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Topic: First Surgical Consult

Forum: Just Diagnosed — Discuss next steps, options, and resources.

Posted on: Apr 10, 2008 04:32PM

canuckintx wrote:

I was diagnosed on 4/1 with invasive ductal carcinoma. My tumor is 1.2 cm, low grade, stage 1 according to the initial pathology report from my core needle biopsy.  The surgeon I met with today seems very competent, pretty much told me that he would perform a lumpectomy with a sentinel node biopsy - and refer me to an oncologist following the surgery based on the pathology report from the surgery.  In the midst of our consult, he got paged, and for the remainder stood up and quickly answered my questions.  In a nutshell, he indicated that my cancer isn't very serious, and that I have a 95% chance of not getting any further breast cancer.  Can he honestly predict that before conducting surgery?  I really felt like he was minimizing the seriousness ofmy cancer.  I know that in the big scheme of things, that my cancer is probably less serious than many on these boards, but it is still weighing heavily on me.  Also, the local "community" hospital is small.  I know that I shouldn't base my decision on the hospital facilities, and that big doesn't mean better, but it makes me a little nervous.  When I asked him whether I should have a diagnostic MRI, he said "no" because my tumor is so small.  Any thoughts on this from those of you who have been through the process?  I am planning to get a second opinion from a surgeon at Baylor in Houston for comparison purposes.

Dx 4/1/2008, IDC, 1cm, Stage I, Grade 1, 0/9 nodes, ER+/PR+, HER2-
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Apr 10, 2008 04:41PM , edited Apr 10, 2008 04:42PM by wishiwere

It sounds like after that page, he left you in spirit from your observations.  I think a second opinion is good whether you feel comfortable or not with a facility/doctor, just because 2 opinions are better than one. Another might have other ideas, or they might concur and that would at the very least, put your mind at ease.  Did you have an US or a mammo??  What type of bx did you have?

What else did the path report say?  ER/PR + or anything about the HER2neu?  Was it DCIS, LCIS, IDC, or ILC? or what type of cells?

wishiwere~ Path read stage 1C- 1st Primary was IDC w/DCIS 1.4 cm, ER/PR+ & HER2- Dx 9/21/2007, ILC, 1cm, Stage IB, Grade 2, 0/4 nodes, ER+/PR+, HER2-
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Apr 10, 2008 06:05PM , edited Apr 10, 2008 06:06PM by canuckintx

Wishiwere, thanks for your reply.  I had a mammogram, ultrasound, followed by the biopsy.  My report says ER/PR+, HER2-.  I have been diagnosed with IDC - not sure what you mean by "type of cells".

Dx 4/1/2008, IDC, 1cm, Stage I, Grade 1, 0/9 nodes, ER+/PR+, HER2-
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Apr 10, 2008 07:25PM Beesie wrote:

I understand your discomfort.  I'd suggest a 2nd opinion.  Your cancer may appear to be early stage, but early stage breast cancer is still cancer, and it needs to be taken seriously.  The most important thing with early stage BC is that it needs to be treated properly so that there isn't a recurrence, which then could be much more serious.

With information only from a core needle biopsy, I think it's premature for the surgeon to suggest that after surgery you will have only a 5% chance of not getting any further breast cancer.   Perhaps he was just trying to reassure you, but I think he was jumping the gun.  And actually, it's the oncologist who is the expert on this, not the surgeon.  Frankly, even if you had your final pathology report and nothing had changed from the initial biopsy, 5% seems to be an usually low recurrence rate.  He is obviously making a lot of assumptions  - that your cancer is as small as it appears, that he will get large clean margins with the surgery, that your nodes will be clear, that you will have radiation, and likely, that you will take Tamoxifen.

He might be a great surgeon, but if you are not comfortable with him, definitely get a 2nd opinion and change to the other surgeon if you are more comfortable with him or her.

Dx 9/15/05, DCIS-MI, 6cm+ Gr3 DCIS w/IDC microinvasion, Stage IA, 0/3 nodes, ER+/PR- “No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke
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Apr 10, 2008 07:47PM canuckintx wrote:

Thanks.  As I have been pursing this website, it appears that more than a few women have had an MRI that has indicated additional tumors.  What do you all think about this?  Should I be pushing for an MRI prior to the lumpectomy?

Dx 4/1/2008, IDC, 1cm, Stage I, Grade 1, 0/9 nodes, ER+/PR+, HER2-
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Apr 10, 2008 08:15PM unlimited wrote:

Canuckintx --

My pathology is almost as exact as yours (see below)  after having my lumpectomy 12/4/2006 and a  SNB  -  my surgeon seemed to figure my node removed was ' healthy'  ( prior to surgery at the consult -- he indicated at times a node  that has cancer can have a change in color- texture - and be hard......)  he indicated to my hubby that he figured my node was a- ok ----- BUT then with the pathology of that ... Node ....   I received a phone call from surgeopn a few days later - that indeed the node did contain cancer cells .... where it even broke thru - and was ' extracapsular extension ' ......  so what did this mean for me ????   Back to surgery to remove more nodes -- and I was OK with scheduling this next surgery after xmas ... 12/29/2006 .... and with this surgery he also placed me PORT ---  since I would indeed need chemo due to 1.3 IDC  and 1 Positive node....

Since Grade 1 -- and not likely that more nodes would be ' affected'

I only had Level 1  of the nodes removed under my pit -- ( there are 2 LEVELS of nodes under the pit area....

Good Luck with your surgery  - let us know what is discovered with the surgery ---- I did very well with all my surgeries - and healing -- -and had flying colors thru my chemo and rads --- just taking Tamoxifen now =)

Hugs  .... 

Dx 11/20/2006, IDC, 1cm, Stage IIA, Grade 1, 1/21 nodes, ER+/PR+, HER2-
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Apr 10, 2008 10:28PM Blinx wrote:

Canuck -- I'm glad you're getting a second opinion. Ask around (at support groups?) who other women trusted with their surgery. You will feel much better about whatever choice you make when you have faith in your surgeon.

I too went to a small community hospital, but I'm very happy with my surgeon. After the sterotactic biopsy confirmed DCIS, he scheduled an hour and a half to go over every possible action I might take, and also had an oncology nurse there as well, to give her input. He also insisted that I get an MRI, to check out both breasts -- best to find all the cancer and deal with it at once.

But, be prepared. MRIs can open up a can of worms -- mine led to 2 more biopsies, but also confirmed that the othe breast was cancer-free. Good luck!

Dx July 2007 DCIS Grade 3 (at age 46); Lumpectomy Sept 2007. ER+/PR-; Finished 33 rad tx Jan 2008. 3.5 years of Tamoxifen then quit..
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Apr 11, 2008 11:14AM Nancyg wrote:

Canuck

I was diagnosed on March 12th with IDC of the right breast, 1.5 cm after mamo, ultrasound and biopsy.  My doctor recommended an MRI and I just obtained the results indicating three more tumors, 2 additional in the right breast and one in the left.  I was scheduled for biopsies right after the MRI but the doctor who read the MRI felt another biopsy was not necessary since the one in the left was so small and the two they found in the right after the MRI were in the same "quadrant" as the 1.5 so she spoke with my surgeon and they decided not to biopsy since all three were close together and within the tissue that would be removed anyway.    My lumpectomy is scheduled for Tuesday at Mayo.  My point is that even if the MRI comes up with something additional it is better to know now and take care of it all at one time.

I went to Mayo for a second opinion and switched and even though it extended the treatment time a little it has given me more confidence that I can get through this.

Dx 3/12/2008, IDC, 1cm, Stage I, Grade 2, ER+/PR+, HER2-
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Apr 11, 2008 11:26AM swimangel72 wrote:

Canuck - a second opinion will definitely bring you more peace of mind. My cancer was even smaller than  yours - everyone kept saying it "wasn't that serious".........even after MRI's of both breasts showed no other cancers, my doctor was so thorough he ordered MRI's of both my hips since I complained about hip pain (turned out to be arthritis) - and he even gave me a complete bone scan. Because I am who I am (jumping into the ocean all at once, riding the front seat of the roller-coaster type of person) I opted for a skin-sparing mastectomy followed immediately by Diep (because I saw my dad die of brain cancer at the age of 59). I'm glad I did the mastectomy (not saying YOU should be so aggressive) - because my Her2 status took a LONG time to come back - and when it did (just last week) it turns out I'm positive. So I'm happy my breast doctor was as aggressive as I was all along. My oncologist is just as aggressive - and I'll be starting on chemo and Herceptin soon.

Bottom line - get a second opinion - and I hope they agree that you need MRI's done on both breasts. Good luck - and I'm sorry you have to go through this - but remember, we're all here to help each other!

3/3/08 Right-side mastectomy with immediate muscle-sparing free tram; 3/9/08 Developed abdominal MRSA staph infection and hernia;Completed 4 months Navelbine and 1 year Herceptin; Arimidex - 3 more years! Diagnosed at age 53 Dx 2/5/2008, IDC, <1cm, Stage IB, Grade 1, 0/7 nodes, ER+/PR+, HER2+
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Apr 12, 2008 01:56AM Gardenlady wrote:

My cancer was also much smaller but I have a sister with stage 4 BC.  My surgeon was very thorough.  I had asked the radiologist for an MRI because I had some calcifications in the right breast they wanted to follow for changes.  They did and saw none than all of a sudden some knew ones appeared in the left breast.  They sent me a letter telling me they felt they were benign.  I opted for a needle byopsey and it came back positive for dcis low grade 3-4 mm.  I then saw the surgeon who ordered a MRI of both breasts.  There was a suspitious spot in the right breast also.  The radiologist had moved on from the right breast because there had been no change in the Mamograms.  I had another needle biopsy which came back positive for dcis low grade mm.  I now have had two lumpectomies one in each breast.  I have clear margins and will go onto an oncologist and radiation team meeting in a week.  I live in a town of about 73,000 people but will get the second opinion in Seattle.  The surgeon was very good at being attentive, to all of me which I felt was extremley important.  She knew I had watched a sister go through this and survive.   I knew we all wanted to be obtimistic but there could be surprises.  It is very important to get as much information as you can before surgery and take care of it.  The waiting for results in very hard.  I am so glad the second spot was found and I can deal with it all at once now.  The radiologist said MRIs cost $3,000 and they can't be having every woman get one.  I understand false positives can happen but I think to many woman are not getting the information they need.  I hope you find a surgeon

that you feel deals with all of you.