positive margins

cc2e
cc2e Member Posts: 6
edited June 2014 in DCIS (Ductal Carcinoma In Situ)

I am trying to find answers,opinions for my mom who was diagnosised a few weeks ago with IDC, since then she had a lumpectomy last week and is getting ready to stat chemo followed by radiation. She is a triple negative. My concern is that the surgery showed that the lymph nodes appear to clear but there is still a positive margin but it is DCIS not IDC. The surgeon and oncologist agreed that they want to go ahead and start chemo instead of going back in and trying to get clear margins. When I questioned this I got the answer that the margin was very small and the radiation would take care of it and another procedure would delay chemo. I am calling again tomorrow for more explanation as I am having trouble wrapping my head around not going back to try and get clear margins. Just wondering if any had a similiar experience, IDC first, then DCIS found...did you have surgery again before starting chemo?

thanks for any sharing of experience and opinion. Everything is moving so fast that I want to make sure I am asking the right things

Carrie

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  • Beesie
    Beesie Member Posts: 12,240
    edited February 2013

    Carrie, having "very small" margins is not the same as having a positive margin. Generally 2mm is considered to be an "acceptable" margin for DCIS, but some doctors accept less. Do you know if your mother actually had any positive margins or were one or more of the margins just very small?  That does make a difference.

    IDC and DCIS are often found together, so the fact that the initial diagnosis was IDC (was that from a needle biopsy?) and the surgery has uncovered both IDC and DCIS is not unusual at all. IDC is the more serious condition, so the staging and treatment plan is always based on the IDC.  The DCIS needs to be removed but other than that, it can be ignored. 

    DCIS is a pre-invasive cancer - DCIS cancer cells do not have the ability to move into the nodes or the bloodstream or into the body. Invasive cancer is different; IDC cells are capable of travelling beyond the breast.  In fact anyone who has any amount of invasive cancer always faces a risk that some breast cancer cells may have moved into the body. This is true even for those who are node negative.  The amount of risk can vary considerably; the size of the invasive tumor, the grade of the IDC and the hormone status all factor into this risk. This is where chemo comes in. 

    Chemo is a systemic treatment; it's role is to track down any breast cancer cells that might have moved into the body, and kill off those cells before they have a chance to take hold. That's the main concern with breast cancer. Cancer cells in the breast really don't harm us - a breast is not vital to our lives. It's breast cancer cells that move beyond the breast and take hold in a vital organ that is the big concern. And that's why chemo is given. So chemo isn't given to women who have pure DCIS because technically there is no risk that any cancer cells might have moved beyond the breast.  In my case, I had mostly DCIS but also a very tiny amount of invasive cancer, however my risk was considered to be low enough that chemo wasn't warranted. Women who have very small amounts of IDC, or who have IDC that isn't very aggressive frequently don't get chemo. 

    Chemo is recommended when it's judged that there is a high enough risk that there may be breast cancer cells that have moved beyond the breast and into the body. It's much more important to treat that risk than to treat the breast itself. If there are any rogue breast cancer cells in the body, it's important to get to them quickly so that they can be killed off.  That's what seems to be behind the recommendation of your mother's doctors. 

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  • ballet12
    ballet12 Member Posts: 981
    edited February 2013

    Carrie, I never have much to add after Beesie's posts, because they are so detailed, but I do know that at my facility, they will give radiation boosts to areas with close margins that are not removed by surgery.  Recently, a patient who was getting rads the same time as me, for DCIS, not IDC, had a close margin next to the chest wall. Further surgery (after two lumpectomies) was not possible, as the surgeon essentially got to the chest wall during the second surgery.  Thus, boosts were given to the area with the remaining DCIS.  Ask if boosts will be given to the area with the close margin. That should, hopefully, take care of it.  Obviously, the team feels that your mother's cancer is aggressive enough that chemo is warranted quickly.  That might just be more important than going back for another re-excision, and radiation will take care of what's left in the breast.  Good luck!!! ((hugs))

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  • cc2e
    cc2e Member Posts: 6
    edited February 2013

    Wow! thank you, thank you for the reply, so apprecitated! First to ballet12:), interestingly her tumor was very close to the chest wall, although that was no given as a reason as to why they did not get negative margins. Boosts were not mentioned, but I will be bringing that up when I speak to the doctor again! Thank you!!! These are the things that I was looking for, the what else can I ask stuff!

    Bessie, you rock! Ok, her margin was positive, anterior side only, inferior margin was negative. I did ask about the acutally size, and he did not have it off hand, but said it was "small". IDC was found through needle biopsy. The intial invasion tumor was small (9 x 8 mm), and the grade was 3, but being a triple negative, it is considered aggressive I guess. Your insight is very helpful in helping me wrap my brain around the recommendation. As I said it is happening quickly, surgery last Tuesday and chemo schedule to begin in 7 days.

    One question, if I could, your second paragraph, last sentence..The DCIS needs to be removed but other than that, it can be ignored.....what do you mean by that?

    Thank you sooo much for your reponse, I am part of a different online medical based community for myself, and I know that I find the most insight from those who have already or are going through their journey. I truly believe lives are saved through forums like this. Thank you again, and healing thoughts to you both!

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  • Beesie
    Beesie Member Posts: 12,240
    edited February 2013

    Carrie, what I meant by that line is that if someone has IDC and DCIS and they have a treatment plan that's developed for the IDC, they don't need to worry about or even think about the DCIS.  Anything that's done for the IDC will be more than sufficient to treat the DCIS.  

    It sometimes happens that women who have IDC aren't even told by their doctors that some DCIS was found too. If they don't read their pathology report, they may never know.  As long as it's removed, the DCIS doesn't need any special attention or any treatment that would be different than what they are getting for the IDC. 

    ballet's suggestion to ask about a radiation boost is a great idea. I hope that your mother's doctors agree.  Good luck to your mother with the chemo and rads!

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  • cc2e
    cc2e Member Posts: 6
    edited February 2013

    That is what I thought you meant, unfortunately the DCIS  was not removed completely. I am feeling like I understand better the decision to start the chemo, instead of going back to remove the DCIS, it is hard as my thought is, just go in there and take it out, what is another week or two of postponing chemo, but maybe it is a bigger issue than I realize. Thank you again, for your insight, I feel better prepared for the conversation I will have hopefully tomorrow:) with the doctor. And the little I have just read on the the boost seems like a great idea, I will definitely advocate for that! Thank you again, your response is so truly  appreciated!

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