Brand Spanking New and clueles Help with what this all means..

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GoodVibrations
GoodVibrations Member Posts: 3
edited June 2016 in DCIS (Ductal Carcinoma In Situ)

I am 56, healthy and active with no family history of breast cancer. I have had annual mamograms ..forever..

I felt a lump 4 years ago.. it was a cyst..No further issues. I have now felt another lump at the same location of the last cyst..But this time there was some tingling and itching.MyOct 2014 negative no issues..I go in for a mammogram with a specialist. Radiologist is concerned,so schedules me for needle biopsy( 2 suspicious sites).Here is the path report. Only left breast involved

Good news- I think..Estrogen and Progesterone Pos and Her2 Negative (0) but...Ki-67 HIGH (80%)

areaA- DCIS at least 1.0cm nuclear grade 2, Comedonecrosis

Area B- Microinvasive ductal Carcinoma 1.5mm thats MM! 2 foci

Only Microinvasion present

Associated DCIS grade intermediate central luminal necrosis present

I thought this was a "great cancer" to have.. but my breast surgeon look like shes highly concerned and ordering another biopsy and a breast MRI.

She is one of the best and I have a family member that is an MD.BS is saying mastectomy ..why is she saying this from these results..Can anyone help me with what the BS is thinking is so wrong that has me meeting with a platic surgeon asap..I thought standard thinking was a lumpectomy..what am I missing?
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  • MelissaDallas
    MelissaDallas Member Posts: 7,268
    edited June 2016

    This is my guess, but the MRI may mean that she is concerned that there are more areas not seen on mammogram based on the fact you already know it is multifocal (in more than one spot). She may be talking mastectomy because the fact that it is multifocal might make breast conserving surgery impossible to do with a reasonable cosmetic result. You can have large areas of multifocal DCIS and still not be found to have any invasive cancer, but that would be a concern too. Until you have the remainder of the testing done it is just kind of up in the air.

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  • Ingerp
    Ingerp Member Posts: 2,624
    edited June 2016

    Have you looked up "microinvasive ductal carcinoma"? Looks like there were a small number of cancer cells outside the duct lining? Sounds like borderline IDC? My understanding is if there's more than one area of concern, mastectomy is recommended.

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  • april485
    april485 Member Posts: 3,257
    edited June 2016

    Also, anytime you have comedo-necrosis, that means the DCIS is already more concerning but you are still in an early stage and that is a good thing. Couple that with micro-invasion and you are likely looking at IDC Stage 1A rather than DCIS . Please read Beesie's "Layperson's Guide to DCIS" It has a lot of very good information that you should have at this time. Best to you moving forward.

    Edited to add the link to Beesie's post

    https://community.breastcancer.org/forum/68/topics/790992?page=1

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  • BarredOwl
    BarredOwl Member Posts: 2,433
    edited June 2016

    Hi GoodVibrations:

    Just wanted to clarify that "microinvasive ductal carcinoma" is not a "borderline" form of IDC, as noted by another. It is a very small IDC. However, the terminology used in your report is a little confusing, as explained below.

    Tumor sizes ("T" status of the TNM staging system of the AJCC) are as follows:

    https://cancerstaging.org/references-tools/quickreferences/Documents/BreastMedium.pdf

    T1mi Tumor ≤ 1 mm in greatest dimension <==== MICRO-INVASIVE DEFINITION

    T1a Tumor > 1 mm but ≤ 5 mm in greatest dimension

    T1b Tumor > 5 mm but ≤ 10 mm in greatest dimension

    T1c Tumor > 10 mm but ≤ 20 mm in greatest dimension

    T2 Tumor > 20 mm but ≤ 50 mm in greatest dimension

    T3 Tumor > 50 mm in greatest dimension

    You indicated the following:

    "Area B- Microinvasive ductal Carcinoma 1.5mm thats MM! 2 foci"

    If a single focus is larger than 1 mm in greatest dimension, then that single focus does not qualify as "micro-invasive". Perhaps there is a 1.5 mm focus ("T1a") and another smaller microinvasive focus (≤ 1 mm, "T1mi") or some other situation. You may wish to request clarification.

    For example, I had a 1.5 mm IDC, which is considered a "T1a" size tumor. I also had extensive DCIS, essentially spanning the entire breast (both sides), which necessitated mastectomy in my case.

    It sounds like your surgeon is still gathering information regarding the extent of disease. With that information in hand, including the combined results of all imaging and biopsies, you should not hesitate to request an understandable explanation of the known and suspected locations of disease within the breast, their extent, and the implications of same for your surgical options.

    Best,

    BarredOwl


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