Biopsy report seems to be incomplete.

Hi EbonyEyes,

My tumor is small too -- less than 1 cm. I'm having sentinel node injection on Monday and on Tuesday I'm having a lumpectomy and intraoperative radiotherapy.

When I saw your first post, my first thought is that I think that there are two biopsy reports...the first one is from the needle biopsy when they take a small sample of tissue through a needle when they are trying to determine if the breast lesion is cancerous or not. The second biopsy report is after the tumor has been removed surgically and sent to the pathology department where they determine more thoroughly the characteristics of the tumor.

Intraoperative radiotherapy is radiotherapy done in surgery. It was pioneered by my surgeon and is an alternative to external radiation therapy.

My surgery is this Tuesday. I, too, went through the gamut of emotions, fear, anger, self-pity. They have lessened considerably now.

If you're inclined to learn more about intraoperative radiotherapy and see if you might be eligible to receive it, you can read about my surgeon here.

http://drholmesmd.com/bio/

With you in spirit,

Evie

EbonyEyes, I get it. I have not had a mastectomy, but it is on the table pending scans in September and December. The first thing people do when they figure out I had chemo for breast cancer is look at my breasts. It makes me feel that they will think I am less than a woman if they see something missing. I think women who have been through it understand, other people are not so kind. Thursday I went to work with no head covering and super short hair, and everybody stared. What the heck people, it's only hair.

We have a forum on here called Crazy Town, and another one called Steam Room for anger. Come there and rant, we all do it there, it is a great outlet for whatever and however you are feeling. No judgment or nitpicking

EbonyEyes,

If you're considering looking for another surgeon, consider Dr. Holmes. If your tumor is small, you may be able to have lumpectomy and intraoperative radiotherapy (IORT) which is radiotherapy done in surgery (20-minute application) in the tumor bed once the tumor has been removed. That's it -- lumpectomy and IORT and done.

If nothing else, perhaps you can call his office and see him for a second opinion.

He was actually my second opinion.

You're in my prayers too sister!

xoxo

EbonyEyes, don't leave. Just ignore inflammatory posts. If you end up having a lumpectomy, also check the Lumpectomy Lounge. PeggyPontiac started it I think, and she is super supportive, funny, quirky, and just a joy. There are lots of caring, supportive, concerned women on here. I just ignore the ones that aren't. I even had one send me a personal message chastising me once, I blocked her and reported her to the Mods.

Hugs, and keep us posted as you go through this bewildering process! And know there are people who care and are here to hold your hand when needed!

You had not mentioned size - just that a mastectomy makes one a 'freak' - WRONG it does not Even for large breasfed women there are options and no need to be a 'freak' unless by choice. There is reconstruction, prothesis, and with either reducfion surgery can also be an option.

EbonyEyes,

I'm so sorry you find yourself here with a BC diagnosis. But "here" on BCO is good place to be for information and support, so welcome to our family.

It sounds like your other health issues will make your cancer treatment more challenging than perhaps for many of the rest of us. Your cancer is very small; in Cancerland that typically can be very good. It's quite possible that chemo won't be necessary, and perhaps not even radiation. BarredOwl makes very good points; your surgeon may know about - but does not decide - treatments like chemo and radiation. in my town my surgeon (who is a general surgeon but is also known as "the" breast surgeon) is also the head of the tumor board. Once I was initially diagnosed, and my surgery was complete (I chose a lumpectomy), the board met to discuss my case and collectively create a treatment plan. But my medical oncologist talked with me directly about my need for chemo, and my radiation oncologist discussed rads. My surgeon knew instinctively that I'd need chemo because my tumor was larger than 1 cm, but additional testing showed my cancer was aggressive so I was offered a more intense chemo regimen. Sometimes, things change.

Treatment plans take into account your general health, too - and for you that will be an important consideration. So where maybe someone else with a smaller tumor might be able to get away with a lumpectomy, it sounds like they're recommending a mastectomy for you. Do you know why they're recommending an mx? For instance, do they think this will protect you from needing radiation? If you don't know why the surgeon is making this recommendation, I encourage you to ask, and know, and be comfortable with the treatment decisions being made. Because the most important piece in this whole process is YOU - and you get to make the final decisions. All these doctors - they make recommendations, give you the pros and cons, tell you percentages and potential outcomes. You make the final decision. There are women here who were strongly encouraged (maybe even "told") to do chemo or rads, and they said no. We make decisions about surgery every day -lumpectomy, mx, bmx. I chose not to take Tamoxifen or an AI. My doctor gives me grief still, but understands it's my choice. All of this - it's your choice too.

Lastly, I want to reach out and hug you, and let you know you won't be a freak. I know it may feel that way to you, especially given your size (my daughter is a 36GG so I think I know where you're coming from). Its life-changing to lose a body part, especially one that has cancer. Please be kind to yourself while you're making your way through this really, really hard time in the diagnosis and treatment process.

Take care - Nancy

Hi EbonyEyes,

Intraoperative radiotherapy is also offered at the University of Virginia.

You can also google "intraoperative radiotherapy breast" and the city you live in...that is how I found Dr. Holmes.

Here is the UV link:

http://www.uvaphysicianresource.com/intraoperative...

I'm grateful I found out about IORT -- IORT with a lumpectomy is a lot less scary than all the other treatments I've read about.

I just went to the above website and clicked on Clinical Trials. I am part of a clinical trial with Dr. Holmes. There is an IORT clinical trial at UV and here is info about it:

http://www.uvaphysicianresource.com/clinical-trial...

Hugs still coming : )

xoxo

Hi EbonyEyes:

From your comment today, it looks like you think your surgeon was more alerting you to possibilities, which is good.

NancyHB makes a good point about understanding why the surgeon thinks mastectomy is indicated versus lumpectomy in your particular case. I realize you may understand this already.

I see that many people are sharing their experiences with lumpectomy or intraoperative radiotherapy, etc. Occasionally, I have seen patients here who report that they had a double lumpectomy. With a small area of invasion and two sites of DCIS (and possibly other findings not set forth in the threads), these options may or may not be suitable for you. I have no idea.

If you need/want more information, these various options could certainly be investigated by further discussion with your surgeon or other team members. If you wish, a second opinion might also be helpful. In any case, you may still choose to be treated by your current surgeon. (My surgeon was all business, and what I cared most about was her current knowledge, skill and experience.)

When I first received a recommendation of mastectomy for multifocal DCIS, I wanted a second opinion. Some people seek a second opinion about their pathology only. Others (like me) seek a complete review of all imaging (mammograms, ultrasound, etc.), all associated written reports, and a fresh review of the actual pathology slides (which are sent overnight to the other institution), plus an independent recommendation regarding surgical treatment options. There may be additional testing recommended, such as genetic counseling and possible genetic testing under certain circumstances (considering factors such as certain family history, age, and/or presentation). I asked the second institution what they needed, and then followed up with the nurse navigator at the first institution to ask what I needed to do and who to contact to get the materials needed.

BC.org has a good section about second opinions if you haven't seen it already. There are multiple sections (see menu at left).

http://www.breastcancer.org/treatment/second_opini...

Stay with us.

BarredOwl