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Topic: HELP! Need help with margin info

Forum: Mixed Type Breast Cancer — Meet others who have mixed type breast cancer.

Posted on: Dec 5, 2015 05:47PM

Cathytoo wrote:

I have a 2.5cm mixed tumor.  Areas of DCIS intermixed with invasive carcinoma scattered throughout, Grade 3.  I need a re-excision because of some close margins.  

The report reads: Margins uninvolved by invasive carcinoma.  The closest margins are: Inferior margin  >5mm Posterior margin >5mm

Margins uninvolved by DCIS (if present) are:  Superior margin 0.55mm  Anterior 0.55mm

All others are between 1.1mm and 2.5mm

The surgeon said she took more tissue than usual.  But, this doesn't seems like good clean margins to me.

Can anyone explain?

Dx 10/13/2015, IDC, Right, 2cm, Stage IIA, Grade 3, 0/3 nodes, ER-/PR-, HER2- Chemotherapy 1/17/2016 Cytoxan (cyclophosphamide), Taxotere (docetaxel)
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Dec 6, 2015 07:05AM BrooksideVT wrote:

I find your report confusing too. It does seem that there are larger margins around the invasive component than the DCIS, which is reassuring. It sounds as though a re-excision is planned because of narrow (although clear) margins. I'm not sure I understand your question, but think maybe it's that you are wondering how it could be that your surgeon took more tissue than usual while still achieving only very narrow margins? If so, it would be that your tumor extended further than imaging or visualization could show.

Dx 11/21/2012, IDC, 1cm, Stage I, Grade 1, 0/2 nodes, ER+/PR+, HER2- Surgery 1/7/2013 Lumpectomy: Right; Lymph node removal: Right, Sentinel Radiation Therapy 2/21/2013 Breast Hormonal Therapy 4/1/2013 Arimidex (anastrozole), Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Hormonal Therapy 7/4/2014 Aromasin (exemestane) Hormonal Therapy 11/21/2014 Arimidex (anastrozole), Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Hormonal Therapy 9/28/2015 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Dec 6, 2015 08:42AM Cathytoo wrote:

Do you know what is considered a good clean margin.  I read somewhere 11mm.  Does that sound right?

Dx 10/13/2015, IDC, Right, 2cm, Stage IIA, Grade 3, 0/3 nodes, ER-/PR-, HER2- Chemotherapy 1/17/2016 Cytoxan (cyclophosphamide), Taxotere (docetaxel)
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Dec 6, 2015 07:38PM Hopeful82014 wrote:

Cathy, 11mm seems like it would be a lot. My smallest was 1mm (she couldn't go any farther without taking out muscle, so we had to be content with that. We also radiated it thoroughly.)

Standards are changing as far as what constitutes a clean margin. Some say as long as there are no tumor cells on the ink you're o.k., others are much more conservative in that they want much bigger margins. Don't be afraid to have a good discussion with your surgeon to clarify anything you're not comfortable with.


Dx IDC
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Dec 6, 2015 08:04PM slv58 wrote:

Hopeful, can you explain why surgeons are hesitant to take out some muscle to gain wider margins? I've read it often that surgeon stop at muscle, does it cause damage that is irreversible? I'm just curious. My closest margin was 4mm at chest wall. 

Shari "my clouds are always silver" Chemotherapy 1/22/2013 Cytoxan (cyclophosphamide), Ellence (epirubicin), Fluorouracil (5-fluorouracil, 5-FU, Adrucil), Taxotere (docetaxel) Surgery 6/6/2013 Lumpectomy: Right; Lymph node removal: Right, Sentinel Radiation Therapy 7/4/2013 Breast, Lymph nodes Surgery 3/9/2015 Mastectomy: Right; Reconstruction (right): DIEP flap Chemotherapy 4/21/2015 Carboplatin (Paraplatin), Gemzar (gemcitabine)
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Dec 6, 2015 09:05PM Hopeful82014 wrote:

Shari, I'm not sure about that but have assumed that muscle injured in that fashion would not heal as well as breast tissue and that the risk of greater, permanent effects would be considerable.

It's an interesting question and I'd be interested in a more authoritative answer!

Dx IDC
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Dec 11, 2015 06:43PM SoCalGrl wrote:

I'm actually going back under next week because my margin was .15mm near my DCIS. This was supposed to be my exchange surgery after chemo but my MO said she wanted radiation because the margin was too close for comfort. My breast surgeon thought the margin was fine but consulted a radiologist that ended up agreeing with my MO.

If I'm not mistakena "good" margin is considered 2mm, but doctors are different. As you can see even my MO and breast surgeon disagreed.

Oncotype 22 | October 26, 2015 = Last round of chemo! Surgery 6/16/2015 Mastectomy: Right Surgery 6/16/2015 Prophylactic mastectomy: Left Chemotherapy 8/19/2015 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Hormonal Therapy 11/17/2015 Femara (letrozole) Dx IDC, Right, <1cm, Stage IA, Grade 1, 0/2 nodes, ER+/PR+, HER2- (FISH) Dx DCIS/IDC, Right, <1cm, Stage IA, Grade 2, 0/2 nodes, ER+/PR+, HER2- (FISH)
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Dec 11, 2015 07:02PM marijen wrote:

I just checked my pathology report, it looks like good margins are .5cm and I am also going back next week for one margin.

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Dec 11, 2015 10:10PM SpecialK wrote:

Desired margins are usually 2mm or greater, less than that is a subjective call if the margins are narrow, but clean, as to whether or not to do an additional excision.  A dirty margin needs more surgery.

BMX w/ TE 11/1/10, ALND 12/6/10. 15 additional surgeries. TCHx6 2/17-6/2/11. Herceptin until 1/19/12. Femara 8/1/11, Arimidex 6/20/12, back to Femara 6/18/13-present. Dx 9/27/2010, DCIS, Stage 0, Grade 3 Dx 9/27/2010, IDC, Right, 2cm, Stage IIB, Grade 3, 2/14 nodes, ER+/PR+, HER2+ (IHC)

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