Can biopsies cause cancer to spread?
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I read all of the responses so far. I agree with Beesie the most, to the extent that I accepted having radiation as a "clean up" procedure of the local breast tissue after CNB and Lx; and am now on Tamox. as an "insurance policy" against any cells that might have decided to travel further. Hopefully I have lowered my risk to the lowest category, but have you noticed they don't give out guarantees, even to the earliest of early-stagers, that it will not return? B/C is ultimately unpredictable.
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When first dx with high grade DCIS, I worried about seeding. Once I learned that DCIS doesn't have an invasive component, I thought nothing of the biopsy. My second dx was again DCIS (MULITFOCAL) so I wasn't worried about seeding. I would had a mx if I had insurance. The next year although I was dx in the good breast with idc, stage 1, grade 1, I wasn't worried about seeding because the rare cancer muscinious (especially my tumor size 1 C) rarely goes into the nodes or is invasive. So, the 4th time I was dx, I assumed again it would be another DCIS dx. I figured since I was doing regular screening they would find it before it became invasive.
I was surprised when the 4th biopsy was idc, 2 C, grade 3, and HER2+++. I did fear seeding, but also feared more waking up without a breast so for me at that time I wanted immediate reconstruction. I heard breast are hard to reconstruct after a mx. I was not rational. I learned that breast surgeons and plastic surgeons work as a team and getting the right pair is not so easy. I ended up changing surgical teams. I had to wait on the first plastic surgeon 3 wks before I could get an appt. It took me a month to six weeks to get a surgical date with second breast surgeon and plastic surgeon.
Altogether I had to wait 3 months between original biopsy and mx. I learned through an MRI, after the biospy, I had a 2 C seroma from the biopsy which they said was hemoraging. The surgical biopsy was only 1.8 C, which I thought might be only DCIS due to the mammo after biopsy just a few stray califications left. I learned after the final surgical that there was a lot of hemoraging in my breast.
I studdenly felt like an idiot. What in the world was I thinking? If I could go back, I would have not played Russian Roulette by even doing a biopsy. I wouldn't have taken the chance of cutting into a IDC tumor. If I could go back after the mammo, when the rad doctor said it was cancer t(with my history), I should had made an appointment with the surgeon and at least gotten a wide margin lumpectomy and then gone back after it was ALL OUT and done the mx. My surgeons were concerned about my cancer seeding.
I feel really bad that I had 3 months for the tumor to have spread. I didn't think the biopsy would be IDC. With all the mri's and mammo's you would had thought they had seen it.
I am glad that I am only 1a. I am glad the few nodes they removed were negative. BUT...I now have to do the whole HERCEPTIN, which has had some major side effects. I now have added a cardio dr. to the list of medical docs. I know that even with Herceptin, I still could have a recurrence elsewhere.
I am at fault for not taking my early dx more seriously or not pushing for a mx earlier. Now, I will be looking over my shoulder for a few years, where if I had done an earlier mx this all would had been behind me.
If ever they suspect cancer in the future, I will insist they cut out the whole leison or tumor. No more biopsies for me.
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Evebarry, No point to looking backwards, and certainly no point to blame. You did the best you could with the information you had.
I just read a post where cancer came back 19 years later, so we can't live "looking over our shoulder", we just have to do what seems to be the best plan at the moment. I do wonder about the medical team you had though, I was multifocal DCIS and the only option was a mastectomy, no other option given.
use your energy for positive healing thoughts for yourself...we all could have made better choices. Can you imagine a woman like myself who has now had a double mastectomy for multifocal dcis now wonders if there were easier options? We always question if what we did was correct.
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crystalphm...I know looking back isn't going to change anything. I share my story in hopes that others like myself will consider seeding a possibility. It's no big deal if your cancer is DCIS, but you don't know, even with 6 month screenings. You just don't know. I don't know why when they do the biopsy they just don't take out the whole tumor, and if need be go back and get wide margins or a mx...especially when someone has already been dx with cancer or high risk. Why just nick the tumor and take part of it out?
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Eve, you have to remember that doctors are operating blind. Unless there is a clearly defined lump, which usually isn't the case with DCIS or DCIS that evolves to become invasive, the surgeon can't actually see the cancer when operating. The cancer cells are microscopic, mixed in with the breast tissue. So there is no way for a doctor to know if he or she is removing the whole mass and getting wide margins. The amount of breast tissue that a surgeon removes is a judgement call, based on an estimate of the size of the area of cancer as shown on the films. As you know, the problem that so many of us have had is that our cancer hasn't been fully visible on the films. That's why dirty or negative margins are so common.
When doing a surgical biopsy, because there is always a chance (often a fairly good chance) that cancer won't be found, while surgeons try to remove the whole area of cancer, they also try to not remove too much excess breast tissue, which can impact the appearance of the breast. No surgeon wants to remove a 1/3 of a breast for what appears to be a small mass, only to find out from pathology afterwards that the mass was benign. So what that means is that if cancer is found during a biopsy, additional surgery is likely to be necessary, whether the biopsy was a needle biopsy or a surgical biopsy. The implication of that is that both types of biopsies present the risk that some cancer cells might be moved away from the original area of cancer and left in the breast until the next surgery - in fact the risk is probably greater with a surgical biopsy. Plus a surgical biopsy comes with the added risks of anaesthesia.
The issue to me isn't whether or not biopsies might move cancer cells. They can. Seeding can happen. The issue to me is whether this impacts prognosis or results in recurrences that might otherwise not happen. Post-surgical treatments such as radiation, Tamoxifen, AIs, chemo and Herceptin are all given to address the risk that some rogue cancer cells might be left in the breast, or in the case of invasive cancer, might have moved into the body from the breast. Most women, except possibly those who have mastectomies for DCIS, are recommended to have at least one of those treatments. Those treatments don't distinquish between cells left behind naturally from the tumor itself (cancer cells that had travelled beyond the margins) or cancer cells displaced by a needle or surgeon's tools - the role of those treatments is to kill off any cancer cells that remain. If someone does have a recurrence, despite clear margins and post-surgical treatment, can we say for sure whether the source was the original area of cancer or a displaced cell? No, I don't think that medical science can determine the cause. But knowing that most breast cancer has been in the breast for years before being discovered (thereby giving the cells the opportunity to slowly move away from the original area of the tumor), I'd venture a guess that virtually all recurrences are caused by cells that moved on their own from the original area of cancer, not a displaced cell. That, I believe, is the consensus of the medical and scientific communities as well, which is why seeding is not considered by most to be a big concern. Seeding does happen, but I think it would be extremely rare that seeding will have any long term negative impact.
That's my understanding and that's why I don't think that seeding should be a reason to avoid a needle biopsy, or opt for a surgical biopsy instead, or cause any additional concern beyond the concern for the cancer itself. The havoc that the original area of cancer can cause on our bodies and lives is a whole lot more than the havoc that a few displaced cells may cause. And in treating and destroying the original cancer, we in all likelihood are treating and destroying any cells that might have been displaced by a biopsy.
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Beesie, you always have a good way in making things make sense. In my rare cancer, mucinious, they did find a tiny lump that they thought at first was a inflamed node. They allowed me to watch them, through an ultra sound, with a tiny wire go in and nick the tumor. They took out 2 small nicks from the tumor to biopsy. Fortunately it was a slow growing tumor so I wasn't concerned. The last dx of the IDC, they actually saw a palipable mass. It was buried under or incased in 2 C of irregular califications with dotted califications above the circle of califications. It was underneith the first lumpectomy scar. It was not done through a needle biopsy, but a vacuum.
In a situation like that the whole area could had been removed. They cut off the body of the tumor and left the head of it. They cut a vein that caused the hemoraging. What concerned me was the open vein and the cut into tumor, which I thought could have been a highway to escape for the idc, her2+ cancer cells.
Hopefully what you said is so in that cancer tumor cells rarely spread from the tumor site. Except being HER2+++ is scary, and for that reason, I've chosen to do Herceptin. If I were to ever again have a biopsy and found out it was cancer, I would asked to cut it out the next day. I don't want to take chances of an inflamed cut open tumor.
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Thank you, Beesie, for explaining that. They used to say that if you had cancer and surgeons opened you up, the cancer would spread like a wild-fire because of exposure to open-air oxygen.
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Quick question..... I had a mamatome procedure back in 2008 that led to emergency surgery latter that night due to a large hematoma. They have now found bi-rad 4 linear microcalcification's very close to the surgery scar. I am having a core biopsy Monday. What are the odds of this being malignant four years latter?
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I was surprised to find out that my core needle and vacuum biopsy seems to have spread the cancer cells.
My biopsy was 6 months ago, and should have been followed by surgery. But I had other health issues to address first, so the surgery was delayed until last week. At the time of the biopsy, the radiologist and mammogram showed that the biopsy had probably gotten all of the cancer on the left side.
Scans taken between the time of the biopsy and the surgery showed that there was something going on at the biopsy site in that breast, but the radiologist thought that it was probably scar tissue developing. The pathology report follwing the surgery showed that cancer spread along the needle and vacuum aspiration lines. Could this have just been coincidence? Not very likely.
Margins were clear, though.
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Sandyflats. I was dx second time just over a week ago, I had the ultrasound core biopsy at the same time (not sure what its called) because there are other types of core biopsies.2 days later dx with breast cancer, my oncologist was sending my records to the surgeon at the cancer clinic where she is anyways. Thought I would hear back for appt but haven't yet.I think I've posted on almost every board here!! well before work today I thought I would check the lump which is cancer in the 7 oclock position very low and almost outside the breast, well I have felt another lump now very close to the one they biopsied last week, that I know was not there because I've been checking.Is it possible that even before I have seen the surgeon, that I might have another breast cancer developed within a week??Would the dr not have had my path report by now and knows what kind of cancer I have?Back in 1999 I was seen and operated on within 9 days,and at that time it wasa 9mm IDC opposite breast in the 6 oclock.I had no node involvement then, but this time I don't know. But I am panicking over this new lump I'm feeling.
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The short answer is no.
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Last September, I had two ultrasound-assisted core needle biopsies, which ultimately revealed two microinvasions of IDC in addition to the already-diagnosed DCIS. IHC testing showed ER/PR+ and Her-.
Shortly after that, my surgery, which was initially scheduled for October, was moved back to November. That made me nervous, but I coped with it.
Then a few days before my November surgery, I got very sick, and surgery was again postponed to December. This time I completely freaked out.
I called the BS and the Breast Care Coordinator, terrified that the biopsies had poked a hole into the area where the cancers were (multifocal) and now malignant cancer cells were flooding through my body, including into my lymph nodes, where they had not been earlier.
Fortunately, they talked me off the ledge. DCIS must go through extensive changes before it becomes IDC. It's not like once it gets outside the duct it becomes invasive. They gave the example that once you take oranges out of the bag, they don't become apples....it just doesn't work that way.
(But I do understand the concept of seeding, and it seems like this is more common in Her+, or other aggressive cancers.)
Ironically, after my BMX, the final pathology report showed NO invasive cancer!
I asked where it had gone, and the answer was that the core-needle biopsy must have gotten it all, which was very common, as the two areas of IDC were so small to begin with.
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Hi, We noticed that we do not have anything on this in our content, so we asked for a response from Breastcancer.org Medical Advisor Brian Wojciechowski, M.D.
This is what he responded:
"This has been studied in breast cancer and the evidence shows that biopsy does not spread the cancer. It may seem this way sometimes, however, because new areas of cancer may be found that were not apparent earlier as more tests and surgery are done after the biopsy."
We hope to have a bit more on this soon.
Best,
The Mods
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Mods, thank you!
If Dr. Wojciechowski will be writing more about this topic for the content pages, it would be great if he could include an explanation that DCIS cannot be turned into invasive cancer because of what happens during a biopsy. This question comes up a lot on the board. Women worry that if the duct is punctured by a biopsy needle, this will allow DCIS cells to escape and they will then become invasive. Or they worry that a DCIS cell might be displaced during a biopsy and moved into open breast tissue, and that this will result in the development of invasive cancer. Many of us try to explain that this can't happen - DCIS cells remain DCIS cells until they undergo a molecular change - but it would be much better if we could refer people to something written by one of your expert doctors. Thanks!
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Beesie, we'll send along your suggestion to the Editorial team, thank you!
• The Mods
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Hi Mods,
just wondering if there was a response on this subject by Dr Wojceichowiski and I missed it on another site.
Kindly advise when convenient so I may be redirected to the appropriate site please.
Huge thanks for all your ongoing valuable information. Much appreciated.
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What Beesie says is correct - but I don't think what Dr. Wojciechowski says necessarily is. There IS evidence that biopsy may cause Cancer cells to escape from their cluster to other areas goaded by the needle. What there is NO evidence for is that this cancer, if in situ, somehow turns invasive. And the evidence for spread of cells, while weak, is compelling enough to cause surgeons to worry about eliminating track lines.
Mods, I think it would be a good idea to ask the expert to phrase the information in a more intellectually humble way.
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Hi Athena,
Can you post a link to studies that report biopsy causing cancer cells to escape the cluster to other areas around the needle? I just had a stereotactic needle biopsy myself and this information is freaking me out. I would want to bring the studies in to my med onc to discuss. Let me know; thanks!
LB
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I will look. I haven't seen scientifically done statistical studies though - just anecdotal reports. I wouldn't worry too much if I were you. In any case, if surgery is imminent the problem can be solved from there. It's something that isn't really settled. I happen to believe that it happened to me, but I do NOT believe it changed the diagnosis, or that it had an effect on my outcome.
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Hi folks,
Dr. Wojciechowski has written a blog post on this issue in response to your questions. You can view and respond to the post here: What My Patients are Asking: Can Getting a Biopsy Spread the Cancer?
We hope this helps!
--The Mods
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Great! Thank you, and thanks to Dr. Wojciechowski. Now I have a place to refer people to when they ask this question.
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Interesting article by Dr. Wojciechowski.
I know there is no scientific evidence. But I do remember very cleary (because I asked her again at a later appointment) that my BS specifically pointed out to my husband that they use completely different sets of sterilized surgical instruments on the cancer side vs. the prophy side (I had a bilateral mastectomy even though only one side had cancer).
I specifically asked her about this later and she said it was a precaution because they just don't know.
So if they are that afraid of it spreading during surgery..... I wouldn't be too confident about the biopsy tract being left without post surgery treatment.
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Very grateful to the Moderators and Dr. Wojciechowski for addressing this topic of concern.
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Beesie and others, I appreciate in advance for your thoughts and views on the following as I am literally broken down and shocked as what has happened and is going on...
I am a single 34 year old woman- healthy (or at least that is what I thought I was), active and a professional engineer. I had not gone for my physical for about 5 years. About 3 months ago I went for a physical. My general physician had me do a blood test. The test was done at his office by an old lady who did not seem to know what she was working. At one point she came to the room with her hands covered with blood with another patients - though she washed and I can only hope she washed it well. Anyway, she took my blood and everything was fine. It was right after then that all got loose which for all I know it could be just coencidence.
About 2 weeks later after my physical checkup (with everything being OK), I saw bloody discharge from my left nipple. I got scared, and called my Dr I then did my mamo. The radiologist referred me to a general surgeon with her specialty being in breast cancer. The surgeon had me go through a core-biopsy on my left breast. The pathology report then came out and I was diagnosed with DCIS (grade 3) non-invasive stage 0 cancer 6cm wide. The surgeon (being her special domain) in a determined manner suggested for me to get a mastectomy. She then had me do a MRI. The MRI results came with the same results plus showing a tiny smaller area next to where the original mamo had ended up showing calcification. My dr. said she did not know what this was, but it would be ok since she was going to cut my breast and throw it away anyway (not in these exact words but conveying the same message). I then did my genetic testing, and the results have come out showing me being BRCA1 negative but BRCA2 positive meaning I have a higher chance of getting breast cancer from average women.
My blood-like left nipple dischage no longer happens as often and is now colorless discharge and it happens especially when taking shower under warm water or when I squeeze it.
Needless to say, I am shocked and going through an agonizing time. I have done lots of research on the topic and alternatives. I do not want to go through mastectomy as my surgeon so eagerly wants me to do. She was pre-determined for me to do the mastectomy to begin with and I feel sending me through biopsy, and MRI were just a formality.
My questions and concerns:
1) Since they had me do a core biopsy, I am now extremely worried if the biopsy itself may have already contributed to the spread of my DCIS cells? Or may have further caused the situation worse? I have read the following article http://community.breastcancer.org/blog/what-my-patients-are-asking-can-getting-a-biopsy-spread-the-cancer/ and it is comfoting - yet I am a bit still concerned because of my BRCA2+ condition. Please advise as I need to know this to find out what the best treatment option would be for me.
2) What are your thoughts on Hyperthermia as oppose to total mastectomy? (incidentally the surgeon is suggesting that I should get a double mastectomy and have her cut my right breast out also (even though it shows no sign of cancerous cells) because of my BRCA2 positive genetic test result. She does seem to enjoy cutting things out and throwing them away (I am sorry for being sarcastic with her, but she treats me and I feel others as though we are just pieces of meat. She does not explain things and is always in a rush). I am going to get 3 other opinions from highly respectable clinics including UCSF, and Stanford in early January, and I hope my experience with them would be better than what and how this surgeon been treating me.
3) I have been a healthy eater all my life - though being healthy eater is a relative term of course - but I can say that compare to 50% of population in the U.S I am a healthy eater, avoding fat, suagr, etc. etc. I am in a very good shape and active. I have read about alternative treatments including Gerson, and Dr. Lorraine Day's treatment. Both focus on a strict healthy nutrition (fruit and vegetables, no sugar, etc.), and changing the thinking, eating, and stress handling in a profound manner that would re-build our body's immune system. What are your thoughts on Gerson and/or Dr. Lorraine Days approach in treatment of cancer.
Thank you so kindly in advance and wishing you all a very merry Christmas and happy holidays,
AJ
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AJ,
If you look through the alternative threads you will find info on Gerson and other diets.that's probably the best place to get that sort of info on this forum. I get all of my second opinions at Stanford. Will you be going before the tumor board? I found that experience to be very helpful. I also have an individual mo at Stanford,Dr. Melinda Telli . She is a gem. I receive my primary care at Kaiser Santa Clara. Wishing you the best.
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Hi AJ,
First of all, I am sorry you are going through this agony. You are facing very difficult decisions right now, but soon you will get more opinions and be able to decide more confidently, what is best for you. I also had DCIS, 4.5 cm in one breast, and experienced some clear discharge from my nipple. I did the BRCA test and it came back negative. I was 40 and healthy when I was diagnosed. I opted for a bilateral mastectomy because I felt that getting it out of my body would make me feel much better and I would worry less about recurrence if they took both breasts. By having a bilateral, I hoped I could avoid radiation, chemo, etc... if they didn't find anything more during the surgery. They found 1 mm of invasive cancer (IDC) when they did the mastectomy and it was Her 2+++. Many of us who start out with DCIS don't find out we have any invasive cancer until after they take it out during surgery. Unfotunately, the biopsy doesn't show everything since it's just a small area, and many people find out later that there is more cancer than they thought. Fortunately, I was able to avoid further treatment because my IDC was so small. I feel comfortable with my choice, but like you, I did a lot of research on alternative methods such as the Gerson Method. I do not like chemicals! In your case, it sounds like your genetics might be your enemy, not your lifestyle, as you are already following much of what Gerson recommends. For me, my breasts had served their purpose and so, unlike having a major organ hacked at, I decided I didn't really need them, especially if my life was at risk. I know it's hard, but try to find comfort in the research they have done showing that biopsies do not cause cancer to spread. It's the best information we have. I would think that the BRCA2 results would merit eliminating the chance of the cancer showing up in your other breast, which is why your Dr. is suggesting the bilateral. With the large area of grade 3 DCIS and the BRCA2 results, I think your Dr's recommenation is legitimate. I'm sure you will feel much better after you get more opinions. That is the best thing you can do. Hang in there. I hope this helps a little... ~amy
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This is truly sickening. Why do they still take biopsies in this way? Money?
When my mother had a biopsy years ago, it was done under anesthesia and they just lifted the mass out.
Before i had my core biopsy i stopped the surgeon and asked "couldn't this spread whatever is in there?"
I was already on the table and scared as anything. she said "that's an excellent question. We don't think so." Then she kind of faded out, and sounded like "yada yada yada". I just nodded like the good little girl I was raised to be.
She took the biopsy and sent me home for 3 weeks. My entire underarm swelled up and stayed that way until the surgery. I said to my husband, "If my nodes were clean before they sure aren't now!" they had to be swimming in lymph.
Sure enough they found a mircormet in a sentinel node. I think when they find a clump of cells growing, they think it's not from the biopsy. Just loose cells. But who knows? Cancer cells grow quickly and 3 weeks seemed like a long time to wait. But I don't see them going back to surgical biopsies...the emphasis is on saving money.
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I don't mean to argue with anyone but there is, currently, not enough evidence to support the idea that biopsies spread the cancer. As to cancer cells growing quickly, some do, some don't. Surgical biopsies may remove the entire mass but the surgery is more invasive and anesthesia has it's own risks. Since the vast majority of biopsies yield benign results, core biopsies remain the standard procedure. Like so much else with bc, there are many unknowns and we just go by what is known now.
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ex, you raise a good point, most biopsies are negative. now that i think of it, I wonder how they knew to give my mom a surgical biopsy? I think he just decided it was cancer through examination and mammography. She had to have a mastectomy afterwards. You're right there is a lot we don't know. Still, I think that it's a reasonable thing to wonder about and that's what my surgeon said. She said "we don't THINK so", which says to me that they have their own doubts,
My comment about cancer being fast growing comes from my onco. I had ((I like to think it's in the past) a supposedly slow growing cancer but she told me that it still grows faster than any of the other cells in my body. I think they compare growth rates only to other cancers, not to normal cells.
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Most breast cancer cells are slow growing. One main difference between cancer cells and normal cells is that normal cells know when to stop multiplying, whereas cancer cells continue to multiply. The other main difference is that normal cells stay within their own type, whereas cancer cells move. So a normal breast tissue cell stays within the breast tissue. But a mutated breast tissue cell, i.e. a cancerous breast tissue cell, might enter the bloodstream and travel to another part of the body and start to grow and multiply there.
I can't vouch for the reliability of the following website but it provides one of the clearer explanations of breast cancer cell growth: "By the time one can feel a lump in the breast it is often 0.4 inches, or one centimeter, in size and contains roughly a million cells. It is estimated that a tumor of this size may take one to five years to develop." http://medical-dictionary.thefreedictionary.com/breast+cancer
So 3 weeks, in the scheme of things, is nothing to worry about.
The thing that I don't understand is why there is so much concern about needle biopsies but so much less concern about surgical biopsies... why people seem to prefer surgery to a simple needle procedure. First, there is exbrnxgrl's point, which is that most biopsies, approx. 80%, are benign. So why subject yourself to surgery for something that is likely to be benign? Other than the risks of the surgery itself, and and the scarring that comes from the surgery (which can make screenings more difficult in the future), if cancer is found, it seems to me that a surgical biopsy presents at least as much risk as a needle biopsy that some cancer cells might be misplaced by the surgical instruments or moved into open breast tissue. Think too about how often surgical biopsies don't end up with clear margins. This is understandable; when doing a surgical biopsy, the surgeon doesn't know if there is any cancer present so the goal is to remove the suspicious tissue without removing too much excess breast tissue. So it's very common to have dirty margins after a surgical biopsy. It seems to me that this would present a greater risk of 'spreading the cancer' than just the insertion of a core needle.
I'm not suggesting that surgical biopsies present a significant risk - everything I've read suggests that they don't present much of a risk at all - but the point I'm trying to make is that on the whole, needle biopsies are probably a whole lot less risky than surgical biopsies. Overall, both are very safe procedures.
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