Freaking out. Breast MRI shows more potential tumors :(

Hi swg,

I'm so sorry that you're potentially dealing w/ two BCs. You said:

"I need to talk to my surgeon but I can't imagine they could conserve my breasts, having to take 2 tumors out. The Dr I saw today said she thinks it's a 1 cm mass.

I don't know if my BS can do a mastectomy on the right breast, reconstruct it, and have it look the same as the left? I'm honestly more concerned about looks, than feeling--which I guess you lose in a bilateral mastectomy--just because I'm a model. So it's important."

Before you do anything else (like have surgery!) have a consultation with a medical oncologist. Increasingly they're doing chemo before surgery (called neoadjudvant chemo) for some kinds of BC. If this is appropriate for you, they can (often?) shrink the tumors which can give you additional surgical options and reduce the amount of tissue that needs to be removed. You'll want to find out if this is something you want to consider.

HTH,

LisaAlissa

Good idea, swg. Have some fun, and I hope the waiting isn't too anxiety-inducing.

Yes, LisaAlissa, neoadjuvant chemo is more common these days, though it's typically used for HER2+ cancer and triple negative (ER-/PR-/HER2-) cancer. Since swg is ER+/PR+/HER2-, she won't find out about chemo until after surgery. Her surgeon should request an oncotype test to determine whether or not the benefits outweigh the costs of chemo. Many breast cancer patients with hormonal positive cancer can skip chemo because of the oncotype test and just do hormonal therapy.

swg,

It might depend on how many lymph nodes are affected, how affected they are, and the oncotype test. If you have micromets in one or two lymph nodes, your oncologist may decide to run the oncotype test to see whether chemo is indicated. If not, your doctors might consider radiation to the lymph node area as a way of cleaning up any stray cancer cells. If more lymph nodes are significantly compromised and/or your oncotype score is high, your oncologist may recommend chemo. It may depend on your oncologist. Increasingly, surgeons are reluctant to remove more than the sentinel nodes (so as to decrease the rate of lymphadema). I've also seen a growing number of women get radiation rather than the removal of all of their Levels 1 and 2 lymph nodes (which is what I got). Hope this helps!

swg, my mom was diagnosed in April, had preventative double mastectomy with immediate recon. She has a very small tumor but 2 micromets. The micromets freaked us out but luckily we did research and they actually do not change survival in early stage BC, only treatment plan. MSKCC ordered oncotype we received score of 11 leavint my mom with reoccurrence % of 6. NO CHEMO. We insisted and got second and 3rd opinion. All 3 facility refuse chemo... your oncotype is the tell all for treatment. Because of micromets she opted for a more intense radiation but worth it to insure no coming bac

Hi SWG,

Your lymph nodes can look fine on all the scans. Which is positive news but your BS will tell you that you won't know for sure until they take the sentinel nodes out at surgery. A pathologist will look at the removed nodes in the operating room (if your hospital offers this) that test is 70% accurate. If that is negative they won't remove any additional nodes. But after surgery they do further tests on the tumor and removed nodes with the results taking about a week to complete. These results could still show some cancer cells in the removed nodes and that would require an additional discussion with your BS.

If you have a copy of your MRI report it should comment on your lymph nodes and mammary lymph nodes status. Hope you get good news today.

Swg. I originally had one lump that I found myself in the mammogram had missed it 6 months earlier. When I had the MRI because of a few calcifications also noted on the mammogram they found a second tumor at 3 my original tumor was at 10 my original tumor was a 2.2 and my second tumor turned out to be 0.7 centimeters after they remove the breast they found a small dcis I think beside the original one. I had a bilateral mastectomy because I wasn't sure about the left breast it had some atypical cells in there on the MRI. However the final pathology showed that it would have been clear. I don't regret removing it because I would have been fretting every 6 months thinking that the cancer would have spread. And I wanted the breast to look similar. But good luck rooting for you

swg...I was in a similar situation. Event from having a lumpectomy to BMX after preoperative MRI. I had the direct to implant reconstruction. Please let me know if you want to talk more about it. Good luck and keep us posted.

Good morning I have a question, if your original MRI showed no lymph involvment does that mean that you are probably clear on your lymph nodes or could you still possibly have involvement in your lymph nodes.

wow, okay.Thank you for your input. I will wait and see what happens in surgery.

It's almost like, exactly WHY do we have these scans?

Swg- it depends. After surgical pathology comes back, your oncologist should send your tumor out for Oncotype score which will test the tumor and give you a recurrence score which will tell you based on tumor make up how likely your tumors are to recur and effectiveness of chemo. Basically lower the score less likely it is to recur and the less effective chemo is. You'll get a node negative report if node negative and 1-3 node report if you have 1-3 positive nodes. I had 4 involved nodes. 2 sentinal with micromets and then 2 positive axillary after I had axillary dissection. Low Oncotype means chemo not really effective and you tumor responds best to anti hormonals. If you're node negative and get an intermediate Oncotype score chemo might be recommended as it's showing higher chance of recurrence. Some people get on the bubble scores which is a tough decision as to get chemo or not. I had a very low score of 3 but because of 4 involved my MO although encouraged by score still recommended chemo as studies not yet proven in Oncotype for 4 nodes. He just changed my chemo regime based on score.

Oncotype always on surgical tumor that I know of. Mine was.