Benign papilloma with some low grade malignancy

[Izbiz]

Core biopsy showed papilloma with hyperplasia of usual type -  recommend exicisional biopsy.  I had an exicisional biopsy and the verbal report was large benign papilloma. One week later the surgeon called me to say that the written report was slightly different saying some low grade malignancy, so as he had only done exicisonal biopsy, I have to have another op to remove more tissue.  Will I need to have radiation after the op?  What questions should I ask the surgeon when I see him this week?
I'm still in a state of shock after thinking things were OK.

[PaulMD]

Hi.

When you meet with the surgeon, better ask him first and foremost what type of low grade malignancy that is present.  Is it the usual breast duct or lobule type? Or is it that of spindle cell type (phylloides tumors)?  It is important to make a distinction as tumor behavior varies, as well as the strategies of treatment (like hormonal treatment can be used for hormone receptor positive breast duct cancers but not for spindle cell tumors).

Radiation may also depend on the histologic type, with spindle cell tumors of low grade type usually not necessitating radiation.  I would agree with the plan to have a bigger chunk of tissue removed, possibly by lumpectomy.

Regards.

[Izbiz]

I've just come from seeing the surgeon and everything is much worse than I was led to believe - "intraductal papillary tumour with invasion." "at the the periphery of the lesion we identify foci of invasive ductal carcinoma, the largest measuring 0.5cm in diameter (on slide)".  The invasive component appears intermediate grade (2), tubular score 3, nuclear pleomorphism score 2, mitotic score 1.
Final diagnosis - invasive papillary carcinoma WHO grade 2.  Foci suspicious for lymphatic invasion.

The surgeon has scheduled me for partial masectomy with axillary lymph node disection next week and says I will need radiation and possible chemo.  Would I be better to have a mastectomy - I'm 51 years old.

Feeling rather scared at the moment.