Topic: Newish diagnosed excisional biopsy

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

Posted on: May 5, 2022 08:29PM

Posted on: May 5, 2022 08:29PM

n2themystic wrote:

I have been recently diagnosed IDC along with incidental finding of DCIS per surgical pathology report from 4/8/22. I am looking for current recommended guidelines on surgical margins parameters. I am finding different numbers for idc and dcis. And I am receiving conflicting opinions from surgeon, MO, and RO thus far. Not sure what to make of it. This seems all so strange and convoluted.

Trying to narrow down my options I have been offered about SLNB, lumpectomy, or mastectomy for next steps. Anyone point me in the right direction?

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May 5, 2022 09:25PM katg wrote:

ntthemystic..

I am sorry this has been tough for you. I was not asked about margins, I was told. The Medical Oncologist may be the 1st contact to talk with if the surgeon is not a focused breast surgeon. The surgeon is the one who takes out lumps or more.

Please contact them and ask your questions. At my hospital the three you spoke of are a team, so my info is shared, and the info is accessible through the portal. Do you know if your hospital has that sort of team? I am sad where i read you post saying you are trying to narrow your options!!!!

I was not offered a lumpectomy because my breast is not large and the tumor was, so you must have more information. I expect more will respond, but i wanted to post that there is a lot if information on this site. Helping you find the questions to ask is what i want for you right now. Get your doctors to work as a team, and you be the patient. Feeling taken care of. Hugs to you.

Chemotherapy 8/14/2021 AC + T (Taxol) Hormonal Therapy 1/1/2022 Femara (letrozole) Surgery 2/9/2022 Cryotherapy (Left); Lumpectomy (Left); Lymph node removal (Left): Sentinel, Underarm/Axillary; Mastectomy (Left): Modified Radical, Nipple Sparing, Partial, Radical, Simple, Skin Sparing; Prophylactic mastectomy (Left); Reconstruction (Left): Aesthetic Flat Closure, Fat grafting, Nipple reconstruction, Nipple tattoo, Removal (Left), Tissue Expander Dx IDC, Left, 5cm, Stage IIB, Grade 2, ER+/PR-, HER2+, ISH, IHC
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May 5, 2022 09:35PM - edited May 5, 2022 09:37PM by moth

The clinical guidelines from the American Society of Breast Surgeons is on this page:

https://www.breastsurgeons.org/resources/statement... (left column, 2nd from top)

You can also see the NCCN guidelines here

https://www2.tri-kobe.org/nccn/guideline/breast/en...

It's a huge document. Pages 46-47 have the margin guidelines.

afaik, these are the up to date guidelines

(ps. in this case, the radiation oncologist & the surgeon are the subject matter experts, less so the medical oncologist so if there's a diversity of opinion, I'd give more weight to what the RO and BS are saying)

I take weekends off

Initial dx at 50. Seriously?? “Sometimes the future changes quickly and completely and we’re left with only the choice of what to do next." blog: Never Tell Me the Odds

Dx 12/2017, IDC, Left, 1cm, Stage IA, Grade 3, 0/5 nodes, ER-/PR-, HER2- Surgery 12/12/2017 Lumpectomy; Lumpectomy (Left); Lymph node removal Chemotherapy 2/13/2018 AC + T (Taxol) Radiation Therapy 8/13/2018 Whole breast: Breast Dx 2/2020, IDC, Left, Stage IV, metastasized to liver/lungs, Grade 3, ER-/PR-, HER2- Chemotherapy 3/18/2020 Taxol (paclitaxel) Immunotherapy 3/18/2020 Tecentriq (atezolizumab) Chemotherapy 11/25/2020 Abraxane (albumin-bound or nab-paclitaxel) Radiation Therapy 12/8/2020 External Hormonal Therapy 12/15/2020 Femara (letrozole) Radiation Therapy 3/2/2021 External Local Metastases 3/2/2021 Radiation therapy: Bone Targeted Therapy 1/1/2022 Trodelvy (sacituzumab govitecan-hziy) Chemotherapy 6/1/2022 Other
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May 6, 2022 07:54AM n2themystic wrote:

Thank you! Exactly what I was looking for. I see 3mm margins for both idc and dcis fall within guideline parameters but perhaps closer than surgeon would prefer on DCIS? I need to see him again next. I’m sure these drs will come to agreement after they talk to discuss. Surgeon is general and the MO & RO deferred to his initial opinion so far re margins. I’ve basically already had a lumpectomy (path says complete) with the surgical biopsy already done with tumor pathology so I’ve already fallen outside their usual processes and I’ve thrown them all for a tiny hiccup loop in their own flowchart.

From my perspective as the patient, I’m trying to make sure I understand my options as to thread a very tiny needle with my choices primarily to maximize my avoidance of radiation if possible bc of higher risk of complications with RT (I have a skin disorder that borders on relative contraindications.) The RO says I’m a candidate for PBRT to avoid problem areas on breast and axillary depending on node status of course. Ultimately, the final answer depends on the cancer I suppose and may not be mine after node analysis. Mastectomy seems so extreme but may be smarter decision over reexcision for margins/slnb and pray for clean nodes. Easy choice is to not do my due diligence. My curious brain won’t let me anyway. So here I am half diagnosed without confirmed node status trying to decide. It’s a quandry & hard place to be unless someone can loan me a crystal ball ha.

I do appreciate the quick replies though. Thank you, thank you. Wow typing my thoughts up was kind of therapeutic and clarifying.

Cancer is so weird. Sorry I was so wordy!

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May 20, 2022 08:25PM msphil wrote:

hello sweetie hope you are getting help and info you need her with us. I was diagnosed with idc after I found lump in shower. Got 2nd opinion and it was suggested by oncologist for mastectomy said my chances for recurrence after I make it 2 yrs. I wanted lumpectomy going into new marriage as she were making wedding ok and for our 2nd marriages but fiance now husband encourage the mastectomy for linger time survival. This yr is 28yr Survivor Praise God tomorrow is also your 28th wedding anniversary we re going out to eat to celebrate. msphil idc stage2 0/3 nodes 3 mo chemo before and after Lmast got married then 7 wks rads and 5 yrs on tamoxifen. Hang in there be Positive it got me thru.

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May 22, 2022 08:59PM rain88 wrote:

One of my margins was at 5mm after lumpectomy for mucinous (& incidental findings of DCIS), with no lymph node involvement. My RO suggested radx, since, even though acceptable, it was considered very close. Best of luck! ♥️

Dx 27/7/2019, Mucinous, 11 mm, Stage 1, Grade 1, 0/10 nodes, ER+/PR+, HER2-, Lumpectomy (right), Radiotherapy, Tamoxifen (15 months) Radiation Therapy 11/27/2019 Whole breast: Breast Radiation Therapy 11/27/2019 Whole breast, Radiation boost: Right breast Radiation Therapy 11/27/2019 Whole breast, Radiation boost: Right breast Hormonal Therapy 1/1/2020 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Jun 3, 2022 02:23PM n2themystic wrote:

Hi all! Thanks for all of the replies. The response here is a huge comfort when my brain gets mushy! And the information is tops and spot on!

Hanging in here for now. Still in hurry up and wait mode for test results ha!


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