Nov 29, 2012 05:38 PM Beesie wrote:
nesw, well crap, that's not what you wanted to hear from the pathology report!
One area I can comment on is the microinvasion, since I had one too. One point of clarification, however. Was the microinvasion within 2cm of the margin or 2mm of the margin? If it was within 2cm, then it's really nothing to worry about at all. A single tiny microinvasion means that it's really good that your removed your DCIS, since it obviously was just starting to progress to become invasive, but just having that single tiny microinvasion usually doesn't change the treatment or increase the local recurrence risk. It does change your staging from Stage 0 DCIS to Stage I DCIS-Mi, and with that comes a very very small risk of mets but the long term prognosis for those who've had microinvasions is not statistically different than those who've had pure DCIS (at least not in any of the studies I've seen). The one question is whether you had an SNB at the time of your mastectomy. If you did and the nodes were clear, then the microinvasion should really have no impact on you, assuming it ws 2cm from the margin.
If the microinvasion was 2mm from the margin, then it adds to the concern about the closeness of the margins at the nipple and the presence of ADH and ALH at the nipple. Does that mean that the nipple needs to be removed? I don't know. I guess for me the question to the surgeon and oncologist would be: What do you estimate to be my recurrence risk and new BC risk (a possible new primary from the ADH or ALH), with this information from the pathology?
I had a 1mm margin by the incision line after my MX. During my exchange surgery, I asked my PS to remove a bit of skin on both sides of the incision. The result is that the incision is not quite as smooth as it otherwise would be, but that was something I did for my own peace of mind. I didn't have a nipple sparing MX so I don't know what I would have done if the close margin had been by the nipple, although I suspect that I probably would have removed the nipple. I never wanted to have a MX but had too much DCIS in a small breast. I figure that the one benefit of the MX is that it's lowered my recurrence risk / new BC as much as it can be lowered. It's the only silver lining of needing to have the MX so I don't think I would be willing to give that up. But those are my reasons and what I would probably do. You have to decide what's right for you.
As for your other breast, I don't know how worried you should be. If there were numerous enhancing nodules in both breasts, it seems that a number of them were not DCIS. Were there other small areas that enhanced in your right breast? You know that one that enhanced was the original diagnosis and another was the cancer behind the nipple; the rest of your breast tissue appears to have been cancer free so if there were more nodules, they weren't cancer. And the one that was biopsied on the left side wasn't cancer. So it could be that none of the left breast ones are cancer. Would you feel better if you had a biopsy done on another one?
I'm so sorry that you are having to deal with this!