Lumpectomy- no evidence of malignancy?
I just heard from my surgeon's nurse that the pathology report on my lumpectomy shows "no evidence of malignancy" so the DCIS must have been removed via the biopsy. Is that unusual? I have so many questions, but won't be able to talk the doctor until next week. While I know that it is good news, I feel suspicious of the original pathology report. The DCIS must have been so small! It also makes me feel like radiation is too aggressive a treatment.
If anyone could advise me on questions to ask, please let me know.
Comments
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Slate, it is a very common outcome! The newest core needles are very very large, and surgeons are usually very aggressive with the number of cores they take (especially if you are tolerating the procedure well - which thanks to valium I did). All told I am pretty sure my biopsy had well over 1.5cms of tissue in total! I sent my original pathology out for a second opinion before I decided to have radiation. I would have sent my lumpectomy specimen too, but the original path was updated (a little worse than the first one in terms of how many foci there where and how much total) and it was a deal-sealer for me.
Size is only one consideration in whether or not to have radiation. Grade, your age (particularly pre- or post-menopausal), and ER-status (Tamoxifen) are all factors that the radiation oncologist will go over with you when you meet about radiation.
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That is exactly what happened to me. My tumor was small (3mm) and must have all been removed by the core needle biopsy. As for radition, I went with the 5 day partial breast radiation rather than whole breast radiation. You may want to ask your RO if that is an option for you. On one hand I felt radiation was overkill, but on the other hand, since I was going to skip tamox, it was something else I could do to reduce risk. It did not even occur to me at the time to get a 2nd opiniion on pathology, but I can see how that would be a good idea.
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Ok, I guess I better get an appt with the RO so I can find out what is recommended. My dcis was also said to be 3mm. I'm 42 and not sure how that will factor in. Thanks for the quick responses!
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This was my situation, although in my case, the final dx was somewhat confusing. I had my slides analyzed by no less than 3 different hospitals: dx at the first was DCIS, the next 2 came back as ADH. Excisional biopsy yielded only normal tissue, so, like you, everything was removed by the needle biopsy. Not sure exactly what the size of the ADH lesion was, but the onc characterized it as "exquisitely small."
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That's really great news!
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Hi Slate, here is a website you can fiddle with before your RO appointment:
http://nomograms.mskcc.org/Breast/DuctalCarcinomaInSituRecurrencePage.aspx
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I think my biopsy removed my DCIS as well. I had the lumpectomy and skipped the radiation and tamoxifen. No problems nine years later, so I know I made the correct choices.
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Wow - that happened to me too and I have been suspicious ever since that maybe I didn't even have cancer at all. I was so new to everything that I did have 38 radiation treatments and wonder if it was overkill. If I knew then what I know now, I think I would have handled things very differently. I also did not do Tamoxifen because every time I tried I had crazy side-effects, but every doctor I see urges me to take it, so I started again last week. A 1/4 of a pill for a while then I'll move up to 1/2, then ..... My oncologist said if a person can make it through the first three months the side effects usually level out.
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my cancer was found on an mri so i had an mri guided biopsy. after they did the biopsy they sent me back through the mri machine and nothing lit up so they figured all had been removed with biopsy. i had lumpectomy any way and path report showed no cancer in lumpectomy. i had 25 rads (no boosts) and was on tamoxifen until i had an allergic reaction 3months in. now i am not taking anything and contimplating a double mastectomy without reconstruction because i refuse to try any other drugs.
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McKenna,
Did you have an ultrasound before your MRI? My cancer was detected by ultrasound. I subsequently had an MRI, had 2adsitional sites that showed up biopsies, but those proved benign. Now I'm at my 6month check up, wil have mamo and ultrasound, but insurance is refusing to pay for an MRI this time. After reading your post I'm a little worried about not having one. -
The last couple of posts confuse me.
McKenna, it sounds as though you have the best possible situation (except of course for the DCIS diagnosis itself). A small grade 1 DCIS that was fully removed during the biopsy. And then surgery, which probably resulted in nice wide margins. To be honest, if it were me, at that point I don't think I would have had rads, although I certainly understand why others would choose to have rads. With your diagnosis and with the treatment you've had, I would imagine that your recurrence risk is in the low single digits, probably no more than 5%. So while you can take Tamoxifen to lower your recurrence risk even further, there really isn't a whole lot more that it can be lowered. Of course, Tamox. is also a preventative that can reduce your risk of a new BC in either breast, but the medical community is mixed on the benefits of prescribing Tamoxifen to 'high risk' women. I had a single mastectomy and discussed Tamoxifen with my oncologist, as way to reduce the risk of BC for my remaining breast; my oncologist actually recommended against Tamoxifen for me. That doesn't mean it's not right for you but it's just to make the point that there isn't agreement on the need for Tamoxifen.
Given what seems to be your very low recurrence risk, what's causing your worry and your thoughts that you might want to have a BMX?
Susannah, what is it about McKenna's post that caused you concern? Everyone's situation is different. Your BC was discovered on an ultrasound; your MRI resulted in a couple of false positives. Given that, I would think that a mammo and ultrasound is the logical screening for you; if anything suspicious shows up, then I would expect that you will be sent for an MRI. MRIs are usually considered diagnostic and are not usually are not recommended for screenings; in your case, since your cancer was detected by the ultrasound, I don't see why you would be worried that you are not having the MRI. Given your history of BC, you may want to talk to your doctor about your on-going screening; it may be appropriate to include MRIs on an annual basis or perhaps once every couple of years. But personally I wouldn't worry about not having the MRI now, for your 6 month screening. I'd be more worried that an MRI would result in false positives again!
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Slate5,
Pathologists disagree up to 20 percent of the time, so it may be wise to get a 2nd pathology opinion, especially since all treatment is based on that pathology report.
Doing this was key for me when after my lumpectomy in 2007 local pathologists said I did not get good margins and my surgeon was recommending a mastectomy. An Aurora RODEO MRI found two suspicious areas, which when biopsied were both benign. I then had Dr. Michael Lagios, a world renowned DCIS expert and pathologist, with a consulting service anyone can use, review my pathology.
Dr. Lagios disagreed with the local pathologists and said I did get good margins and did not need a mastectomy. He also calculated my risk of recurrence without radiation,using the Van Nuys Prognostic Index, as only 4 percent. Because you can only use radiation once in the same area and because my risk was so low, I chose not to do radiation. The 50 percent radiation typically provides would have only been 2 percent in my case.
Another tool for assessing your risk of recurrence without radiation is the Oncotype DX genetic test. This is fairly new and somewhat untested, but could be a valuable piece of info in conjunction with the opinions of your doctors.
If you would like more info re Dr. Lagios, the VNPI or would like to read more of my story, please go to my website: http://dciswithoutrads.com/.
Please also feel free to PM me anytime.
Wishing you all the best,
Sandie
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