Nuclear grade 3?

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Anonymous
Anonymous Member Posts: 1,376
edited June 2014 in DCIS (Ductal Carcinoma In Situ)

How bad is it if I have DCIS w/nuclear grade 3?

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  • Hindsfeet
    Hindsfeet Member Posts: 2,456
    edited October 2011

    Suzanne, After going back and reading what I wrote, I realize how I said it might be confusing. I agree with Beesie in that dcis grade 3 is a non-invasive cancer stage 0. However, due to it's aggessiveness over other dcis grades, I feel it should be upgraded due to it's aggressiveness. Maybe to a 0+ or something to give those dx with grade 3 more of a sense of urgency to get it right the first time. Just my opinion that means absolutely nothing :)

    And because my dcis jumped over the seemingly clean margins all of it wasn't caught the first time around. I don't know if women dx with dcis realize that can happen. They rely on clean margins, which isn't a 100% fool proof.  

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  • Beesie
    Beesie Member Posts: 12,240
    edited October 2011

    All DCIS is non-invasive.  All DCIS is Stage 0.  DCIS - even grade 3 DCIS - cannot move outside of the breast into the lymph nodes or the vascular system.  DCIS - even grade 3 DCIS - is always confined to the breast and therefore the survival rate for pure DCIS, with no recurrence, is 100%.

    That's the good news.  The bad news is that grade 3 DCIS is more aggressive which means that there is a greater risk that when all is said and done, it may be found that you have more than DCIS. In about 20% of cases where DCIS is found in a biopsy, the diagnosis changes to invasive cancer once all the surgery is done.  This risk is greatest when the DCIS is aggressive.  So grade 3 DCIS presents a somewhat higher level of risk that there might actually be some invasive cancer present.  Usually it's just a microinvasion, as I had, and that really doesn't change much in the treatment plan or prognosis, but sometimes the diagnosis can change significantly.  

    The other risk with grade 3 DCIS is that it's more likely to recur if some rogue cells remain in the breast after treatment. And when DCIS recurs, in approx. 50% of cases the recurrence is not discovered until after the DCIS has already evolved to become invasive cancer.  So while the objective of treatment is always to remove all the cancer cells, with aggressive DCIS it's particularly important that you do whatever is necessary to ensure that all the cancer cells are either removed surgically or killed off with radiation and/or hormone therapy. 

    But, back to the good news, if your doctors successfully remove and/or kill off all the grade 3 DCIS, then your prognosis is no different than it would be if you'd had grade 1 DCIS.

    Edited to add:  Suzanne, I just read your other post.  Since you've already had a lumpectomy and not just a biopsy, you don't have to worry about the risk of finding some invasive cancer hidden in the middle of that grade 3 DCIS.  But I noticed that your surgical margins were narrow - only 1mm or less - and with grade 3 DCIS, that's a concern. The narrow margins mean that there is a reasonable chance that some cancer cells might still be in your breast.  With grade 3 DCIS, this would give you a very high risk of recurrence. So it's likely that a re-excision will be recommended, which would be followed by radiation, or you could chose to have a mastectomy.  

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  • 3monstmama
    3monstmama Member Posts: 1,447
    edited October 2011

    What my onco told me about my grade 3 DCIS was that DCIS is not yet invasive cancer.  The grade gives you an indicator as to the liklihood of the DCIS becoming invasive.  If you have grade 3 DCIS, it is not a question of "will my DCIS become invasive" but "WHEN will my DCIS become invasive?"

    Her explanation was enough to make me feel comfortable with doing zaps and taking tamoxifen.

    Good wishes.

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  • Anonymous
    Anonymous Member Posts: 1,376
    edited October 2011

    Thanks 3monstmama for your reply.  I hadn't thought about it that way: "WHEN will my DCIS become invasive?"  I had my lumpectomy 2 weeks ago today.  When I went for my post-op earlier this week the surgeon said the margins were clear, but also close.  She is having a meeting with Pathologist and Radiation Oncologist tomorrow.  I am wondering if I will be going back for more surgery to have more of the margins removed b4 I start radiation. I guess I will find out tomorrow.  I am wondering if I should switch to masectomy.

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  • 3monstmama
    3monstmama Member Posts: 1,447
    edited October 2011

    I had to get a re-excission. I seem to recall one margin was not so good. I believe they like to clear that up before zaps.



    I have to say, a mastectomy is a big surgery. Even if you are not "attached" to the concept of having breasts, its a big surgery. I would do a reexcission first and try to avoid a mastectomy if possible. It may not be possible and then we do what we must to survive but take it one step at a time.

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  • Emaline
    Emaline Member Posts: 492
    edited October 2011

    I would rather have had the option of radiation versus MX.  I still miss my breast.  It is what it is but it isn't always easy.

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  • Trishbogle
    Trishbogle Member Posts: 37
    edited May 2013

    I have dcis nuclear grade 3 of 3 mine is 6 mm not sure what that means trying to learn

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