Didn't have a clean margin, go back in and re-excise?
I had surgery 2 weeks ago (lumpectomy); and just got to meet with my surgeon. One of my margins wasn't clear and she's recommending going back in and doing another surgery. I'm scheduled to start chemo next week, and then radiation. Isn't the whole point of doing chemo and radiation to kill anything that might still be there? I was a pT1b pN0. The tumor was 1 cm. I know she has to say "let's go back in" because that's what the breast surgeon society says, but I feel like I would be moving backward, not forward. And there doesn't seem to be any clear answers. This is so frustrating.
Comments
-
@bonj65 We are so sorry. Yes, it IS frustrating!
Not having clear margins means that the initial surgery's margins (the tissue surrounding the tumor) were not free of cancer cells, which typically requires a second procedure (re-excision lumpectomy) to ensure all cancerous tissue is removed. Unfortunately it is not uncommon 😣 While the chemo and radiation will kill cancer cells, it is standard of care to surgically remove as much of the cancer as possible.And from this page:
"Re-excision lumpectomy
When you get your pathology results from your doctor, you’ll find out if cancer cells were found in the tissue surrounding the tumor. The rim of normal tissue surrounding the tumor is called the margin. If no cancer cells were found in the margins, then the margins are considered to be negative, clear, or clean. If cancer cells were found in the margins, then they are considered to be positive.
To get clean margins, your surgeon may recommend a second surgery, called re-excision lumpectomy. Some surgeons refer to re-excision as “clearing the margins.” About 20% of people who have lumpectomy require a re-excision lumpectomy because of positive margins.
If there are still positive margins after re-excision, your surgeon may need to do another re-excision or perform a mastectomy."
0 -
I agree with the mods explanation. This is extremely common and no, you are not moving backwards but simply removing confirmed cancer cells, which is what you want. Breast cancer, as you may be finding out, is more complex and not simply a straight path, than most of us imagine. Although chemo and rads do mop up stray cells, particularly those too small to be detected yet, if they are seeing cancer cells in the margins, it is to your advantage to have a re-excision . Breast cancer treatment is often not as straightforward as many believe. In having a re-excision, you are still moving forward. I would personally avail myself of that re-excision if I were in your shoes since those are observable, active cancer cells as opposed to anything underlying that needs to be mopped up. But, like all medical decisions, you are the driver !
0 -
I had a reexcision and it was less complicated than a basic dental appointment. I had lightweight anesthesia, they reopened the excision, did what they had to, and I was good to go in a short time. I think I was home by mid-morning. I did my usual pressure on the incision like I had after the biopsy and again after the lumpectomy, using a rolled-up child's sock. The only thing that changed was radiation having to start a few weeks later to allow more healing time.
0 -
I want to emphasize that bc treatment is not about moving in a linear path. There can be developments and complications that can not be foreseen and answers are not always clear nor relevant information available. This does not mean, at all, that you are moving backwards and understanding the incredibly complex nature of bc (not a quick or easy process) should help ease your mind though maybe not the frustration. You have visually observable cancer cells in your margins please understand the significance and don’t skip this step because of an artificial idea that this is moving backwards. Take care
1 -
Hello, diagnosed with IDC triple positive grade 3 breast cancer 1/8/25, and I had surgery 6/9 dmx with sentinel lymph node bx. My pathology report showed positive margin and poor chemotherapy response. I am scheduled for a re-excision and axillary lymph node dissection. My radiologist told me during my consultation that it isn’t necessary to do the ALD since I will be getting radiation therapy and it’s one surgery I can avoid. However, my surgeon along with the tumor board suggests otherwise. Any input or advice on what would be the best approach ALD or no ALD? Thank you 😊
1 -
I was also TP, and my sentinel node was declared clear in the OR, but in the lab was found to have isolated tumor cells. Both my MO and BS advised complete ALD and were pretty insistent that this was the right course of action. Did you have positive nods initially? Is the ALD being advised because of the poor chemo response? I was treated before the advent of Perjeta and neoadjuvent chemo and targeted therapy for Her+ patients, when the typical sequence of events was usually surgery/chemoand Herceptin/rads/anti-hormonals. The advice was based on the Her2 aspect, and the pathology from the ALD was quite a surprise. I had MRI done pre surgery and it showed nothing of note in the axilla - of course it could not see the ITC in the sentinel, but it actually also missed a much larger area of cancer in the nodes further up the chain. Without that additional surgery we would have been relying on chemo/Herceptin, and possibly rads, to eradicate the equivalent of stage 1 cancer in the breast. Rads was often not advised for ITC in the sentinel. This doesn't happen often - but I know of others on this site who have had similar situations, and I image poorly - mammography missed a palpable 2.6cm tumor in the breast, and transvaginal ultrasound missed a 3cm tumor (thankfully benign) in my right ovary, so there is also that. I did not have rads after the ALD plus bi-lateral mastectomy, both docs said it was not necessary after the clearance surgery. I would ask your MO, BS, and RO for the stats on your situation so that your decision is an informed one.
0 -
Thank you for the advice truly appreciate it :) yes, according to pathology I have a positive node which did show on MRI prior to surgery, along with poor response to my neo adjuvant therapy as well as positive for lymphatic/vascular involvement. The team advised a re-excision and ALD because of the results from pathology and they believe that is the best course moving forward along with doing targeted therapy, radiation and PT. I trust my team with their plans as they are the professionals, but just want to make sure that it is truly the right path for me. I due plan on getting a second opinion. When I did my MRI prior to surgery it showed shrinkage of the tumor and that my node was clear, but its not what pathology showed after surgery. Hoping and praying that second surgery will be better and will be clear.
1 -
@goodflower143 Welcome again! It's totally understandable that you’d want to be sure you’re on the right path, and it’s great that you’re planning to get a second opinion. If it helps, we’ve a really helpful section on getting a second opinion, complete with tips on what to expect and how to prepare. Hope this helps!
Wishing you all the best as you move forward, and please keep us posted. We’re here for you!
The Mods
0
