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Topic: newly diagnosed and have questions

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

Posted on: Aug 10, 2019 09:32PM - edited Aug 10, 2019 09:49PM by brandy42

brandy42 wrote:

I was just diagnosed on August 8th - we are still waiting on some information in the initial report but they found 2 spots on my right breast. Area 1 and 2 are both DCIS, comedo-type necrosis present and intermediate grade. Area 1 is 4mm x 3mm and area 2 is 2mm x 2mm. I meet with a surgeon on August 10th (Monday) and have a 2nd opinion scheduled for August 23rd.

I know I am in the very beginning of this process and there are still many uncertainties. My biggest question is how much this diagnosis has affected your life and responsibilities.

I am 45 years old and have 2 teenagers. Now that my kids are a little older, I decided to go back to college to pursue a teaching degree about a year ago. I completed my 1st of 4 semesters in the Spring with all A's and have been looking forward to my 2nd semester this Fall. I am really concerned about this diagnosis and how much this will affect me being able to finish with my classmates. I know I can drop this for a semester and pick it back up when the DCIS has been taken care of. But I really don't want to quit or lose my spot in this program.

How did your diagnosis and treatment affect your other responsibilities?

Am I crazy to think I can do school and deal with this diagnosis at the same time? My schedule is set and can not altered because the classes all kind of work together. The program for this semester is 16 hours of lecture per week (basically 2.5 days of in class lectures) and then I will be required to complete a total of 50 hours of school classroom observations over this semester (which would probably be the other 2 days a week). So it is full time. And, of course, I want to do well.

I start school on Tuesday the 20th of August so I need to try to figure out what I need to do so I don't lose too much tuition if dropping the semester is the best option. I kind of feel like I am in denial about the commitment that both of these will require but I want to be able to make a better informed decision and just don't know what to do...

Any advice or suggestions would be helpful for me!!

Thanks in advance!!!

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Aug 10, 2019 11:20PM Beesie wrote:

Brandy, welcome! But sorry you've had to join us.

I will try to answer your questions but with one caution. Your diagnosis is preliminary, and could change when you have surgery. And that could change a lot.

At this point, if the two areas of DCIS are near each other, you probably could have a lumpectomy. With a lumpectomy for DCIS, lymph node removal isn't required, so it's usually an easy surgery and a quick recovery. But with a lumpectomy, normally radiation is recommended. There are different protocols but I believe most common is 5 days a week for 6 weeks. To my understanding (I never had rads), the appointments are quick.

Alternately, if the areas of DCIS are far apart, a mastectomy might be recommended. Or you could opt for a MX rather than a lumpectomy. Normally a sentinel node biopsy will be done with a MX even though DCIS does not require that nodes be checked. This is just in case some invasive cancer is found, because at that point the nodes would need to be checked and an SNB can't easily be done after a MX. The recovery after a MX and SNB (and reconstruction, should you choose it) will be longer and considerably more restrictive than the recovery after a lumpectomy. In most cases, radiation is not necessary after a MX.

With pure DCIS, that's it in terms of active treatment. If your DCIS is hormone positive, endocrine therapy will be recommended (although possibly not after a MX), which is a pill you take once a day. So this has no effect on your schedule.

But...sometimes there is more DCIS than expected, and the surgical margins after a lumpectomy aren't clean, necessitating a re-excision surgery. I think that happens in about 20% of cases. And sometimes invasive cancer is found mixed in with the DCIS. Again, this happens in ~20% of cases. Most often, if it's just a microinvasion (1mm or less of IDC) or just a bit larger, the treatment plan doesn't change. But if it's a larger area of IDC, or a small IDC that is particularly aggressive (hormone negative or HER2+) then chemo might come into play. And if you have a MX and opt to have reconstruction, that could add more recovery time, more appointments, and possibly more surgeries.

So could you continue with your plans for school? Probably yes, if all goes well and so long as you can work around the time off for surgery. But there could be surprises that throw a wrench in the plans.

I don't know how much you know about DCIS. This thread might be helpful:

“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke
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Aug 11, 2019 06:13AM Ingerp wrote:

brandy—just my thoughts. Beesie always gets things spot on. First of all, I never considered a second opinion because I trusted my medical team. It seems to me that’s adding a delay to the process. You might consider putting that on hold unless you’re not happy with your doctors. As many will tell you, the hardest thing about radiation is having to go five days a week, but yes the appointments go very quickly—maybe ten minutes once you’re called back. Unless you’d be in school all day, the treatment center should be able to work around your class schedule. Many women get the hypofractionated schedule—higher dose over fewer sessions. That would be 20, so four weeks of five days a week. Many women continue with work/grad school/. . . throughout treatment. There might be some fatigue with rads but honestly I only experienced it 2-3 times each time I was treated and if I got off my feet for an hour I felt much better.

You should be able to continue with your plans ***as long as it’s only DCIS***

Dx 3/11/2016, DCIS, Left, 6cm+, Stage 0, Grade 3, ER-/PR- Surgery 3/23/2016 Lumpectomy Surgery 4/20/2016 Lumpectomy: Left Radiation Therapy 5/18/2016 Whole-breast: Breast Dx 3/2/2018, IDC, Right, 1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR+, HER2+ (FISH) Surgery 3/13/2018 Lumpectomy: Right; Lymph node removal: Sentinel Chemotherapy 5/18/2018 Taxol (paclitaxel) Targeted Therapy 5/18/2018 Herceptin (trastuzumab) Radiation Therapy 8/20/2018 Whole-breast: Breast
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Aug 11, 2019 10:43AM - edited Aug 11, 2019 10:45AM by brandy42

Thank you for your quick replies!! The two areas are very close together at 9 and 10 o'clock.

I will talk to an advisor and speak to each of my professors and I will definitely TRY to make it all work. I have a great support system and group of classmates and we will complete the program together and I don't want to get separated from them.

And, yes, its very early and there is so much I don't know. I am currently with Kelsey-Seybold and that's where my GP doctor is and I got my diagnosis from the breast center there. My appointment on Monday is with a surgeon at Kelsey but I have not met him before. I might love him and be very comfortable with what he discusses - I just don't know yet. But I live in Houston and have easy access to MD Anderson and want to get a second opinion from them also - or at least I think I do, as of right now.

So far, the possible treatment that has been discussed is a lumpectomy with 4-6 weeks of radiation monday thru friday and possibly hormone therapy (but a mastectomy will also be an option). I will have a better idea after meeting with the surgeon tomorrow though and hopefully will have more test results also. I am extra anxious because I had 2 cases of cervical cancer (adenocarcinoma in situ) back in 2002 (conization) and in 2011 (hysterectomy leaving my solo ovary). I lost an ovary in 1994 due to benign cysts. And now my remaining left ovary has a complex cyst and we will need to investigate if there is any association between the ovary and the DCIS. Also - I am a little concerned because the initial mammogram I had a couple of weeks ago shows a small (6mm) mass on the other breast (left) that has been there for a few years but it says that is "benign appearing micro calcifications". It's just a lot to process and with starting school just around the corner - I am pretty anxious about it all.

I will need to let it all play out - I am just really nervous and I am not good with not having a plan and being in control. I will be learning how to practice patience and a new level of "going with the flow" :)

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Aug 11, 2019 10:47AM brandy42 wrote:

Beesie - thank you for your reply and the post you linked is very helpful. I am brand new here but I have already seen what a blessing you are :)

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