Sep 1, 2009 12:31PM Beesie wrote:
9 mm isn't tiny but it is small. It's less than 1 cm. So that's good! To put it in perspective, I had a large amount of DCIS - somewhere between 7 cm and 9 cm. Mine was larger than most, but it's not uncommon for women to 2 cm or 3 cm of DCIS. So 9 mm is not a lot.
I'm not sure why your doctor is suggesting the sentinel node biopsy. Whenever DCIS is diagnosed with a needle biopsy, there is always the possibility that some invasive cancer might be found once all the affected breast tissue is removed and examined under a microscope. This happens in about 10% - 15% of cases. If invasive cancer is found, then an SNB needs to be done. But for pure DCIS, an SNB is not necessary.
For those who have a mastectomy for DCIS, because an SNB can't be done after a mastectomy, often an SNB will be done at the same time as the mastectomy, just in case some invasive cancer is found in the final pathology. But for women who are having lumpectomies, this isn't necessary. If invasive cancer is found, the SNB can be done later. Since any removal of lymph nodes creates a lifetime risk of lymphedema (which is a condition that remains for life) and requires caution in the use of that arm for the rest of your life, you might want to question whether the SNB is really necessary. Certainly the risk of invasion is higher for those who have high grade DCIS, but with such a small amount of DCIS, I'd guess that your risk is probably no higher than average. Perhaps your doctor is just overly cautious, or perhaps he feels that your risk of invasion is higher. Whatever the reason, you should know.
Since the SNB is not mandatory, this should be your decision. Without knowing more, let's say that the risk that you might have some invasive cancer, thereby requiring an SNB, is around 10% - 15%. The risk of nodal involvement if a microinvasion is found is around 10%. So this means that as you sit here today with a preliminary diagnosis of DCIS, your risk of nodal involvement is probably 1% - 1.5%. The risk of lympedema from an SNB is about 3%.
A couple of things to be aware of if you have the SNB. While the node can be checked during surgery, usually this is a quick check that will only catch larger amounts of cancer. If there is only a very tiny invasion into the node, this may not be discovered until a more thorough pathology review is done in the days after the surgery. Many women who have come out of surgery with a clear node are surprised to find out later that the final pathology report does mention nodal involvement. This is very unlikely in your case, because your diagnosis at this point is pure DCIS, but it's something to be aware of.
The other thing to know is that from a recovery standpoint, most women find the SNB surgery and recovery to be more difficult than the lumpectomy (or even a mastectomy). With the SNB, your underarm area and possibly the top half of your arm may be numb for some time (days to months), and you may experience sharp shooting pains, tingling and sensitivity as the nerves regenerate. The lumpectomy itself is usually not very painful and the recovery is usually quite easy, although you may feel mild pains in your breast over a period of time as the nerves regenerate and as the breast tissue moves and fills in the empty area.