Can anyone tell me what this means...Ref Margins/and Lobular?

Beesie - as usual you are such a wealth of information.

Diane

Nicole,

Breast cells usually become cancer cells through several steps. DCIS, in which there are cancer-like cells confined within the ducts of the breast, is the last step before an invasive cancer develops. When some of those DCIS cells undergo a particular biological change at the molecular level, this evolved cell has now developed the ability to break through the wall of the duct, and that point, this cell has become an invasive cancer cell. But just because some DCIS cells go through this final stage of evolution to develop into IDC doesn't mean that all the DCIS cells do the same. Some DCIS remain DCIS and never become IDC. This is why is it very common to find both DCIS and IDC together in the same tumor. Some of the cells are still in the ducts and are still DCIS; other of the cells have evolved to become IDC and have moved into the open breast tissue.

Both DCIS and IDC can be grade 1 (slowly dividing/growing), grade 2 (Intermediate) or grade 3 (dividing/growing quickly). From the information you provided, it appears that both your DCIS and your IDC are grade 3.

A grade 3 DCIS is dividing quickly, but because DCIS is confined to the duct, as DCIS cells divide and multiply, they fill the duct and spread out within the ducts. The DCIS is still non-invasive, it is still confined to the duct, but it is spreading out wildly within the ductal system. I had over 8 cm of grade 3 DCIS, running throughout the ducts of my whole breast.

With invasive cancer, on the other hand, as the cells divide and the cancer grows, it is more likely to form a solid tumor in a single location, with the tumor increasing in size as the cancer cells divide and multiply. So rather than spreading out like a spider web, as IDC spreads it is more likely to form a solid round, oval or misshapen mass.

Lastly, if your current diagnosis is a recurrence, it means that some DCIS cells survived your treatment in 2014, and eventually began to grow and multiply again. Some of those cells evolved, through the process I mentioned above, to become IDC and as a result, your current diagnosis includes both DCIS and IDC. This is not uncommon; in about 50% of cases where there is a recurrence after a diagnosis of DCIS, the recurrence is not found until there is also some IDC present.

This drawing, from the BCO information pages, shows how cells evolve from normal to become IDC:

Don't fret about prior treatment choices. We make the best decisions we can at the time with the information we have. No treatment is 100%, and someone always is the statistical "outlier" (which is what my MO calls me). Concentrate on the situation at hand, and once you have all results in, you and your team can make decisions moving forward.....that's the direction you're going. Once you have a plan in place, you can plow forward. Best wishes.

Beesy, nice to 'meet' you.

My "Beesie" was my Dad's nickname for me when I was very young, derived from my real first name.

teaka, with a 0.7cm (7mm) invasive tumor, you now are Stage I - the Stage 0 preliminary clinical stage is no longer relevant now that the invasive cancer has been found. With the invasive tumor, your staging and treatment will be based on the invasive cancer, and the DCIS has become incidental.

Because your invasive tumor is HER2+, it's quite likely that chemo and Herceptin will be recommended. While you are surgically cancer free, this refers only to your breast area; the greater concern is whether some cancer cells might have escaped the breast and moved into the body prior to surgery. With HER2+ cancers, the risk of this is greater, and therefore more aggressive treatment tends to be recommended even for small tumors. The good news is that chemo and Herceptin are very effective on HER2+ tumors, bringing the risk of distance recurrence down to the same level as for the most favorable breast cancers.

I don't know you are ER+ or ER-, but here are the two pages from the NCCN Treatment Guidelines that cover HER2+ disease, the first for ER+ and the second for ER-:

Let us know the how it goes with the oncologist.