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All TopicsForum: DCIS (Ductal Carcinoma In Situ) → Topic: DCIS Very Close to Chest Wall

Topic: DCIS Very Close to Chest Wall

Forum: DCIS (Ductal Carcinoma In Situ) — Just diagnosed, in treatment, or finished treatment for DCIS.

Posted on: Oct 9, 2008 11:55PM

soapsnug wrote:

Hi Everyone,

I was diagnosed with DCIS on October 3rd.  Five years ago, a biopsy indicated the presence of ductal hyerplasia, and I've been seriously worrying about developing cancer since then.  On Sept. 29th. I had my 5th. breast biopsy, after an area of calcification was seen on my mammogram.  Two radiologists who reviewed my films felt that it was benign, as I have calcifications throughout both of my breasts.  My surgeon felt that way, too.  Additionally, on my mammogram, the calcified area appeared very small--it looked like a cluster of about 4 tiny calcifications.  The radiologists felt that I should have a surgical biopsy, as opposed to a stereotactic breast biopsy, for two reasons--one, my small breast size, and two, the location of the calcified area.  My surgeon agreed that a stereotactic biopsy shouldn't be done, as he felt that the needle could puncture my chest wall.  The area that was excised was 2 x 3 x .08 cm.  For something that appeared as basically nothing on my mammogram, that seems large to me!  Plus, the pathology report indicated no clear margins, so I have absolutely no idea how large the cancerous area is.  I do know that the types are cribriform and solid, and that it is estrogen and progesterone positive.  As far as the grade goes--there wasn't one given--the report just indicated "low to high grade", so I don't know what to make of that.  Plus, the cancer is extending into the lobules.

I've decided to have a bilateral mastectomy, and feel at peace with my decision--I had been thinking of having prophylactic bilateral mastectomy for the past year and a half, so, for me, the decision was not difficult.  I'm now deciding if I'm going to go with my surgeon (he's a general surgeon who does a lot of breast surgery, but also does a lot of other types of surgery) who's done all of my biopsies for the past 14 years, and with whom I feel really comfortable, or go with a "dedicated" breast surgeon.  I have an appointment with a breast surgeon, who comes highly recommended, next week.

My new concern, which just surfaced a few hours ago, has to do with the fact that the cancer is so close to my chest wall.  Will any surgeon--breast or general--be able to get out all of the cancer if it's that close to the chest wall?  I know they never get out 100% of the breast tissue, so now I'm starting to really worry that some cancer cells will be left behind, and that not only will I have a recurrence, but that it will become invasive breast cancer.  When I met with my general surgeon on Tuesday to go over my pathology report and ask questions, I didn't even think to ask about that--as I said, this is a totally new fear!!  Something else which fuels my worry--when I saw my surgeon in the hospital after the biopsy on 9/29, he said that he thought that the finding would be benign.  If the surgeons cannot always tell the difference between cancer cells and normal cells--how do they know they've gotten all the cancer out?!  My surgeon assures me that I will be cancer-free with mastectomy, but again, I am worrying about that small bit of tissue that will be left behind.

Has anyone else had a similar situation, with DCIS very close to the chest wall?  Any stories, information, reassurances, etc. would be much appreciated!  Thanks.

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Oct 10, 2008 01:16PM koshka1 wrote:

Hi there.....

If you are having a mastectomy they remove all of the breast tissue....if the dcis is close to the chest wall and they remove that milk duct (like they do in mastectomy), there should be no more dcis...no milk duct=no dcis...

If..and i mean if...there are further concerns with close margins after a mastectomy they may decide to send you for radiation therapy......

This is all too soon to consider..chances are you will be okay with just the mastectomy.

Try not to worry about any of this stuff until you get your final pathology report....

Hugs Kosh...

Dx 12/2007, IDC, <1cm, Stage IA, Grade 1, 0/1 nodes, ER+/PR+, HER2-
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Oct 10, 2008 01:33PM lewisfamily503 wrote:

Hi Soapsnug (cute name!)  Your story pretty much parallels mine!  I too, started with atypia hyperplasia and lots of areas of calcifications in one breast.  I had been dealing with this since 2001.  Last October I had yet another biopsy and learned I had DCIS.  I opted, just as you have, to have a mastectomy plus a prophylatctic mastectomy in my "good" breast.  My pathology was like yours as well, except the area excised was about 8 centimeters.  What really concerned me prior to my mastectomy decision, was the dcis didn't show up on the mammogram and ensuing biopsy.  The area they were targeting turned out to be just more calcifications.  It was only by chance that they found the dcis on a margin of the biopsy tissue where they just happened to test--thank god!!  So.....I decided I wanted my breast gone--now!   I didn't have the area of concern as close to the chest wall as you, but I wondered then (and still do now) if they only found the dcis by chance, where else might it have been as well?  My final pathology didn't show any additional dcis, but it my understanding that they can't sample ALL of the tissue removed, so who really knows?  That is why they do radiation when people just do a lumpectomy.  I think you could ask for radiation if you really feel concerned, but I would consult with your doctors.  They have plenty of experience with all of this, and I do feel comfortable with mine that they got it all.  There will always be that one % chance that they didn't get it all, but 99 % is pretty good odds!  If you need any advice about what to expect with regard to your mastectomy, please feel free to PM me.  I opted for reconstruction as well so I can help with that too!  Good luck to you!

Anne 

Anne Dx 10/19/2007, , Grade 2, 0/2 nodes, ER+/PR+
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Oct 10, 2008 01:46PM kalyla wrote:

They will probably suggest doing radiation in addition to whatever else you do. Radiation is very good at killing any remaining cancerous cells and they can focus on specific areas during your boosts. Good luck.

Kalyla Dx 2/12/2008, IDC, 6cm+, Stage IV, Grade 3, 22/27 nodes, mets, ER+/PR+, HER2-
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Oct 10, 2008 03:36PM Beesie wrote:

They may or may not recommend radiation.  With a mastectomy, not all of the breast tissue can be removed.  However DCIS cancer cells are not floating free within the breast tissue; DCIS cancer cells are completely contained within the milk ducts.  So while a tiny bit of breast tissue will remain after a mastectomy, it is quite unlikely that any milk ducts will remain.  For this reason, the majority of doctors and experts do not recommend radiation even when there is DCIS near the chest wall.  The feeling is that the risks from radiation are greater than the risk of recurrence after a mastectomy for DCIS (most sources put the recurrence risk at 1% - 2%).  There are some doctors who will recommend radiation after a mastectomy for DCIS but they are in the minority.  Quite a few of the DCIS women here have had close margins after their mastectomies and most were not given radiation. I had a close margin (1mm) at the skin and radiation was not recommended for me.

It is a very different situation for anyone who has invasive cancer (IDC) near the chest wall.  In this case, there is a very real concern that some cancer cells might remain in the small amount of breast tissue that is left after the mastectomy so the recurrence risk can be much greater.  For this reason, radiation will pretty much always be recommended when IDC is found near the chest wall.  

My recommendation is that you specificly discuss whether or not radiation would be beneficial for you after the mastectomy, given how close your DCIS is to the chest wall.  See what your surgeon says and consult with a radiation oncologist.  Then make your decision from there.

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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Oct 11, 2008 05:10PM josirus wrote:

In one of my discussions with my breast surgeon, he told me that recurrence is still possible (although much less likely) with mastectomy because there will still be about 2-3% of breast tissue left behind. It is impossible to remove it all. I assumed that the 2-3% remaining tissue would be on the chest wall, but, in actual fact, my surgeon corrected me and told me that it is quite straightforward to "peel" the breast tissue off of the chest wall. There is some layer in between the breast tissue and the chest wall that allows almost all of the breast tissue to be removed there. The 2-3% of tissue that can be left behind is towards the outside of the breast, on the sides. I can get more information when I see him on Wednesday. Hope this bit of information helps.

Dx 9/8/2008, DCIS, 6cm+, Stage 0, Grade 3, 0/0 nodes, ER+/PR+
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Oct 11, 2008 05:47PM sheesh1961 wrote:

Hi soapsnug, I also had DCIS very close to the chest wall (5 and 6 o'clock, left side). The information Beesie gave you is exactly what I learned too. You said your cancer is extending into the lobes, though, so that could make things different for you. Are they still telling you DCIS, or DCIS with microinvasion? My radiation oncologist told me that there was no indication for radiation because there is nothing left to radiate -- it was strictly DCIS, and I had a mastectomy -- even though it was grade 3 and I had a clear margin of less than 1mm. Also, my breast surgeon told me that since I opted for implants, now the chest muscle that had been lying under the breast tissue is right next to the skin, with the implant under it. So it should be very easy to feel any lumps if there's a recurrence. I hope that helps and doesn't confuse matters more! Also, my breast surgeon and the radiologist BOTH thought that my spots would be benign, and they were both wrong!

Sheila

Dx 6/20/2008, DCIS, <1cm, Stage 0, Grade 3, 0/3 nodes, ER+
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Oct 11, 2008 09:26PM soapsnug wrote:

Thanks for all of your replies!  I am feeling a lot more positive after reading that radiation was not necessary in a number of cases in which the margin was only about 1mm.  Also, I just assumed that the breast tissue that remained was tissue that was close to the breast wall.  I was surprised to hear that it's actually tissue from the outside of the breast.  Ultimately, I know that I will have to wait to see my final pathology report, and take it from there.  So, I have decided to stop worrying about this issue for now, and focus my attention and energy on choosing the right surgeon, and getting through the surgery.  I do have a new question, though.  Sheesh1961 asked if my cancer is DCIS w/microinvasion.  The pathology report from my biopsy indicates that it is DCIS-- "low to high grade with calcifications and extension in the lobules".  There is no indication that there is microinvasion.  Is there a greater likelihood of microinvasion when the cancer has started to extend into the lobules?

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Oct 11, 2008 10:04PM nosurrender wrote:

I would definitely go with a breast surgeon over a general surgeon.

There was a study done  a couple of years ago by ASCO and there is a survival benefit for women who have used a BS over a GS. In fact, 70% of all BC is cured by surgery alone- so I would go with the BS.

I answered you someplace else with surgeon recommendations.

Good luck to you

hugs

g

nosurrenderbreastcancerhelp.org ~What a long, strange trip it's been...
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Oct 11, 2008 10:57PM sheesh1961 wrote:

soapsnug, my understanding of DCIS is that it's contained just within the ducts. Microinvasion is when a few cells start to grow outside the ducts. So I guess I"m not quite sure what they mean by extension in the lobules. I haven't heard that before. It would be worth asking. Possibly a combination of DCIS and LCIS? I'm not sure -- sorry I can't be more help!

Sheila

Dx 6/20/2008, DCIS, <1cm, Stage 0, Grade 3, 0/3 nodes, ER+
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Oct 11, 2008 11:06PM soapsnug wrote:

sheesh1961--Thanks.  I think I'll start a new topic to see if anyone else has experience with DCIS extending into the lobules.

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Oct 12, 2008 12:47AM rockwell_girl wrote:

in my case we had thought I just had DCIS (7 clusters) but during my surgery the surgion found IDC close to the skin and chest muscle.  So she choose to take extra skin and some of my chest muscle to check it for cancer.  I'm glad to say it all came back clear : - )

Sandy/Sunshine : ) Dx 3/4/2008, IDC, 1cm, Stage I, Grade 1, 0/2 nodes, ER+/PR+, HER2-
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Oct 13, 2008 11:49PM hopefor30 wrote:

I also had DCIS which was close to the chest wall and extended into the lobules.   Radiation was not recommended but I did have a mastectomy.   Unfortunately, in my case, a small invasive tubular cancer was found -- it was not considered a microinvasion, but a separate cancer.   Apparently tubular is often found with DCIS -- but it was only the DCIS which was close to the chest wall and since that is not invasive, no radiation.   I had more than one opinion so I felt confident with that decision.

M.

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Nov 12, 2008 04:28PM Beesie wrote:

Bumping for momto3kidz.

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