Not sure but scared please help me

Mirnahc, you might also want to check out the Spanish-language threads at https://comunidad.breastcancer.org/ .

Hi Mirnahc:

Sorry to hear about your recent diagnosis. Regarding the size of the tumor, I would clarify that a T1c-sized tumor is technically:

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

T1c Tumor > 10 mm but ≤ 20 mm in greatest dimension (greater than 1 cm, but less than or equal to 2 cm)

My thumbnail measures 1.2 cm across (12 mm) and I am very small. I would suggest obtaining a copy of the complete pathology report from the surgery, checking the actual dimensions of the tumor, and looking at a ruler, if you are interested in the actual size.

I note the nodal status as "Nx". It sounds like your biopsy showed atypical cells, which led to an excisional or surgical biopsy to further sample the area, leading to the diagnosis of invasive disease. Thus, regardless of the type of additional surgery recommended (lumpectomy "re-excision" or mastectomy), a sentinel node biopsy ("SNB") will also be done in the next procedure. The lymph node status determined from SNB will further inform any treatment recommendations.

Due to having ER+ PR+ positive disease ("hormone receptor-positive" disease), I agree that endocrine therapy (e.g., tamoxifen or an aromatase inhibitor) is likely to be recommended. However, until lymph node status is known, it is not clear whether chemotherapy would be recommended in your case or not.

Margins of 1 centimeter are very good, however, the "Margins involved Focally by invasive carsinoma" may be a consideration for some type of additional surgery. Do not hesitate to request an explanation of the basis for the recommendation of mastectomy (e.g., margins focally involved? other pathology result? certain imaging findings? other? why is "re-excision" not advised?).

Since the first surgical procedure was essentially a surgical biopsy, you probably did not get a chance to think about what option you might prefer (if it was appropriate), such as "lumpectomy" plus radiation (a type of "breast conserving surgery"); mastectomy; or mastectomy with reconstruction.

Many patients who receive a mastectomy can avoid radiation. However, sometimes certain pathology findings may lead to a recommendation for post-mastectomy radiation. Here is some information about Lumpectomy versus Mastectomy:

Beesie's post Lumpectomy v Mastectomy (invasive disease):

https://community.breastcancer.org/forum/82/topics/848049?page=1#post_4802494

Breast conserving surgery may not be recommended in all cases. However, if you are interested in whether "breast conserving surgery" might be possibly be a suitable option in your specific case, in light of all pathology and imaging information, then you may wish to seek a second opinion as suggested above.

When you are not sure about something, a second opinion at an independent institution can be very helpful to probe advice, and obtain additional explanation and discussion.

Information about second opinions (see all six sections):

http://www.breastcancer.org/treatment/second_opinion/why

By the way, if your surgeon is not a "breast surgeon", then I would strongly recommend obtaining a second opinion from a breast surgeon who specializes in the treatment of breast cancer or patients at risk of breast cancer as essentially all of their practice, preferably located at a comprehensive breast center.

When I received a recommendation for mastectomy, prior to surgery, I sought a second opinion to confirm that another breast surgeon agreed that lumpectomy was not suitable for me.

BarredOwl

Hi Mirnahc:

Re your question: "Well can i think I did not have cancer at all?"

The answer based on the above is No. Clear margins and negative lymph nodes are good news. However, these observations relate to the tissue removed in the most recent surgery and do not indicate that there was no cancer in the prior excisional specimen removed in Puerto Rico.

Please confirm it, but I think that the New Jersey team is saying that they would like their local pathologist to independently review the pathology slides prepared from all of your prior biopsies (biopsy and surgical biopsy in Puerto Rico). This is so they can confirm the diagnosis and the key features of disease, such as histology, ER, PR, and HER2 status, and grade, before they make any recommendations about treatment (e.g., radiation therapy, endocrine therapy, chemotherapy) and/or further tests (e.g., Oncotype test for ER+ and/or PR+, HER2-negative disease). These glass pathology slides with tissue samples mounted on them are what is examined by the pathologist. For the purposes of a second opinion pathology review, actual slides are sent so the pathologist can look at the tissues himself.

====> Please work with the New Jersey facility and the facility in Puerto Rico to arrange for the actual pathology slides to be sent by Fed Ex or DHL or similar courier (overnight WITH TRACKING) to your New Jersey pathology department. Also arrange to provide copies of all associated written pathology reports from those procedures.

The question of further systemic treatment, such as endocrine therapy (e.g., with tamoxifen or an aromatase inhibitor) or chemotherapy (e.g., based on an Oncotype test) is within the area of expertise of the Medical Oncologist.

The question of radiation should be determined by a Radiation Oncologist.

BarredOwl