After lumpectomy? What's next?

Most of the time they do a OncotypeDX test to genotype your tumor. I would imagine you would be following up with your breast surgeon and he/she would be able to tell you whom you would see next The Oncotype test usually determines what treatment is needed. I saw both radiation oncologist and medical oncologist before surgery for a consult. After my lumpectomy/breast reduction I saw the radiation oncologist next. It is rather confusing, it's like what came first the chicken or the egg!
Hope that helps!

I met my surgeon and oncologist right after diagnosis but only dealt with oncologist after surgery. Radiation oncologist was after surgery (and after oncologist) in my case. Cancer care seems very busy these days so perhaps it helps to make appointments early. I would ask!

flowergal @flowergal

Hopefully you will have one person who will coordinate care and develop a treatment plan. In my case, it was the oncologist. They developed treatment plan determining the type and order of treatment. After lumpectomy, I had chemo first and then radiology. I have continued to be followed by oncology for 5 years now.

Each clinic has own approach.

Laurie

Breast Surgent, Radiology -Oncology, Hematology-Oncology

Thank you it does help. I was just reading about Oncotyping.
I just have to keep asking questions.

Yes ask questions. What are my options. I had stage 2 breast cancer with 2 lymph’s involved one of them micro so they have to state 2 lymph’s were involved. I had lumpectomy and reduction while in surgery to have the girls look the same. Have 6-8 recovery time I had whole breast radiation for 5 weeks. Had some redness but placing cream on help out a lot. For the next 5-7 years will be taking hormone therapy. I have minimal side effects right now. Has a few in the beginning before my body except the blocking my estrogen.
My cancer was estrogen driven her2 negative.
Oncotype is 20
Ki67 is at 10 percent.
So didn’t need chemo because of low/ medium reoccurrence status. Hope this helps to get you started on writing down some of your questions and thoughts Sending prayers

Same here. Primary care with referral to surgeon (oncology surgeon), then referral to radiation oncologist, then referral to medical oncologist. As you proceed through the process, each doctor should refer you to the next doctor.

Ty this does help.

Hi I got my pathology report via the health care portal. Haven't spoken to the MD yet. But it looks like they had clean margins all the way around what they remove (yay!) and they will send out for Oncotype testing. I am unsure what the weak positive means for me yet via treatment. Anyone have familiarity with this kind of result?

Report:
Ductal carcinoma in-situ, comedo type, nuclear grade 3 (grossly
identified lesion 2).
Intraductal papilloma and pseudoangiomatous stromal hyperplasia (PASH)
(grossly identified lesion 1).
Lymph (3) nodes negative, Estrogen Positive (15%weak positive) and PR less than 1% weak positive

Thank you

The weak positive ER and weaker positive PR could mean that estrogen blockers won't be as effective, but they may also still be prescribed since you are not negative. I am not sure who those numbers will affect your Oncotype.

I just googled all the terms, which you can also do- and ask your doctor about this info. I am only posting to help you collect questions and am just a fellow cancer (former) patient.

1) The papilloma and the PASH are both not cancerous. (You can google these.) So that's good news!

Comedo type DCIS is aggressive as you can see from the grade 3 and apparently you want to make sure that it hasn't pushed further out if it is greater than 2.5cm. I assume "occult infiltration" means infiltration not seen on imaging but I don't know if it is seen in pathology : https://radiopaedia.org/articles/comedo-type-ductal-carcinoma-in-situ-4?lang=us

"Comedo-type DCIS completely fills and dilates the ducts and lobules of the terminal duct lobular units (TDLU) with plugs of high grade tumor cells with pleomorphic nuclei and central necrosis ("comedonecrosis").

Infiltrating ductal carcinoma (infiltrative ductal carcinoma with central necrosis) may so closely mimic the pattern of DCIS with central comedonecrosis that on initial morphological analysis these foci of tumors are often labeled as DCIS (high grade, comedo-type).

There is a risk of occult infiltration. A comedo that extends for >2.5 cm has an invasive component in 45% of cases."