multi-focal tumors.....and survival

I'd love to hear some too.  I had 10 tumor/tumorlets, micromets in 2 nodes, one that was extranodal.  I have a low oncetype and am on tamoxifin.  I'm not interested in statistics (because we're not differentiated out) and would love some anecdotal evidence.

My wife had multi focal disease. All the tumors were histologically similar.



I read where mastectomy essentially wipes out any higher risk of recurrence with multi focal... and frankly, a lumpectomy----if it excises the tumors with good margins----would be fine, too. It's just trickier to be certain you got all the lesions with lumpectomy.



My wife had a 2.2 cm primary tumor and 1 cm and 4 mm 'satellites' very nearby.



When trying to figure tumor burden with multi focal for staging, it gets tricky. Adding the tumor diameters (at their widest area) is misleading and overestimates tumor burden.



I was trying something with my daughter's Play Doh. I rolled a 2.2 cm ball, a 1 cm ball and a 4 mm ball (keep in mind that this may also be overestimating as her 2.2 cm was not a ball, but rather was 2.2 cm at it's widest diameter) ------and if you add the 3,diameters up, you get 3.6 cm.



BUT if you literally roll all 3 balls into 1----the diameter of the 1 larger ball is just 2.6 cm.



VOLUME isn't about adding diameters at their greatest width.



It makes sense to me that tumor burden is more closely related to volume, which is likely to be somewhat close to the size of the primary tumor, particularly if the primary lesion is significantly larger than the satellites.



It's probably why they still go with just the primary's size for staging purposes.



In the end, because surgery is referred to as the "primary treatment", any surgery that achieves clean margins essentially serves the purpose of surgery, whether you're multi focal or not.



My wife's oncologist wasn't the least bit concerned with the multi focality since the surgery my wife had achieved clean margins.

Thanks for the replies.  I was given a T1c from pathologist (surgery) with the largest nodule being 1.3, one at .9 and one at 1.1.  (two were IDC and one was dcis).  Also only close  margins were obtained following BMX (one tumour was within 1mm of chest wall) and lymphovascular invasion was positive.  The tumour load (stage) was being treated for the largest of 1.3 cm.  I have been turning it over in my head that if one added up all the tumours, I would be at 3.2 cm and that would change my stage  (the one article that I found discussing this on the Internet also fed my fears).  Colt45--appreciated your play-dough experiment.  It made sense as i was wondering why they might only use the largest size of one for staging.  I feared "under" staging and the results. There seemed to be little discussion about this topic.  Also I was to get Sentinel dissection but the dye did not travel to my nodes.  So three axially nodes were found and submitted which were clear (thankfully).  But then one wondered why the dye was blocked.  The surgeon suggested that the sentinel node was the cancerous mass or maybe the passage to the lymph nodes were being blocked by cancer cells or maybe just scar tissue from the first diagnostic biospy was causing the blockage.   

i guess i know now why I'm getting radiation following BMX.  That was not expected.  

I didn't realize I was posting in the Stage III Breast cancer forum since I found this discussion using the search function.   I think it could apply to all of us with multifocus/foci tumours.  

My extra tumors were not tested for ER/PR/HER2... Did you have to ask to have them tested? Maybe mine were too small to test??? Now I'm worried that maybe I should have gotten Herceptin too. 

Lekker, thank you, that is very reassuring!! I don't know the exact size of the smaller tumors but it sounds like they would've been well below the cutoff for Herceptin. So that makes me feel much better!!

I was also multi focal. Main tumour was 5cm with satellites of a further 3cm. Just 1.5 years out I find it interesting that majority of women with multi-focal on this thread areassociated with ER/PR+ Subtype.

Kathleen, good for you. You are a prime example of it can be done.

Hi everyone. I also was multi centric. I had 1cm ILC and 1cm tumor IDC in same breast but far from each other. They don't add the tumor sizes together anymore for staging so I'm stage one. Good luck to all...

I had sentinal node and one more biopsied and nothing found, only the 2 tumors. I was er 95% and pr less than 1%.

dtad:

I take it you did  not have any lymph involvement either?

Hey ladies:

My second primary cancer was multifocal - 5 little tumors. 2 IDC and 3 ILC. I am node negative. And the oncologist says all the multiple tumors just means I needed a mastectomy. Which I had. I am waiting for oncotype dx results, but the MO said likely I will not even need chemo. I do not need radiation. She says the prognosis for the second cancer is good. I am 100% ER+/98% PR+ her2-

wallan

My diagnosis is multi-focal IDC. A second tumor was detected on the MRI. The second tumor was about the same size as the primary tumor. So it turns out my left breast was really loaded. I had a masectomy on 4/6. My surgeon seems confident that he removed all of the cancer. The MO didn't seem too concerned that it was multi-focal. The goal was to get treatment started sooner rather than later. I start chemo next week...so here's to moving forward.

kathleen1966 - Just read your March 2017 post above, which was so cute! I love the idea of you waving back at yourself from the future. I found my post on this thread from 2012, so I'm waving back at us too

Hugs to you in the present...Julie (middle name Kathleen!)

susan, can I ask how you found out that it was in your hip? I had multi focal (10 foci ) invasive lobular. All clustered in one area. Had lumpectomy and radiaion. Started femera and zoladex shots. Have had hip and back pain which I am told is a side effect of the meds - both have that side effect. So, my question is did you have any joint pain from the meds? How did you realize it was in your hip?