1. < Breast Cancer

Repeat lumpectomy? And treatment decisions. Need advice

Posted by kikay @kikay, Dec 15, 2023

Just had lumpectomy Dec 1. Pathology report was: positive margin on the posterior edge DCIS Micropapillary Grade 2. My surgeon called me yesterday for re-excision or another lumpectomy. I was hesitant to do it since I am a single mom and I was so difficult for me and my teens . Today he said he present my case to the tumor board to help me decide. Any suggestions? Did my surgeon messed up and missed the rest of the cancer cells? Or he just didn’t see the cancer with his naked eye just what he told me? What is the percentage that second surgery will be successful. ? After this , my oncologist said I will have radiation and hormone therapy for 5 years since my ER is positive. I need help in decision making please.

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Rubyslippers | @triciaot | Jan 2 2:22pm
In reply to @lifetraveler "Hi! Jaynep & my comrades in fighting the war with cancers: I just had my surgery..." + (show)
@lifetraveler

Hi! Jaynep & my comrades in fighting the war with cancers:

I just had my surgery to remove that mass of Breast Cancer on 12/26. Just read the post surgery Pathology report of mine from the portal of the hospital as following:

"Invasive ductal carcinoma, intermediate histologic grade, measuring 40 mm in
greatest dimension.
Carcinoma extends to posterior margin focally (2 mm front).

Margin Status for Invasive Carcinoma: Invasive carcinoma present at margin
Margin(s) Involved by Invasive Carcinoma: Posterior
(block 3G), focal (2 mm front)"

This seems like I did not get "clear" margins, right? 2nd surgery shall be the next step? ? Due to the holiday season, I am hesitating to contact my oncological surgeon. I was hoping to get a clear margins to opt-out of the rediation treatments, for I am 71+ and don't want to deal with any side effects of rediation treatments. Any experienced advice is highly appreciated!

Wishing you all a very healthy and blessed Year 2024! God bless you all!

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I had a 1 mm anterior margin, focal, all other areas were 2 mm, DCIS, intermediate grade, ER+ 100% PR+ 95-98%.
I chose to not have the second surgery to increase the margin:
-Because I had already decided to do radiation as it was intermediate grade, with the likelihood of recurrence without radiation.
-Because it was on the anterior (skin) side, which I felt a second surgery would compromise the thickness of skin where the radiation is aimed, and more likely cause skin breakdown.
- Because it was focal - which means only a point was touching.
I’m 69 yo, had radiation in October 2022, 5 consecutive days, 600 gy each, total 3000 gy. I had the option of doing 15 sessions, same total 3000 gy each session 200 gy. I had read the Italian research on the 5 days and thought it was sound. I do believe the cancer center is now doing 5 days radiation with an off day in between each day.
I had no skin breakdown, no sunburn. My breast remains mostly soft, lumpiness is felt when I’m lying down but I can’t tell if that is from surgical reconstruction or radiation. Nothing noted on my 1 year MRI except expected reconstruction changes. I do not have an insert. My breast was reconfigured smaller with existing tissue.
At one year out, I started having some pain. Different pain than I’ve had and is only located in the radiated area. Intermittent, mod level. An OTC lidocaine patch helped. It has receded the past few days, some minor sensitivity to touch. Possibly there is some radiation fibrosis - or it could be fat necrosis or calcifications causing the pain. I’ll ask at next appointment.
Knowing what I know now, I would still choose radiation.

REPLY
2 replies
kikay | @kikay | Jan 2 4:05pm
In reply to @triciaot "I had a 1 mm anterior margin, focal, all other areas were 2 mm, DCIS, intermediate..." + (show)
@triciaot

I had a 1 mm anterior margin, focal, all other areas were 2 mm, DCIS, intermediate grade, ER+ 100% PR+ 95-98%.
I chose to not have the second surgery to increase the margin:
-Because I had already decided to do radiation as it was intermediate grade, with the likelihood of recurrence without radiation.
-Because it was on the anterior (skin) side, which I felt a second surgery would compromise the thickness of skin where the radiation is aimed, and more likely cause skin breakdown.
- Because it was focal - which means only a point was touching.
I’m 69 yo, had radiation in October 2022, 5 consecutive days, 600 gy each, total 3000 gy. I had the option of doing 15 sessions, same total 3000 gy each session 200 gy. I had read the Italian research on the 5 days and thought it was sound. I do believe the cancer center is now doing 5 days radiation with an off day in between each day.
I had no skin breakdown, no sunburn. My breast remains mostly soft, lumpiness is felt when I’m lying down but I can’t tell if that is from surgical reconstruction or radiation. Nothing noted on my 1 year MRI except expected reconstruction changes. I do not have an insert. My breast was reconfigured smaller with existing tissue.
At one year out, I started having some pain. Different pain than I’ve had and is only located in the radiated area. Intermittent, mod level. An OTC lidocaine patch helped. It has receded the past few days, some minor sensitivity to touch. Possibly there is some radiation fibrosis - or it could be fat necrosis or calcifications causing the pain. I’ll ask at next appointment.
Knowing what I know now, I would still choose radiation.

Jump to this post

Thank you for sharing your experience.

REPLY
dlmdinia | @dlmdinia | Jan 2 6:24pm

My surgeon did an exam to determine that everything was healing properly. I also had lymph nodes removed which required a drain tube which was removed at that visit.

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dlmdinia | @dlmdinia | Jan 2 6:26pm

My surgeon did an exam to determine that everything was healing properly. I also had lymph nodes removed which required a drain tube which was removed at that visit. He also explained the pathology results and the treatment plan going forward.

REPLY
1 reply
lifetraveler | @lifetraveler | Jan 2 6:48pm
In reply to @dlmdinia "My surgeon did an exam to determine that everything was healing properly. I also had lymph..." + (show)
@dlmdinia

My surgeon did an exam to determine that everything was healing properly. I also had lymph nodes removed which required a drain tube which was removed at that visit. He also explained the pathology results and the treatment plan going forward.

Jump to this post

Thanks for sharing your experience to help us:)

God bless!

REPLY
lifetraveler | @lifetraveler | Jan 2 7:17pm
In reply to @triciaot "I had a 1 mm anterior margin, focal, all other areas were 2 mm, DCIS, intermediate..." + (show)
@triciaot

I had a 1 mm anterior margin, focal, all other areas were 2 mm, DCIS, intermediate grade, ER+ 100% PR+ 95-98%.
I chose to not have the second surgery to increase the margin:
-Because I had already decided to do radiation as it was intermediate grade, with the likelihood of recurrence without radiation.
-Because it was on the anterior (skin) side, which I felt a second surgery would compromise the thickness of skin where the radiation is aimed, and more likely cause skin breakdown.
- Because it was focal - which means only a point was touching.
I’m 69 yo, had radiation in October 2022, 5 consecutive days, 600 gy each, total 3000 gy. I had the option of doing 15 sessions, same total 3000 gy each session 200 gy. I had read the Italian research on the 5 days and thought it was sound. I do believe the cancer center is now doing 5 days radiation with an off day in between each day.
I had no skin breakdown, no sunburn. My breast remains mostly soft, lumpiness is felt when I’m lying down but I can’t tell if that is from surgical reconstruction or radiation. Nothing noted on my 1 year MRI except expected reconstruction changes. I do not have an insert. My breast was reconfigured smaller with existing tissue.
At one year out, I started having some pain. Different pain than I’ve had and is only located in the radiated area. Intermittent, mod level. An OTC lidocaine patch helped. It has receded the past few days, some minor sensitivity to touch. Possibly there is some radiation fibrosis - or it could be fat necrosis or calcifications causing the pain. I’ll ask at next appointment.
Knowing what I know now, I would still choose radiation.

Jump to this post

Dear Tricia:

Thank you so much for sharing your experience and explaining so clearly on your reasoning behind this tough decision making process!

You are such a brave lady with wisdom that I truly admire:) Please ask your physician at your next appointment regarding this new kind of pain, just to be sure of overall well being. I pray that the new year brings you health, blessings and hope, for we are comrades in spirit:)

Wishing you all a very splendid year of 2024!

REPLY
Rubyslippers | @triciaot | Jan 2 10:15pm

Thanks @lifetraveler for your kind words! I thought my age was similar to @kikay with similar cancer and my experience might be helpful. There is so much going on when talking with the docs pre-surgery. I actually felt more sure of my decision to do radiation when I first made it - but when radiation sessions were over I realized what a big decision it was and how much it would affect the future. I believe I’d still make the same decision. But fate is a fickle thing.

REPLY
lifetraveler | @lifetraveler | Jan 9 4:53am
In reply to @kikay "Hi again. I just got a call from surgeon telling me tumor board was cancelled this..." + (show)
@kikay

Hi again. I just got a call from surgeon telling me tumor board was cancelled this Thursday and will be rescheduled January 4. Just got a question. How long was the wait for your second surgery? In your pathology result , what grade do you have? Mine is Grade 2. I am thinking if I need to just let my doctor do the surgery sooner and not to present to Tumor board. Idk how fast the growth is.

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Hi! Kikay:

Did you get the call from your surgeon yet? What the decision of the tumor board for your case? Pray for your full & speedy recovery!

Hope all are well and wishing you all a very healthy, happy and blessed year of 2024!

REPLY
1 reply
kikay | @kikay | Jan 9 10:49am
In reply to @lifetraveler "Hi! Kikay: Did you get the call from your surgeon yet? What the decision of the..." + (show)
@lifetraveler

Hi! Kikay:

Did you get the call from your surgeon yet? What the decision of the tumor board for your case? Pray for your full & speedy recovery!

Hope all are well and wishing you all a very healthy, happy and blessed year of 2024!

Jump to this post

Hi. Tumor board recommended another surgery. In fact, today is my surgery at 1145. My surgeon didn’t call me for the result. His nurse did and my oncologist did.

REPLY
2 replies
lifetraveler | @lifetraveler | Jan 9 12:43pm

I am praying for your full and speedy recovery, Kikay!

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1 reply
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