an appt with the radiologist to discuss options (internal vs external)
They were soooo thorough. Even took baseline measurements of my arms in case I should develop lymphedema (shudder) in the future. She did say if my tissue comes back as DCIS only, they may not need to do a SNB.
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Sorry about your diagnosis. You know your doctor can proscribe painkillers to take before you do the mammogram on the biopsied boobie.....I didn't have another mammogram post biopsy but I did have it post lumpectomy and was floored by how much it hurt. The next time, I had drugs. For all I know it may still have hurt but I was too looped to notice.

Good you are getting a second opinion--the "good" side of DCIS is that you can get all the second opinions you need and still not put yourself at risk.
Re your question about staging and all, yes you are correct, that is something that is done post surgery when they have really had a good look at the tissue.
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Thanks 3monstmama. I'm gonna email the doc's nurse now and see if I can get something. I'm not signing up for extra pain if I don't have to!
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Dance .. sounds like a great experience at UAB. I'm happy things worked out for you and it sounds like a very comprehensive plan .. and right on the money too!
My lumpectomy breast is so painful during mammograms, I will take the advice and take a pain pill before my next one.
hugs,
Bren
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Dancetrance,
Sounds like you have a good team behind you.
Get copies off ALL reports; Mammo, US, biop, MRI (if you have one; I had one, they are very good but it's important for you to know that they also give a lot of false-positives; many place when doing a breast MRI like to make sure you are something like 7-14 days in your cycle, so remember that...I was never told....)
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Thanks Marie for the heads up on the false positives and on the 7-14 day thing. You all are so awesome!
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dancetrancer it sounds like you are in excellent hands! I obtained an MRI also, and it was at my own suggestion...and I only knew about it because of this site here!

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DeeLJ, if you don't mind my asking, what factor led you to decide to have bilat mast? I don't know your whole story and if you don't want to repeat it, I certainly understand...just point me to the appropriate thread to read. :-) I see we have very similar dx and age so I'm curious about your thought process, seeing as I am going to be having to make some big decisions soon. :-)
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dancertrancer -Sorry that you are over here, but the good thing is that we've all been where you are and I promise that there's a light at the end of the tunnel. My profile is similar to yours: I was also early 40s when diagnosed with grade 2 dcis after a rountine mammogram showed a cluster of micro calcifications and a stereo. biopsy confirmed dcis. I think it's wise to have the brca1&2 testing and mri -- my breast surgeon had me do these before we discussed whether the right course was lumpectomy, mastectomy, or bilat.mast. I wanted to save the breast and sensation, and was fortunate that the mri and brca testing came back favorably, so we moved forward with the lumpectomy and no snb and then on to rads.
I took a little detour when a small amount of invasive was detected in the pathology report from the lumpectomy and underwent a snb second surgery ( I have no regrets about bs not doing the snb at the time of the lumpectomy, just my luck, but one can certainly have it done at the time of lumpectomy, just make the right educated decision for you). Then on to rads., which were far easier than the fear I'd had about them.
This board was so comforting to me when I was where you are; all are happy to share so please do not hesitate to keep posting and good luck.
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CTMOM your story is comforting in that I just have this gut feeling they are going to find more than DCIS in there. Hopefully I'll be wrong, but I'm trying to get myself mentally prepared (although I know that you never can do this fully, after trying to mentally prepare myself for a positive biopsy didn't work - still freaked out, LOL). Doc has also told me there is a chance there is some invasive in there, as there were some deeper calcs that didn't get caught in the biopsy. We'll see...
I was relieved my doc said we could do the SNB at a separate time, waiting to see what the full path looks like after surgery (unless we decide upon mast, b/c you have to have the blood flow for the mapping). I really don't want to mess with those lymph nodes unless it is truly necessary.
So did you MRI give any hint that there might be a bit of invasive lurking, or were you pretty shocked when the path report came back?
Also very glad rads were easier than you expected. Yay - glad not everyone has a tough time. I'm pretty freaked about those. Oh well, I'm pretty freaked about it all...but hanging in there and pushing forward!
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dancertrancer - Yah, I was very(!) shocked when the final path report came back with idc, as there was no indication on the mri or any hint from the mammo or stereo. biopsy or family history and I fooled myself into thinking that grade 2 dcis couldn't so quickly become idc. BS also had a prelim. path. done while I was under during the lumpectomy and that came out fine.
You can't truly prepare yourself, and you may very well NOT have any idc, I certainly will keep my fingers crossed for you, the vast majority are just dcis! But, even if there is idc, it'll likely be very small and thus, like me, it won't change your treatment plan at all (no chemo, just delayed rads a few weeks because of the snb which came back fine thankfully). So once the shock wore off, I found comfort in knowing that I was going to be treated just like "normal" and then I welcomed the rad. treatments so that any stray cell(s) would get zapped out of there!
I am very thankful that I did get my routine mammogram (digital mammography = early detection), because the darn thing about dcis, we're still not at the point in tests to know which dcis will turn and which won't --- we only know after every bit is cut out and analyzed.
Hang in there, the mental is truly the hardest part of this whole thing. I remember someone writing that in a post when I was where you are, and it helped me to stay focused on what I needed to do to get through it. Once your plan is in place, it'll go faster and seem easier.
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OK, so I survived a LONG day of follow-up tests yesterday: multiple mammo's both sides, US's both sides, plus a surprise US biopsy. More issues were found on the L side. Two addtional areas of calcifications at 3 and 9 o'clock that the radiologist says looks like could be branching out from the original biopsied 12 o'clock spot (that is DCIS). US was done to try and get clarification, but it actually found another new "questionable" area towards the armpit (not a lymph node - they look ok on US so far). Doc said it was borderline on whether it should be biopsied or not, as it may just be a cyst, but given my recent dx, they decided it was best to do an US-guided core biopsy.
My breast MRI was approved by insurance and will be done this coming Monday. Depending on the results, I may or may not need a 3rd biopsy - stereo for the 3 o'clock calc. (They cannot biopsy the 9 o'clock one b/c of it's location). If the 3 o'clock calc is cancerous, then the decision is made for me - I will require mastectomy b/c I am so small and the area is so large in comparison. Per the radiologist - "You would have quite a defect." If negative, I may be able to get by with just a lumpectomy and excision of the 9 o'clock calc. However, if path does not show clear margins I may end up needing a second surgery for a mastectomy anyways.
So it's not looking good for me in terms of breast conservation. The radiologist said if I came to her saying I just wanted a mast then they wouldn't even do the stereo. Essentially I feel like I'm letting them go ahead with all of these tests just to give my brain time to adjust to the idea of a mast and also "proof" that I have no other choice. Intellectually it looks like that's the way it's going, but I'm having a really hard time accepting this emotionally. Hell, I'm still having a hard time accepting that yes, I have cancer. Yep, me. Still feeling in a state of shock. It's been a week since the initial diagnosis. How long does it take to come to terms with this? (Rhetorical question...I know it's different for everyone.)
All this for DCIS. It makes me so angry that some in the medical community say it's not cancer, but pre-cancer. If it wasn't dangerous, they surely wouldn't be giving people mastectomies and radiation for it. Call it what you want. All I know is it's like a tornado coming through my life.
Yeah, I'm on the downside of the rollercoaster this morning. I know I'll snap out of this funk, but I gotta get this out. Thanks for being there when I'm at my lowest!
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Keep writing, keep talking. Its a process to work through. What a busy day you had and no wonder you are so tired. I have been told that I intellectualized it all well but that emotionally I still haven't dealt with it..I disagree but the fact that someone told me that means that it can happen...and it does take longer to assimilate the facts in relation to our own bodies versus facts that are on a website or that we are reading about. Its so different when its our own selves.
((hugs)) PM me anytime.
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Having my first major meltdown. Can't stop crying. Tried to read about mastectomies and look at pictures b/c I thought it would help me to face the unknown. It didn't.
Thankfully hubby is with me. We just had a big meltdown together. This f*cking sucks.
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OK, sorry for that last meltdown post. Feeling better now.
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dance--
sort of think it is time to stop reading stuff, take a break as it sounds like you have a good group.
go get a pedicure, have some time with your hub and get away from it all.
me, I rushed full force into my decisions, reallized later that a day or so would not have had any effect on my outcome..
ps, me....DCIS, grade 3, 3 lumpies, rads and now 3 years clear on my last mamo!
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