So confused

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Raysal
Raysal Member Posts: 45
edited November 2018 in Surgery - Before, During, and After

Had my lumpectomy & snb 12 days ago and got my results today. Good news is that the lymph nodes are clear. Now for the bad news

The doctor didnt get clear margins. Apparently cancer cells found on skin (or near skin) even though my tumor was deep and close to muscle (she removed part of my muscle to make sure she got clear margins). The tumor was also bigger than imaging.. imaging showed about 1.5cm tumor, while pathology shows an invasive tumor size of 3cm and a whole tumor size of 3.5cm.. in addition to IDC grade II I also have intermediate to high grade DCIS, solid cribriform with necrosis.

She managed to get me a surgery slot for tomorrow to perform a re-excision. I'm debating whether 1. I should just go for a mastectomy instead? And 2. If I shouldn't rush the re-excision and get a second opinion instead? Apparently the pathologist said my tumor was complicated to analyze so seems like it's not your typical IDC?

Just to add to the complication I'm 34 years old with three young kids and I just want to make sure I kick this cancers ass and see my kids grow

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  • star2017
    star2017 Member Posts: 827
    edited November 2018

    oh gosh, Raysal. I'm so sorry to hear of your diagnosis. I was just a little older than you and pregnant with my third when diagnosed, so I can understand how worrying and overwhelming this is. I'm so happy to hear your nodes are clear.

    Can the cancer cells in the skin be due to the initial biopsy? I remember there's a member here who had that, unfortunately. Can you find out if the cancer cells are in the skin or near it? I think those could result in different treatments.

    I didn't have the option of a lumpectomy bc of my tumor size and location. What do your bs and mo recommend?

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  • Runrcrb
    Runrcrb Member Posts: 577
    edited November 2018

    a mastectomy is a big surgery and decision. I would not rush that. You can have the second excision and get more information before deciding on a final course of action. And you can always take the outcome of both excisions for a second opinion.


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  • NotVeryBrave
    NotVeryBrave Member Posts: 1,287
    edited November 2018

    Did you relay those two possibilities to your BS? What do they think? It may also depend on the tumor characteristics and your plan of care going forward.

    Some things to consider: Would mastectomy mean that you would not need radiation? Would another lumpectomy still leave you with an okay cosmetic result? If you have a mastectomy, what are your thoughts on recon or not?

    I'm sorry that you have cancer at a young age and with little kids. These are always big decisions. Good luck with making the right one for you.

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  • Raysal
    Raysal Member Posts: 45
    edited November 2018

    thank you all.

    Star2017 according to my doctor another lumpectomy would still be okay cosmetically. With mx I wont be able to do reconstruction till later since my lumpectomy scar wouldn't be fully healed (it's at 12 position) and for the mx she would have to perform another cut below?

    Where im from we dont see a MO till after surgery. But the BS discusses the case with the MO and bunch of other professionals before recommending a course of action.

    I cant figure out my pathology report where on the skin they found cancer...

    Runrcrb that's what I'm leaning towards.. such big decisions which I just dont want to deal with, but I have to :( I wish we could just know which is right. One moment I thinks let's go for a re-excision, other moments I get worried about cancer cells lurking around and think it's better I just go for a mx but then remember I could still have a recurrence with mx.

    Notverybrave I did, the BS said she couldn't tell me which to do, however she did say I could always reconsider the mx later. Mx would most likely mean no radiation, but they would only confirm after pathology.

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  • NotVeryBrave
    NotVeryBrave Member Posts: 1,287
    edited November 2018

    Sometimes I tell my kids (or myself), when hard decisions need to be made, to consider how they would feel if one of their options was taken away. That has helped me at times to come to a decision.

    There are often no wrong decisions in the mess called BC. Perhaps since you've already had the LX, doing a repeat is the simplest option. Would additional imaging be helpful?

    I'm always a proponent of second opinions, too.

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  • ElaineTherese
    ElaineTherese Member Posts: 3,328
    edited November 2018

    Hi!

    I chose a lumpectomy because I wanted the least invasive surgery, the shortest recovery time, and I didn't want to do reconstruction (can involve multiple surgeries). I have twin boys with autism, and I needed to be on my feet as soon as possible. I always figure that I can do a mastectomy (or bilateral mastectomy) later.

    If the re-excision won't make much of a cosmetic difference, I would go with that. The other thing to think about is chemo. Your MO may or may not recommend chemo, depending on the pathology. Recovering from a mastectomy could mean delaying chemo further down the road. How much help do you have? If others can help with the kids, then having 50% or 75% of your typical energy level won't be a big deal. I had help with my daughter, but no one really can manage the twins as well as me and my DH. That shaped my decision making quite a bit.

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  • Stherye
    Stherye Member Posts: 43
    edited November 2018

    Dear Raysal,

    I am so sorry you are going through this. I am 42 years old and I have twins, 6 yo.

    I would go for a second or third opinion, and, I would go for a bmx, but this is only my opinion. After reading through these forums and reading hours and hours on the internet, I would follow the most agressive path the first time triying to avoid cancer to come back. There are no guarantees, but peace of mind is very important. And later I would try to do some changes as diet, exercise, reducing stress.

    I wish you the best

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  • Raysal
    Raysal Member Posts: 45
    edited November 2018

    Thank you all for your support.

    I sent the report to another doctor for his opinion. He explained that the pathology shows a clear margin however less than 1mm which is why re-excision is being recommended.

    Additional imaging isnt useful, already had a CT, MRI US mammo and bone scan done (initially doctor was expecting worse). Imaging showed the tumor at about 1.4cm, but reality was double the size..

    I decided to go ahead with the LX for now since its tomorrow and not rush for the mastectomy. Trying to take it one step at a time. While I wait on the LX results I'll be going for a second opinion on existing pathology slides and treatment.

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  • Stherye
    Stherye Member Posts: 43
    edited November 2018

    Hi Raysal,

    That is absolutely true, there is no rush for mx, it is an option that is always there, and you need to be completely sure.

    You are doing great going for a second opinion.

    I wish you the best tomorrow. Sending you positive energy.

    Hugs

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  • MBPooch
    MBPooch Member Posts: 229
    edited November 2018

    I went with BMX just for the piece of mind but curious if you've had any genetic testing done? Results of that could play into your decision as well. There's no rush and it sounds like you're making the best decision you can for now.

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  • star2017
    star2017 Member Posts: 827
    edited November 2018

    raysal, I think that’s a good decision. I found out the night before my mx that I was brca2+ and suddenly had to decide if I wanted a bmx. It was my surgeon that recommended not feeling pressured and rushed into the prophylactic surgery. I did end up doing it several months later, but I’m glad I had the time to think it through. Best wishes to you.

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  • NotVeryBrave
    NotVeryBrave Member Posts: 1,287
    edited November 2018

    You sound much more sure of yourself now. That's good! I hope everything goes well tomorrow. One more thing to check off, right? And good on the second opinions, too.

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  • Raysal
    Raysal Member Posts: 45
    edited November 2018

    thank you all for your messages and kind words.

    Mbpooch I havent had genetic testing done yet, genetic doctors appt are full till early next year. Hopefully where I go next I can get a second opinion since you're right the result would play a big role in my decision.

    Noyverybrave yes I'm feeling much better, when I first posted I was so overwhelmed with all the information / news and decision but this board and talking to others helped me calm down and make my decision

    Sending you all positive vibes and talk to you once surgery is over

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  • star2017
    star2017 Member Posts: 827
    edited November 2018

    Raysal, best wishes fortoday.



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  • Raysal
    Raysal Member Posts: 45
    edited November 2018

    thanks star

    Out of surgery and back home. Was much easier this time round and less painful. Currently in bed but unable to sleep, looks like my afternoon nap has taken away all my sleep!!

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  • Salamandra
    Salamandra Member Posts: 1,444
    edited November 2018

    Glad to hear you're back home, and that it was easier this time around!

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