INVASIVE DUCTAL CARCINOMA, NOTTINGHAM TUMOR GRADE 2

Usual a cancer board will meet and make a recommendation. Lumpectomy with radiation statistically can be the same as mastectomy leaving choice to patient preference.

Dear Maxfaith:

it is normal to be very worried, especially when some things are not known yet. In another thread, you mentioned that your mom does not know about your inquiries here, because you don't want to worry her. I am pretty sure she is already worried. You are both alone in your worry. Please talk to each other. Let her know that you would like to understand her diagnosis and treatment better, and to help her as much as you can. Ask her how you can best support her.

Hopefully, you have started to read the "101" materials at the link provided by the moderators. It is a lot to absorb, and you may have to read it a few times, because being worried makes it hard to think. Your mom might be interested in this very helpful website also.

DCIS and IDC:

"Ductal Carcinoma in Situ" or DCIS is a very early form of non-invasive breast cancer that is found only in the ducts. Over time, the cells can break through the wall of the duct, becoming "invasive". Once the cells break through the duct wall, the cells are "invasive ductal carcinoma" or "IDC" and form a tumor. When DCIS and invasive disease are both present (quite common), treatment is based on the stage the invasive disease.

STAGE:

With invasive disease (IDC), the stage is usually based on three things: (1) the size of the IDC tumor in millimeters or centimeters; (2) whether or not there is any involvement of the regional lymph nodes; and (3) whether or not there is distant spread.

The exact stage may not be known at this time. If an excisional biopsy was done, the pathology report should include information about the size of the IDC tumor. However, the status of regional nodes could still be unknown, since it is determined by a different biopsy (e.g., a sentinel node biopsy). Complete stage information will be available after surgery and sentinel node biopsy.

Please note that "lymphovascular invasion" is a local observation (near the tumor or "peritumoral"), and is NOT a finding of regional lymph node involvement.

Since they are saying it is early stage, that means there is no evidence of distant spread.

MASTECTOMY or LUMPECTOMY:

Meow is correct that lumpectomy plus radiation is as effective as mastectomy. In some cases, a lumpectomy is not possible or is not recommended. For example, patients who may have received radiation to the breast previously or patients with extensive DCIS relative to the size of the breast, may not have the option of lumpectomy. Sometimes, other considerations or risk factors may lead a patient to choose mastectomy.

If a patient does have the option, there is a good re-post on these boards here about some factors to consider:

https://community.breastcancer.org/forum/68/topic/...

If the IDC is relatively large, sometimes patients receive chemotherapy before surgery ("neoadjuvant" chemotherapy) to try to shrink the IDC, so that a lumpectomy plus radiation can be done. (DCIS does not really respond to chemotherapy, so this option only applies to invasive disease.)

BILATERAL MASTECTOMY:

Cancer in one breast does not usually spread to the other breast. If your mom has DCIS and IDC in the left breast only (the one that was biopsied), removal of the right breast may be "prophylactic" or preventative (known as contralateral prophylactic mastectomy or "CPM"). CPM may be recommended because of certain findings or other risk factors.

You could ask your mom if she understands why bilateral (left and right) mastectomy is being recommended to her, or why she may have chosen it. If she is not sure why, she should contact the doctor, and ask them to explain the basis for the recommendation to her again. That should not be a problem.

She also has a right to receive copies of all reports, such as the full pathology report. This may include more information about the IDC, including the size, whether it has estrogen receptors ("ER"), progesterone receptors ("PR"), and/or is HER2 positive or negative.

She may also wish to obtain a second opinion from a breast surgeon, which will include a review any images and the pathology slides by a radiologist, and provide an independent recommendation regarding a treatment plan.

By the way, in what country are you and your mom located?

BarredOwl

Yes and thanks Muska for boiling it down. Further communication with the doctor may be needed to know why.

I was just saying there might be reasons why mastectomy is being recommended (even for early stage). But from the information provided, it is not clear if they apply or not. And (in boldface), to ask again until you understand.

(I should add this is not a request for more patient history or test results: The best way to understand a treatment recommendation is to discuss it with the medical professionals who have access to all test results and patient history, or if still in doubt, obtain a second opinion when feasible.)

MaxFaith: How old are you? With a 49 year old mother, you could be quite young to young adult to adult. If you are younger, I would encourage you to first talk to your mom per the first paragraph of my long post above.

BarredOwl