multifocal cancer

Glad to learn about this thread. I had a lumpectomy in 12-2011 to remove an IDC and DCIS, learned there was more DCIS. Margin problems led to a UMX in 1-2012, pathology showed another IDC. So, 6 tumors total in one breast. Now wishing I had had a BMX to reduce worry about the "healthy" breast. Someone in another thread suggested an MRI for the healthy breast to increase chances of catching whatever may be/develop there, and I think I'll push for that. 

Have my first MO appointment on 2-24-12, imagine due to my young(ish) age and the multicentric/multifocal issues, chemo will be recommended, along with Tamox. 

This whole business just gets ever more complicated, doesn't it? 

Glad to see that this thread is active again.  I was multi-focal and multi-centric, two masses in two different areas of one breast.  Lumpectomy was not really an option, and mastectomy was recommended for that breast.  I opted for a double mastectomy, getting rid of cancer on one side and a prophylactic on the "healthy" side.   With every mammogram, I've had bumps and lumps and a lot of worry.  I've had my kids, been married for 18 years, it wasn't an easy decision but I'm glad that I did it.   My surgery was a nipple and skin sparing, made the decision a little bit easier.

I wish everybody well in making a choice.  It's complicated, and everybody is different.   

Wren44, I had the same choice (another lumpectomy or an mx), and also decided on the mx. The mx turned up yet another tumor, that hadn't even been seen on an MRI. I'm glad I opted for the UMX. I also ordered on of those microbead foobs, to deal with the current imbalance between my TE side and my natural side.

I originally felt a lump, and after core biopsy testing, was diagnosed with IDC.  I was scheduled to have a lumpectomy, but my BS requested an MRI beforehand.

Unfortunately the MRI identified several potential suspicious-looking areas.  I made the very difficult decision to have a mastectomy, without knowing 100% that those areas were cancerous. 

Turned out to be the right decision.  The lump I had originally felt was the largest of three IDC tumours.  The tumours had a spread of 55mm, and they measured 22mm, 14mm and 4mm.

The tumours were removed completely, with clear margins.  Sixteen lymph nodes were also removed, all clear of cancer.

My BS said that the multifocal nature of my cancer could potentially mean that I will need radiation therapy on the chest wall.  But when I met my MO, he was not concerned about the number of tumours.  Staging was based on the size of the largest tumour, and the lymph node status.

Apparently chemotherapy and hormone treatments should be the most beneficial for me.  Radiation will probably not  be necessary for me because the margins and lymph nodes were clear.  But I will see what happens further down the track...

Had a first appt. with a Hungarian oncologist - his opinion was that I wasn't multi-focal with 2 masses, I was bi-focal!  First time I've heard this.  He said that multi-focal means more than a few masses, possibly with a mix of different cancers.  Anybody else heard something like this?  

Just logging my experience for the benefit of those who may be researching this in the future.

 Multifocal IDC, 5 tumors, all the same morphology (I guess this means it all stemmed from the same DCIS and popped out in 5 different locations) ranging in size from 0.5cm to 2.1cm.  Staging and oncotype was done on the largest tumor.  Oncotype score 14 (9% chance of distant recurrence assuming 5 years on Tamoxifen/AI).  UMX with DIEP reconstruction, no chemo.  I had radiation because they didn't get clean margins first time around (reexcision 2 weeks later gave clean margins though), there was some evidence of LVI and, although I was "node negative" there were about 20 tumor cells in sentinel lymph node (onc believes just cells that were knocked off during surgery).  Not at all convinced that radiation was truly necessary but wanted to be aggressive since chemo was not believed to be of any benefit (grade 1, very nonaggressive).

My tumors were believed to be under construction for 7-8 years.

No one seems to know how much weight to place on "tumor load", i.e, the mere fact that there are multiple small tumors, but one thing is for sure - they are not all added together.  Largest tumor trumps all (assuming same morphology, I guess).

Blessings, do you mind me asking what your oncotype score was? I am still waiting for mine, but my BS told me that due to the multifocal/centric nature of the cancer, he thought chemo would be recommended. 

Kadia - I never had the Oncotype test...which was probably because my IDC was considered a microinvasion from the DCIS - I had two tiny areas of IDC: 1.5mm and .5 mm. The rest was DCIS.

I think my treatment of an AI only was due to the size of the invasive cancer, and my ER+ status.

I had my first visit with the Oncologist, finally got lots of answers. One was that the cancer was 'multifocal'. IDC & DCIS in R breast. 2 tumors were biopsied in Feb and I had a mastectomy 3/21, and that showed 2 more tumors, no lymph node involvement, stage 1, grade 3.  Onc say multifocal is like an octopus ,tumors are like the tentacles. She says no radiation needed, but recommends  C,M,F chemo,based on it being multifocal and that there was some cells in the lymphatic tissue,and that it is grade 3 .. Ok gals, is this  getting really complicated, nodes clean but prob with tissue? Waiting for oncotype results, (very happy I qualify for their assistance program and will not have any co-pay) before making final decision.

Hi, everyone, I am new here. I posted my experience on the other board but found this thread today and would like to hear your comments.

I had simple mastectomy last month. I have been very worried about a missing tumor after surgery.

The biopsy shows two tumors:
A: 1.5cm, behind nipple, ER+, PR+, HER2- (score 2+, FISH negative)
B: 0.8cm, 12 o'clock, ER+, PR+, HER2+ (score 3+)

Surgical pathology shows only one tumor, the bigger one behind nipple. The other one is missing and even the clip placed during biopsy is missing too.

According to the surgical pathology report, there are two specimens for the breast:
1. left breast, simple mastectomy (lateral aspect of left breast skin);
2. left breast tissue (re-excision with evaluation of margins).
It seems that my surgeon removed additional tissue after removing the most part of my breast. Has anyone of you had same experience?

I have very small breasts and I don't know if this caused difficulty for surgery. My surgeon has 20 years experience. I hope the re-excision is not a problem. What do you think?

All doctors said, most likely, the tumor is not in my body. But seeing that all doctors are saying I have a hard case, I am extremely nervous. I tried to ask if I can have Ultrasound or MRI to make sure no residual breast tissue in my body. No doctors think it will help. Just want to know your comments. Any advice will be highly appreciated.  

Also, this missing tumor cause different opinions on my treatment plan.
The first oncologist I saw recommended TCH*6 with H for 1 year. She said even score 2+ is not good and even a small HER2 positive tumor means chemo is needed.
The other oncologist I saw said if the missing HER2 positive is too small to find, she doesn't recommend chemo if the oncotype score for the bigger tumor is low.

The third oncologist I saw today said the second opinion pathology review is the same as the original one and he will bring my case to their weekly case study for more discussion before he can recommend a treatment plan. It has been four weeks since my surgery. I think I should start chemo ASAP but there are still no answers to all my questions.

Multi-focal/centric, five lesions in different quadrants of all different types. Mx due to large area of lesions. Found three more despite MRI. They only performed histology on largest (2.3 cm), so I will never know whether the other four were of the same histology. Too late, the baby's born. I wish I had this knowledge three years ago. Tammy

I was diagnosed with multi-foci breast cancer in 2007. The surgeon wanted to give me a double masectomy and then chemo. I was not up for that until I had time to pray about it and see what alternative methods were.  I discovered a whole new avenue of treating cancer than putting my total dependence on a doctor I don't even know and I was completely cleare3d 6 months later at my mamogram!! God is Good! I can rely on Him.

To begin with, check the way you are eating. Cancer thrives on sugar, preservatives and other chemicals and stresoids in foods, so you have to get rid of them all. It leaves you with organic meats, fruits, vegetables, eggs, tea, yogurt and cheeses that don't have sugar - but this is a great way to get started fighting that thing and then you can go to your local healthfood store and ask about supplements!

Godspeed!

LizG