Diagnosed with IDC Friday After-Hours -- What Next?

I'm sorry that you have to wait the weekend, but in my case, I was glad to have a diagnosis and wouldn't have wanted that to wait.

I ended up doing lumpectomy and am 90% done w/ radiation.

Ask your doctor for estimated size - is what you gave cm or mm?

What surgical treatment does he recommend?

How do they grade them? (Nottingham is what my dr used) and what is grade?

ER and PR status (this says if the cancer cells are feeding off of estrogen & progesterone) - positive is good

HER2 status - they probably won't have this yet, but negative is good

Then - find the best cancer center close to you and go for a second opinion! I waited until after my surgery to do this. I did have a good surgeon, but in hindsight wish I had done this earlier.

We got the biopsy results on a Wednesday and then left town to visit relatives. The surgical consult was scheduled for the next Friday. I found out the biopsy results on that Wednesday ER/PR negative, HER-2 positive, 1.4-1.5 cm.

Once we had the surgical consult, we both felt better because we had a plan. I had a lumpectomy since it was decent,y small. Because it's HER-2 positive, I am having chemo (Taxol) and Herceptin (targeted HER-2 drug). I will also have radiation.

Good luck to you CherokeeLady. The ladies that are here can offer good advice and a plenty of shoulders to cry

I never bothered with a second opinion—trusted my medical team + I did enough research on my own that I knew what course of treatment would be recommended. I get the potential pushback on treatment, but I am a numbers gal and hearing how a specific one reduced my probability of recurrence made the decisions easy.

CherokeeLady, I hope you have not spent too much time worrying this weekend. I can understand your desire for alternative treatment. You will have many decisions to make after you have your consult and the choice is always yours to make as to the type and extent of surgery and/or treatment you take. I went the minimal route with a lumpectomy and a 5-day radiation protocol. For several reasons, I have not done tamoxifen or AI's. Once you have the full information, you will have a plan which could bring you a bit of relief. Sometimes the hardest period is before a plan is in place. If you don't like the direction, you can always change your plan if you get other opinions. If your grade is low, you have time to make the choice that works for you. Please let us know how you're doing and how soon you can get in for the consult. All the best, Ceanna

The doctor who ordered my mammogram sent me to a general surgeon who also did lumpectomies/mastectomies. The surgeon wanted me to see the oncologist first, which is the right move, but I was ultimately treated at a comprehensive breast cancer center. I met the breast surgeon and oncologist on the same day. My cancer was HER2 positive and the protocol for that at my center was neoadjuvant chemotherapy, followed by surgery. The first surgeon had mentioned removing someteen axillary lymph nodes...I had one suspicious for malignancy on a scan but subsequent scans

Cherokee--with a small tumor and HER-, my guess is you'll get an Oncotype test to see whether or not chemo would be beneficial. Lots of women don't have to do it. Keeping my fingers crossed!!

Next step is surgery. Things can change with the surgery - the size of the tumor might not be what it appears to be from the imaging. If the area of DCIS appears small, then it's likely that a lumpectomy will be recommended. Normally radiation follows a lumpectomy. Some patients who are eligible for a lumpectomy opt instead for a mastectomy. Usually with early stage diagnoses, radiation is not required after a MX, although this could change if the final pathology shows margins close to the chest wall or positive nodes.

If the final pathological diagnosis remains the same as the current clinical diagnosis, with a 3mm grade 2 tumor that is ER+ and HER2- and is node negative, it's doubtful that the Oncotype rest will even be ordered. This diagnosis falls below the line for consideration for chemo, according to the NCCN Treatment Guidelines, which are the gold standard. Instead, endocrine therapy, Tamoxifen or an Aromatase Inhibitor, would be recommended. However as you can see from the chart below, with a larger sized tumor, the Oncotype test (21 gene RT-PCR assay) likely will be ordered and will play into the treatment decisions.

Note that the staging and treatment decisions are based on the size and pathology of the invasive cancer. The DCIS needs to be surgically removed (with clear margins) but is otherwise incidental, because it is the less serious condition

Let us know how your appointments go next week.

I'm so sorry you find yourself here but welcome. One thing that can be very stressful is managing all of your treatments. If you live in an area with a top notch hospital that treats all aspects of cancer that can make managing the process simpler. All the doctors are in one place and are able to coordinate your appointments (sometimes). They can also talk to one another. My oncologist and breast surgeon meet weekly to discuss their common patients. My breast surgeon and plastic surgeon coordinated surgery dates without me having to be the go between. Large hospitals with lots of cancer cases are also better able to navigate the insurance issues. I was not ever caught between my medical team and insurance company.

For the reasons stated above I really like treatment at a hospital that treats lots of cancer cases. However, in addition to the above many hospitals with large breast cancer loads also have support services for patients. I was treated at Cleveland Clinic Florida and there is massage therapy, support for wigs/skincare during treatment, general support groups, exercise that is appropriate for people in treatment, nutrition support and other services I am not thinking of right now.

You will likely be fine. I know it is scary and overwhelming but you will be fine.

Hi CherokeeLady,

I wish for you (and all of us) that we weren't part of this, but we are. My diagnosis seems quite similar to yours so I thought I would share my outcome. I was initially Dx with DCIS in Oct, 2017. I had no lump. Just 3 linear microcalcifactions that were suspicious. After Stereotactic Biopsy confirmed Stage 0, Grade 1, I had a lumpectomy end of Nov. Upon biopsy, they found IDC in an area of biopsy tissue near but not part of the DCIS. In other words, if you visualize this, my DCIS was deep in my breast. My doc sent the whole piece to the lab and the IDC was almost at skin level. 2nd lumpectomy less than 2 weeks later got clean margins and 4 Sentinel Nodes were removed with no Ca. Whew! IDC was Stage 1 Grade 1. Both biopsies were ER+PR+ Her2-. The Oncotype DX text came back as 13 and I'm adopted so no family Hx. I had full breast radiation (very bad reaction for me, unfortunately). Then I have been on Tamoxifen since 2.2.18. I also had breast and trunk Lymphedema but that resolved after about a year. I'm now 18 months post Sx & rads. I had a clean mammo in July '18 & July '19. I'm very happy with my outcome and certainly hope it stays at bay.

It's so hard to not have your mind go crazy with the what-ifs. That's normal. I found this community to be so helpful. I didn't comment a lot. But I looked and researched. It's all I could do to not go crazy. I'm 53, and my Mom had breast cancer with Mets and died when she was only 64 and that was 25 years ago. Albeit, she's not my biological Mom, I miss her everyday and want a longer life for me & my family

Stay strong, but it's ok to have bad days too. I hope the best outcome for you!