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Second mass found...reconsidering treatment plan

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Hi!

I was diagnosed about 6 weeks ago with IDC (ER/PR+, HER-). I had to pause starting any treatment to travel to the UK to be with my mom, who was diagnosed with stage 4 colon cancer. Sadly she passed away last week. I have just got back and now picking up my treatment journey.

Just before I left for the UK, an MRI showed a second mass in the same breast, same quadrant. I had a biopsy yesterday.

I had opted for a lumpectomy, but am now questioning my decision. I've read lots on lumpectomy vs mastectomy and understand the pros and cons for each, but am wondering if anyone else has been in this position and changed their treatment plan?

With everything going on, I haven't had the emotional capacity to process this. I am feeling eerily calm and a little detached from my diagnosis.

Grateful for any advice on how folks made their surgery decision (obvs I'm taking into account medical team support and expertise!)

Comments

  • moderators
    moderators Posts: 8,185
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    Hi @lh1981, we're sure others will be by shortly to weigh in, but we wanted to share our condolences on the passing of your mom. We hope you're also taking some time to grieve her while you're managing so much with your health.

    Sending gentle hugs,

    —The Mods

  • wishinguswell
    wishinguswell Member Posts: 8
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    Hello, @lh1981 . I’m sorry for your loss and your diagnosis. I was presented with the option of lumpectomy or mastectomy upon initial surgical consult last year. I went in to my MRI thinking that if NOTHING else were found, that I’d consider lumpectomy (both sides, btw), but any finding or even suspicion would definitely lead me to choose bmx. I did have a small additional mass identified, also same quadrant. I was then ready to proceed with bmx without a 2nd biopsy, but the surgeon requested that I take that step so the marker clip (the fancy one) could be placed due to location. That turned out to be wise as a clear margin would have been difficult without the guidance. Recovery wasn’t easy, but I feel good now and do not wish I had chosen lx. I was er+, her2-, t1b n0, taking AI, not recommended for chemo or radiation. I did also ask MO what she would choose in my situation and she replied, “I’d do what you’re doing.”

  • besa
    besa Member Posts: 289
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    Just adding some things things that would help me personally make a decision. Questions I might consider…

    A question for your breast surgeon - What is the expected cosmetic result of a lumpectomy? (Size and spacing of masses might influence cosmetic outcome.)

    Wondering if you have asked if your specific family history of cancers or belong to a specific ethnic group could warrant being referred to a genetic counselor. (The question for me might be - am i at very high risk of another primary bc diagnosis in the future? )

  • lh1981
    lh1981 Member Posts: 10
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    Thank you all for the well wishes x

    wishinguswell - that's where I think I'm leaning, given additional tumor/s...depending on what the biopsy results are. Glad to hear your decision was supported and reinforced by your MO.

    Besa - BS feels that I will get a good result with lumpectomy so it's more the recurrence risk that's spinning my brain. My mom had breast cancer twice (DCIS, but multiple and large, and had lumpectomy surgeries each time). However, I was tested and don't have the BRCA gene.

    I am 43, pre-menopausal, tumors are (at largest dimensions) 2.3cm and 1.6cm on MRI imaging - there's discrepancy between US, Mamo and MRI scans.

    They also found something small that looks benign in my other breast at MRI, but were unable to find it using ultrasound. Plan is to follow up with regular MRIs to 'watch and wait'

    I'm so sorry you've all had to go through this too, definitely a club no one wants to join!

    Appreciate your support!

  • besa
    besa Member Posts: 289
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    In 1981- there are now many more genes (in addition to BRCA mutations) that are associated with increased breast cancer risk. Have you been tested for more than the BRCA mutation? A good source of information is www.facingourrisk.org

    Even with across the board current negative genetic testing results, "new" genetic mutation are being found as research continues.

    I think a good genetic counselor can step you through all of this and help guide you by potentially giving you more info. For me, more info makes the decision making less stressful and easier.

    Also my understanding is that if you decide on lumpectomy now you can still re-evaluate later and go back for mastectomy. (Check with surgeon to be sure) These are difficult and personal decisions.

    Looking at this from my vantage point the question for me would be - should I be evaluating the lumpectomy vs mastectomy question as a person with average risk of a second primary? Or -should I (based on family and personal history and genetic results ) be evaluating this decision as a woman with high risk of a second primary breast cancer?

  • lh1981
    lh1981 Member Posts: 10
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    Thanks Besa, that's really helpful…they only tested for BRCA, but the report concludes that I am considered 'elevated risk' based on various other factors like family history (and well, the fact that I have diagnosed BC is probably a big risk factor for getting BC, 🙄).

    My biopsy came back as IDC, 2cm from the original IDC tumor location.

    My BS isn't happy with watch and wait for the mass on the other side,which was seen on MRI and given birads 3 score, but not found upon US follow up. So I have MRI-guided biopsy on Thu this week. Not sure if I should be worried she's seen something iffy, or if it's an abundance of caution at this point.

    Surgery scheduled for 6/28.

    I think I'm still leaning towards lumpectomy but just hope I'm not setting myself up for a repeat down the line. If the left side comes back as malignant, I'll most likely change my mind.

  • wondering44
    wondering44 Member Posts: 261
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    Hi there lh1981,

    I am glad to read you traveled to the UK before going through treatment. I am sorry to hear of your mom's passing.

    You have time to consider treatment options. The "sucky" part is that you don't have any way to know if you will have a repeat down the line whether you choose lumpectomy or mastectomy. I was a repeat offender, lol.

    You may not know which way you want to go until you get the last biopsy result. I am glad to read your BS did say to go ahead with another biopsy. It could give you peace of mind with a benign result - crossing fingers. It could push you to change to a mastectomy if not benign - rooting for benign.

    Try to consider what you want the most with preparation that it could change with results. Research both options. Make a list of what is important to you. Is the aesthetic look important to you? If so, can you accomplish what you want with either lumpectomy or mastectomy? Is sensation for personal reasons important to you? While it may not be on your mind now, a mastectomy changes sensation drastically. I am not sure about how a lumpectomy affects it. Research photos of both, and ask for people to provide you their insight to their experiences with their surgeries. The great thing about a lumpectomy is that you can do the mastectomy later. You may find better peace of mind with a mastectomy. There are many different reasons you may go either way if you are given the option to do either one. Choose what you feel is best for you.

    Whichever you choose, unfortunately, no surgery option is 100% guaranteed that you won't do another surgery. It is an unfortunate side effect of the nasty cancer beast that no matter what we do we may have more surgeries or treatments we did not plan for.

    It is a lot for you to consider. And you still have the crap part of waiting for results.

    I wish you some peaceful thoughts while you consider decisions. Sending you warm thoughts during this challenge in your life right now.