Just Diagnosed

CaraleeAW

I'm 62 and had my excisional biopsy last week. Pathology report showed both invasive ductal carcinoma in situ and invasive ductal carcinoma. Second diagnostic re-excision to get the margins and sentinel lymph nodes (+3 additional lymph nodes) is scheduled in a couple days. If any cancer in lymph nodes, next step mastectomy and more lymph nodes...

My husband and I are reeling, trying to get our heads around all of this. I had no idea I had a tumor, did not feel it. Now, boom!

I have been reading, trying to absorb all of the new terms and understand what my cancer looks and acts like. So far it is ER receptor positive-strong, which from what I'm learning feeds off of estrogen, produced by fat cells. Also, alcohol increases estrogen. As I process my new predicament, I am grabbing at what I can control: my attitude (which, honestly until I know more, I'm scared); I am overweight, some, not horrible, and am suddenly eating to the best of my ability and recognizing alcohol, even tho I consume 2-3 ounces/week would be in my best interest to stop.

Thanks for the opportunity to share with others who get it.

serendipity09

CaraleeAW - I'm so sorry you have found yourself here, but you have definitely come to the right place to connect with others who have experiences and knowledgeable information.

I hope that all goes well with with your upcoming re-excision and that the results come back favorable.

exbrnxgrl

cara lee,

Sorry to hear about your dx. Maintaining a healthy weight is a good idea for all of us. As far as diet and alcohol, if it helps you to feel more proactive and in control do what you need to do, but do allow yourself some pleasure in life but in moderation. Sadly there is no way to control bc through diet etc. Though it can certainly be helpful there are no guarantees. If a glass of wine provides occasional comfort then accept the comfort for its stress reducing benefits. Some may disagree with me but you don’t have to be compulsive about your lifestyle habits. As you might have guessed, I’m a fan of moderation but I know it’’s not everyone’s cup of tea. Take care

beesie.is.out-of-office

Caralee, I'm sorry you've been diagnosed.

Being thrown into this whole new world is always confusing so let me clear a couple of things up for you about your diagnosis, so that you get the right information and focus on the right things. You say you "Pathology report showed both invasive ductal carcinoma in situ and invasive ductal carcinoma."

It sounds as though you have a combination of DCIS (ductal carcinoma in situ) and IDC (invasive ductal carcinoma). There is no such thing as invasive ductal carcinoma in situ - when cells that are DCIS progress to become invasive, those cells become IDC.

Having DCIS and IDC together is very common. IDC usually develops from DCIS so about 85% of people diagnosed with IDC also have some DCIS. DCIS is non-invasive and is sometimes even considered a pre-cancer - there is debate and many arguments about that. IDC is invasive breast cancer and is the more serious condition. So while DCIS needs to be surgically removed with clear surgical margins, other than that, it can be ignored. The IDC is the more serious condition, and any treatment done to address the IDC will be more than adequate to also address the DCIS. The DCIS does not factor into the staging, the treatment plan or the prognosis. So basically, once surgery is done, you can forget about the DCIS. Focus on the IDC.

This in the DCIS forum. There are patients who have DCIS without any IDC - pure DCIS is Stage 0. That's who this forum is mostly for, and that's not your diagnosis. Since the treatment plans may be different for Stage 0 DCIS than for IDC, the information here might not be right for your situation. So I would suggest that you repost this in the IDC forum, or maybe the Just Diagnosed forum, or you can send a private message to the Moderators asking them to move this post into one of those forums. That will ensure that you get responses and information that is accurate for your diagnosis.

Good luck with the re-excision surgery and SNB.

CaraleeAW

Thanks for clearing up the terminology for me! Sure, yeah, I will get my information to the right place. IDC is my problem, got it.

sheliabreastcare

I have just been diagnosed with DCIS on Jan 24. The doctor said that she did not get enough tissue to clear the 2mm margin required. I am scheduled for reexcision in mid Feb, but not because there were any cancer cells found in the edges of the margins, but because she needs to make sure she completed the 2mm circumference before she can say it indeed clear. Since I am having radiation anyway, why do I need to have another surgery to check that small amount of tissue that was missed?

beesie.is.out-of-office

The nature of DCIS is that the cancer cells are confined to the milk ducts. This is different from invasive breast cancer. IDC cells are in open breast tissue, and as IDC cells multiply, the cancer forms into an ever larger solid mass, usually in single location. But with DCIS, as DCIS cells multiply, the area of DCIS tends to spread out within the ductal system of the breast. Because of this, it is more common to find large areas of DCIS than to find masses of IDC. I had over 7cm of DCIS spread through my breast. The other thing that happens when DCIS cells spread out in the duct is that sometimes the cells skip a spot, leaving a small space with no DCIS cells before the DCIS picks up again. This is why negative but close surgical margins present a greater risk of recurrence for DCIS than for IDC.

Still, margins for DCIS are controversial. Here are two studies:

From 2017: DCIS Margins and Breast Conservation: MD Anderson Cancer Center Multidisciplinary Practice Guidelines and Outcomes https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5604195/

"Thus, there is not an absolute need to achieve wider negative surgical margins when < 2 mm for patients treated with RT and this should be determined by the multidisciplinary team. Utilization of these multidisciplinary treatment protocols and techniques may not be exportable and extrapolated to all hospitals, breast programs and systems as they can be complex and resource intensive."

From 2018: Margins in Breast Cancer: How Much Is Enough? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5894883/

"Consensus guidelines support a negative margin defined as "no ink on tumor" for invasive carcinoma treated with breast-conserving therapy. Given differences in the growth pattern and utilization of systemic therapy, a margin of 2mm has been found to minimize the local recurrence risk for women with DCIS undergoing lumpectomy and radiation therapy."

Have you talked to the Radiation Oncologist and Medical Oncologist to get their recommendations?The decision is ultimately yours and all 3 of your doctors will have their own perspective and valuable input.