microinvasion discounted?

clarrn,

I think you need to ask your breast surgeon why the pathology report says that the microinvasion is "discounted".  

I've seen biopsy reports that say "suspicious for microinvasion" or that there is a "possibility of a microinvasion" or "microinvasion can't be ruled out" - this is what is often said when some cancer cells are found outside of the duct but they aren't certain if the cells were misplaced by the needle or whether it's a real microinvasion.  Often with a needle biopsy they don't do the full biological analysis to determine if those cells are displaced DCIS cells or a true microinvasion - they wait until the surgery to see if any more invasive cells are found.  But they certainly shouldn't completely discount a microinvasion (or possible microinvasion) at this point - it's more appropriate to note the possibility. 

What else did the report say, in terms of the DCIS pathology?  And have you had your surgery yet?

wow. is it your idea or thiers to do mastectomy for dcis?

Hi clarrn:  I just wrote a lengthy response and it disappeared! Trying again.  I too had to have a mx due to a large dcis and a small breast.  The mx went extremely well (I did not have reconstruction) and I hope yours does too.  It is five weeks post mx and I am pretty much fully functional and back to myself (minus one breast!)  You have already heard from the expert on micro-invasion.  I am no expert in that topic, but am gaining expertise in dealing with surprises along the way.  I had a positive margin so have to consider radiation now.  Your situation is very hopeful, but surprises happen.  They usually are not extreme, but they can send you spiraling again.  Try to focus on your surgery and your recovery.  One step at a time.  Your diagnosis is not final until the pathology following your surgery.  If you face a surprise, all the ladies here are amazing to answer new questions and to provide support along the way.  I have been shocked by all the information and treatment decisions to be made and how difficult these decisions are.  Thinking of you and all the best. (((((hugs))))) 

Sam, I think I would want genetic counseling before you make your decisions based on the other cancer. It could have bearing, but it also might not. 

I was surprised that the type of ovarian cancer I had doesn't really up my breast cancer risk very much, but there are genetic syndromes that can cause both colon or intestinal cancers and breast cancer.

I can only repeat that though it is standard to do a sentinal node biopsy in the case of a microinvasion, my MO says she has never seen a positive result in the nodes with a micro.  And, again, I'm presuming that when a micro is discovered, it almost certainly has had to already have been there for SOME period of time.  As to the lumpectomy/rads as opposed to the mx, I will have to defer to the more experienced advice you will get here from someone who knows more than I do.  Best of luck. - P.

A surgical oncologist is still only a surgeon, just one who specializes in cancer surgery rather than general surgery.  A surgical oncologist will of course have familiarity with other cancer treatments (beyond surgery) but that's not their area of expertise nor it is usually their role to advise on or administer these other treatments.  A medical oncologist (often referred to as just an "oncologist") is the doctor who specializes in cancer itself and who is responsible for the overall treatment plan for a cancer patient.

This is from a Canadian website:  "In the context of the
multidisciplinary breast cancer treatment team, the oncologist is the quarterback.
The oncologist is the one who typically requests additional imaging and biopsy/pathology
studies in order to 'stage' the breast cancer. The oncologist is also the
one who ultimately decides on the appropriate course of treatment, after consultations
with the surgeon, the radiologist, the radiation oncologist, and the pathologist.
An oncologist, or more specifically a 'medical oncologist' is also the one
who determines and administers chemotherapy." http://www.breast-cancer.ca/treatment/oncologist-hemato-treatment-breast-cancer.htm

And from the U.S. National Cancer Institute:  "Medical Oncologist   A doctor who specializes in diagnosing and treating cancer using
chemotherapy, hormonal therapy, biological therapy, and targeted
therapy. A medical oncologist often is the main health care provider for
someone who has cancer. A medical oncologist also gives supportive care
and may coordinate treatment given by other specialists."

So yes, you definitely should be referred to a medical oncologist and ultimately it will be the medical oncologist, not the surgical oncologist, who should discuss with you any other treatments that might be advisable to reduce your risk of recurrence.  Should you choose to have any other treatments, it's the medical oncologist who will set up the treatment plan and monitor your progress.  

With early stage breast cancer, often we don't see a medical oncologist until after surgery however for women who have more advanced cancers, it's very important to see the MO early on, before surgery.  Even for early-stagers, if you are uncertain about what you want to do or what may be ahead, seeing a MO before surgery can be helpful. An MO would certainly be able to explain why the type of surgery (lumpectomy vs. MX) won't impact whether or not you need chemo or Herceptin, and would be able to talk about why Tamoxifen might be advisable for you even after a BMX (again, this would be different for someone who has pure DCIS). 

Hopefully you are HER2- and node-negative, in which case Herceptin won't come into the discussion (it's only for those who have invasive cancer that is HER2+) and chemo is much less likely to be considered.   If that's the case, however, since you would not be getting any treatments to address and reduce the risk of distant recurrence (a low risk with a 9mm tumor, but a risk nonetheless), it's more likely that you would be advised to give Tamoxifen a try.

Hi Clarrn and Beesie. As you probably know, I've only been on here a couple of times and am still lost as to how to get to information about my personal concerns. I appreciate your previous response, Clarrn, and I'm sorry I haven't been able to get back here for some time now. I'm also very interested in your opinions Beesie because after reading some of your posts, you sound like a nurse or at least VERY familiar with breast cancer issues.

I finally opted to have right skin-sparing mastectomy with delayed reconstruction instead of lumpectomy, surgery was Feb. 20. As it turns out, I guess I made the right decision considering the surgery pathology report....my oncologist even agreed although she first recommended lumpectomy. I'm having 1 complication -- large 2" seroma on my upper chest right where the armpit starts and right where any bra strap or tank top would hit. Surgeon won't even consider draining it for at least another 4 weeks when she'll look at it then, and also saying it could resolve on it's own but would take quite a while. She said she also wouldn't write a script for a bra or prosthesis until atleast then, saying she'd prefer I didn't attempt to wear a bra yet. Seroma is quite sore and more of a nuisance than a worry.

My core biopsy report diagnosis was DCIS with microinvasion. My surgical report says the DCIS area spanned 4-5cm area "although largest focus on the blocks measures 1.9cm". Taken were 2 sentinel and 1 axillary nodes, all negative. And the DCIS area was at least 1cm from the closest posterior margin. Stage is T1a N0. It also says in the surgical report "ER, PR and HER2 performed on previous biopsy"...which isn't correct because the biopsy pathology report did say ER+ and PR+ but after HER2 it said "requested"....I think I mentioned previously that my oncologist said that meant there wasn't enough area taken at biopsy for HER2 testing.  The surgical report says for Size of Tumor: "Microinvasive foci (see S14-409), whatever that is, and for Tumor Focality it says "Multifocal".  So, this leaves me not knowing much at all about how many ducts were involved or the extent of the microinvasion. And my oncologist while we were looking over this report just quickly brushed by the HER2 comment like it wasn't important.....I thought I had read previously in researching that HER2 is very important insofar as type of treatment???  Oncologist is highly recommending hormone therapy for 5 years explaining, if I understood her correctly, that even though my lymph nodes were negative that the microinvasion part of my diagnosis means that the cancer could, or already could have, spread through blood vessels in the breast tissue...so I was first ecstatic about negative nodes and the clear margins, but am now upset over the thought that I might actually have microscopic cancer cells traveling in my bloodstream.  

I'm trying to decide between Tamoxifen and an Aromatase Inhibitor, looking at all the side effects. Just because I said that having stiff and aching joints as a side effect of an AI might continuously keep cancer on my mind, my oncologist rushed to say, "ok, I'll call in the Tamoxifen to your pharmacy" (treatment was very quickly discussed at end of appointment with her looking at her watch, and she said I could wait a couple weeks to start it). Now I'm wondering if an AI might be safer for me because of one of the side effects of the TAM being uterine cancer....and considering my prior problems--ruptured ovarian cyst at age 21, cervical dysplasia at about 30ys old, appendicealand colon cancer 3 years ago, and Barrets esophagus.

I very much welcome and would greatly appreciate any comments and advice.

Love and best wishes to all :-)

Sam