Radiation? No clear margins with DCIS at the skin!

Options
Omeggo
Omeggo Member Posts: 275
edited June 2014 in Radiation Therapy - Before, During, and After

Hi all,

I had a DCIS dx in June.  Turns out it was muliti focal and with my MX, a small IDC tumor was found.  Pathology indicates that there are two foci where the margins (of DCIS) were less than .1 cm, on the anterior and superior parts of the breast at the skin.

There will be a discussion if further treatment is necessary at the Wed 9/5 "Tumor Board" where sugical and oncological team meets with their radiologist and pathologist colleagues and discusses unusual cases. I don't like being an unusual case and can't stand the idea of any gray zones at all. 

Other relevant info is there family history of BC (mom), I'm post menopausal, started Arimidex, the DCIS was HER2+ but the IDC tumor was HER2-, one lymph node had fewer than 200 tumor cells present. Chemo was optional (4% better prognosis) and radiation didn't (yet) come into the discussion.  My MO seemed to have overlooked the margin issue (hard to believe) but my BS brought it to my attention when I saw him.  He seems to think that with all the cauterization, there is no likelihood that DCIS cells would be left over.

So, does anyone have any such experience with this kind of issue???

I've had BMX with immediate implant reconstruction on 8/15/12.  Radiation, if indicated, would mean I'd have to 'de-construct' I guess and reconstruction would have to be down the line, which I'm OK with...sort of.

THANKS for ANY input or leads to other threads here!!

Omeggo

· Share on FacebookShare on Twitter

Comments

  • dlb823
    dlb823 Member Posts: 9,430
    edited September 2012

    Omeggo, I haven't had experience with the sorts of things that concern you, but I am wondering no matter what the tumor board recommends if maybe you should seek a second opinion on your tx to date.  

    It does sound like RT would be a good added insurance with two possibly concerning margins, but I think I would want to hear the complete rationale for it from more than one team, especially since doing it now may affect your recon.  And since your case is a bit unusual, I don't think it would hurt to have another medical team weigh in on it -- just for your own peace of mind -- especially if it means possibly undoing your recon.

    So sorry you're going through this, but hopefully what to do will become clear to you.   (((Hugs)))   Deanna 

    · Share on FacebookShare on Twitter
  • HLB
    HLB Member Posts: 1,760
    edited September 2012

    I agree with the second opinion. These decisions are so hard; I had so much trouble deciding between lump and mast at the time I think I almost had a nervous breakdown! It seems no matter how much info you have and hours of research you do its never enough.

    · Share on FacebookShare on Twitter
  • mom3band1g
    mom3band1g Member Posts: 817
    edited September 2012

    I had a similiar scenario to yours.  I had mast for huge amount of DCIS (literally nipple to chest wall).  My margins ended up being less than 1mm posterior and anterior.  I was told to have rads.  I had TE's in place for radiation and was fine.  I had to wait quite a bit longer to have my exchange surgery but my skin did very well.   Let me know if I can help you.  My bs told me it would come back if I didn't do rads.  When I met with the rad onc he too felt very strongly that I have rads.  I was 39 and my DCIS was found because I found a lump in my breast.  I did have family history as well (paternal aunts).

    · Share on FacebookShare on Twitter
  • Omeggo
    Omeggo Member Posts: 275
    edited September 2012

    To those who have so far responded, thank you!  Very helpful.  I've been thinking that a second opinion is smart, but even before that, I'm thinking rads may be the way to go. I'm predicting that they (the team) will say it is my decision. 

    It is also good to know that it sounds like I can have rads with a tissue expander in place.  Wasn't sure they could do that.  I"ll be asking my PS about that once I get the next call, i.e. after Wed.

    I'm still very open to anyone's experiences and I always need tons of support! Who doesn't right? :) 

    The gray area is incredibly crazy making. Mom3, I'll pm you when I hear more. Thank you for your offer. It does sound like we have a lot in common, even though I'm a bit older.

    Hugs to all and thanks again!

    · Share on FacebookShare on Twitter
  • Omeggo
    Omeggo Member Posts: 275
    edited September 2012

    UPDATE:  Yesterday the tumor board met and discussed my case.  My onc called today to let me know that they are not recommending RADS.  NO RADs!!!!  He was emphatic.  Will hear more from PS and BS next week at my appointments.  I am relieved.  Thought about second opinion options but there were a few RO's and others reviewing the case.  Sounds like it was unanimous.

    Thanks for your support and input once again.

    Big, clean foobie hug to all! (Just got my first real shower after three weeks.  Second drain out yesterday!)

    · Share on FacebookShare on Twitter

Categories