I have just had my second surgery for removal of high grade DCIS. 2 out of 3 margins were clear. This was on my left breast and the medial margin. What does medial margin mean? Anyway, the pathology report for that one margin indicated Residual high grade DCIS (C7-C10). Several foci up to 0.8 cm, present at new biopsy site. The Gross Description said: In formalin is a portion of tan-yellow rubbery fibrofatty breast tissue measuring 4.0x3.0x1.2cm. There is an area measuring 2.5x2.0 cm which represents the wall of the cavity at previous biopsy site. The specimen is serially sectioned to reveal tan-white to tan-yellow cut surfaces with focal granularity. My surgeon said he was surprised because the tissue looked good. He said this is very small and microscopic. My question to you is: What would be your next course of action? Try to remove this last amount of DCIS? Mastectomy on that breast to avoid any future spread? Radiation or hormone therapy? He said there is no sign of IBC. It seems to me my body is prone to making these precancerous cells. Although who knows how long they have been in there. He has already removed quite a bit of tissue from both surgeries. It's hard to believe that I would have to have a mastectomy without even having breast cancer. Not sure if you can give a recommendation with this amount of info but I would love some thoughts from anyone.
Dear fooddiva: The medial margin is the side closest to the middle of your chest. We could not make a definate recommendation without reviewing the pathology ourselves and examining the breast tissue. Certainly, some additional intervention is required. Whether the physicians can believe that radiation therapy will adequately treat the remaining DCIS or whether additional surgery would be recommended is the critical question. If surgery is recommended the type of procedure will depend more on the cosmetic result between lumpectomy and mastectomy. Sometimes, mastectomy with reconstruction is preferred when a good cosmetic result after lumpectomy is not possible.
medial margin means the edge of the tissue that's most toward the center of your chest. It's not quite true that you don't have cancer: you have cancer, but in a form that has a cure rate of nearly 100% if treated adequately. If not, it has the potential to become invasive, meaning it can spread outside the breast. Curative treatment, based on the best studies, first requires removing all the known tumor; so at the present time, you are not quite there. Whether it makes sense to do more lumpectomy, or whether it's time to consider mastectomy depends in part on the anatomy of your breast; meaning, whether the surgeon thinks it's possible to take more tissue at that margin and still end up with a satisfactory appearance. It also would depend on other factors, such as whether the non-cancerous tissues have what are considered pre-cancerous changes, family history, and of course your own preference. There's still controversy about how much treatment of DCIS is enough, or too much. But when it's considered "high grade," it's pretty clear that thorough treatment is necessary and it's better to be too aggressive than not enough.
I know the surgeon may not be taking questions, but just in case: I have found out that the last pathology report showed both estrogen and progestrone receptors negative. Is that on the remaining DCIS or all the cellular activity in the breast tissue that was removed? I'm still trying to decide between another re-excision or mastectomy.
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