Just Diagnosed Lumpectomy scheduled December 30

You will come out the other end. Trust me/us. But the beginning is the worst, emotionally.

((((Hugs))))
The beginning is really the hardest. There is so much waiting, which can be scary and it's very easy to feel overwhelmed!
One thing you need to know is that you CAN do this! One step at a time, you WILL get through this.

Cancer is scary and the treatments can be scary too, but you're not alone. Coming here, to these boards, is a great help! You will find a lot of support and friendship here.

Hi Mbz64:

Sorry about your diagnosis. You've received some good advice already.

Have you obtained copies of the radiologist's written reports from all imaging, and a copy of the pathology report from the biopsy for your records? It is important to review these documents, understand the features of the disease, and how your treatment plan is suited to treat it.

I have a question about the treatment plan. I am wondering if you were diagnosed with pure DCIS or if you had some invasive disease, such as a small area of micro-invasion?

If you had some invasive disease present (e.g., micro-invasion), then a sentinel node biopsy is definitely indicated.

In contrast, if you have pure DCIS (which is by definition "non-invasive"), then a sentinel node biopsy is not usually indicated for pure DCIS. Under current treatment guidelines from the National Comprehensive Cancer Network (NCCN), Version 1.2016, the recommendation for lumpectomy plus whole breast radiation therapy does not include sentinel node biopsy (emphasis added by me):

"Lumpectomy without lymph node surgery + whole breast radiation therapy (category 1)"

This is because the sentinel node biopsy procedure carries a risk of lymphedema.

There are some exceptions to this, for example:

"However, a small proportion of women with seemingly pure DCIS on initial biopsy will have invasive breast cancer at the time of the definitive surgical procedure and thus will ultimately require ALN staging [sentinel node biopsy]. In patients with seemingly pure DCIS to be treated . . . with excision in an anatomic location (eg, tail of the breast), which could compromise the performance of a future sentinel lymph node (SLN) procedure, an SLN procedure [sentinel node biopsy] may be considered."

Sometimes with very extensive, high grade (Grade 3) pure DCIS, patients and their doctors together decide to proceed with lumpectomy plus sentinel node biospy in the first instance.

However, with pure DCIS, and no specific contraindication based on the excision location or otherwise, it is possible that one has the option to defer sentinel node biopsy until the surgical pathology from the lumpectomy is reviewed. If the surgical pathology confirms pure DCIS, then no sentinel node biopsy would be required at all and one can avoid the possible side effects.

If you are not sure about your pathology, or not sure why sentinel node biopsy is being recommended to you, or would simply like to discuss the option of deferring and possibly avoiding it, please do not hesitate to follow up with your surgeon.

I have posted on this subject before, if anyone wants to read more:

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

BarredOwl