Invasive ductal carcinoma

On 26 October 06 I had surgery for high grade comedo DCIS in my right breast followed by five weeks of radiation in Jan-Feb 07. On May 16 I went for my 6 months checkup with my surgeon who was very pleased with the healing of the site etc. I asked him to check a cyst in my left breast, a cyst that was there when my mammogram was done  August 06. In recent months I had noticed itgrowing larger. HE aspriated the cyst and removed about  about  1cc, straw colored apsirate with brown flecks. Then he said the "cyst" was not completely drained and so  he was sending me for ultrasound guided aspiration.
A week later I had the ultrasound and core biopsy. Within five days the results returned: Invasive ductal carcinoma intermediate to high grade.I am scehduled for a partial mastectomy and sentinal node biopsy on June 21. No lymph nodes are currently palpable. I am 61.

Three questions:
1. Were the brown flecks in the cyst apsirate a clue that cancer might be present?
2. Why didnt the mammogram pick up the IDC last August? Is it possible that it just developed in the last two months since my radiation tmts ended?
3. THe "CYST " used to be marble sized - then like a large marble. SInce the core biopsy (I had a serious hematoma) it has grown to the size of a golf ball.  am wondering if that is all cancer or partially benign cyst. Should the size worry me?
I would appreciate any insight -- Thank you!  

[Cleveland Clinic]

Dear Azile,  1) Until the specimen is looked at under the microscope to see what the cells look like you cannot tell for sure whether there are abnormal cancer cells present or not.  The brown-flecks would not necessarily indicate cancer.  2)  A mammogram looks at a 2 dimensional x-ray view of the breast; findings on a mammogram can be more or less suspicious that there may be an abnormality present.   No test is perfect and a mammogram would not be able to pick up very small or cellular changes if they were present.  3)  A hematoma is basically a collection of blood.  The increase in the size of the

[MiracleB]

I just wanted to touch base with you, since none else has written. I believe it is helpful to get some feed back and thoughts while waiting for the Doctors to reply, which I am sure they will and answer your 3 questions. I I believe talking about your situation can help give you peace and understanding. I really wish you the best after surgery and pray that all margins will be  negative. I had been getting regular, yearly mammograms simply because of my age, 47 and the fact that my insurrance would pay 100% for them. I had 3  years with no abnormailties detected, or at least I thought so. The mammogram results always came back as normal. Then this year in April, my mammogram came back as abnormal.  There was a small lump and a compression mammo and ultrsound both warranted further investigation, However, when I read the copy of the mammogram it stated that the lump was larger when compared to last years!  I suggest you get a copy of the report and read it for yourself ASAP!. and ask your doctor to explain all the why's and how comes. I asked why I got a normal mammogram last year and was not notified that a lump was ever seen before. It was explained to me that it was most likely so small and the first detection did not concern or warrant any further investigation until they could compare it to another one.  I did not appreciate the fact that this information was not reported to me and simply stated as a normal mammogram until the lump was  then detected again and changed in size.  At any rate, it was still a very small lump, 0.8cm and detected early. Even though my biopsy came back as infiltraing ductal carcinoma and I then had a lumpectomy and sentile node which removed only 2 lymph nodes. All is well now, but will need radiation to prevent any reoccurence. How did your radiation treatments go, in regards to side affects?

[lizziecee]

Hi azile - so sorry you are now having to deal with invasive bc after the DCIS surgery and radiotherapy.

I guess mammography is not an exact science, as the nurse has said.
I live in England and we only get 3 yrly mammos from age 50. On my third mammo, age 58, I was recalled to a breast care centre of excellence, where they diagnosed a 2 cm invasive ducatl tumour. Lumpectomy and 8 sample node removal, showed 3 to be cancerous - a huge shock, and after having had a bad haematoma from the lumpectomy, went back for total axillary removal a month later. Another node was found to be cancerous, so 4/18. The number of lymph nodes varies - some women have 50+, others as few as 10. What is important is how many are cancerous. My surgeries were done 4 yrs ago, and sentinel node biopsy was not done in England at that time, but considering the eventual results, I now realise I would have had to have total axillary clearance in any event, given the pathology results.  My path report showed I also had DCIS, both comedo and cribriform, although neither my surgeon nor Oncologist mentioned this, I only found out when I asked for a copy of the path report - by the way, the most important information you can get.  I was assured though, when I asked later, by my surgeon that he removed the DCIS along with the tumour. I had 6 x FEC chemo and 25 rads with 4 boosters. Doing fine now.

It has obviously occurred to me that if I had had annual mammos,  the bc may have been picked up earlier, and not have spread to invasive, and to the lymph nodes. However, hindsight is a quality we don't possess. Even though I had bc, we only get 2 yrly mammos at my particular hospital, unless there is a problem - as I did, 2 yrs after the original diagnosis. My surgeon says there is a risk of further breast cancer with radiation - I don't understand that logically, as we have radiotherapy to zap existing cancer! Am I missing something?   I got a long ropey lump in the top of my breast which turned out to be Mondor's disease. My very experienced bc surgeon said he had never seen this in a patient with bc, but had otherwise. He even brought in all the radiologists and radiographers to have a look and a grope, as it is so rare.  I have just recently googled it, and it can be a sign of breast cancer. So much for the experts!!

Hope your invasive tumour is small, lymph nodes clear and that you will not need chemo - it is tough but doable. I also have Crohn's (for some 37 yrs) and my treatment was a nightmare as I had to stop the methotrexate chemo for Crohn's. However, with a wing and a prayer, I am happily alive and enjoying life once again.

Will be thinking of you on the 21st - if you want to email me with questions or  further information please write to:***@**** and I will help with whatever experience/information I have.
Take care,
Liz.

[azile]

Discovering I had cancer for the second time has been really scary especially because it was so soon after the first. Having this forum to turn to, giving me an opportunity to ask questions of a health professional, and also to share experiences with people like you who are going through similar things is exceptionally wonderful and definitely anxiety reducing.  So thank you for your comments and insights!  

Miracle B

[MiracleB]

Thank you so much for the radiation information, very helpful. I am fortunate that we have a cancer center 20 miles away from my house. Most of the docotrs share their time here from Oklahoma City's OU Med Center. I think I am in very good hands. My work  told me, from the get-go,  to take off as much time as needed for anything during this whole ordeal and not worry about work or my job. I work with some very caring folks.  Of course I am using the Family Medical Leave Act and my work provides disabilty pay which helps relieve the financial stresses. I am taking a vaction July 11th through July 18th which is very much needed, so if radiation is necessary I will postpone it for a week until I get back. I want to be able to soak up some California sun! and swim.  I wish you they very best and you and all the ladies on this site are on my prayer list. I see my oncologist on the June 26th to see what he thinks of the MRI results I am to have on June 2st and will discuss further treatment.

[lizziecee]

Thanks for your response, hope mine and miracle's comments were helpful and reduced your anxiety.

Yes, 4 yrs on, I am in remission - believe they call it NED (no evidence of disease). I had a mammo, ultrasound and core biopsy earlier this year as my cancerous breast was puffy with the aureole grossly engorged, It was also hot to the touch and very pink. Surgeon said it is lymphodema and suggested I go for manual lymph drainage, but the only centre for this near me (2 hours each way, car and ferry) is the local hospice, and I don't think I am quite ready for that at present. It is not painful, as I believe lympodema in the arm is, so have just decided to live with it. I was worried it could be inflammatory breast cancer, as I have read this can occur after having had invasive bc. Surgeon assured me it was not ibc.

The Mondor's disease (superficial thrombophlebitis of a vein in the breast) has resolved itself, and the long ropey lump has dispersed. No treatment was given. As I had a non palpable invasive tumour and had no idea what a cancerous tumour felt like, I was concerned this may have been a re-occurrence. Luckily my bc surgeon doesn't treat me as being paranoid, as I am not, but having had Crohn's for so long, and then a non palpable tumour, I err on the side of caution. I have no problem in getting seen in the Breast Care Centre - just ring my bc nurse and she gets me an urgent appointment.We have socialised medicine here in England, as you do in Canada, but my treatment was at one of only 6 Breast Care Centres of Excellence, which I am so grateful for. Wish it was as easy to get seen by the gastro - a 3 month follow-up (I self inject the chemo drug methotrexate weekly and need monthly blood tesest by my GP's nurse, and should be seen frequently in clinic) turns into a 5 month appt as the gastro dept is so overloaded. Doing well though now, and have put back on the weight, some 28 lbs, I lost during chemo. Don't think it was the chemo per se, but the fact my Oncologist threatened not to treat me if I didn't stop the mtx. and po-faced told me I would die of septicaemia if I continued the mtx behind his back. Junked him after 2nd consultation and got a lovely young female Onc who did her very best to get me through the FEC chemo and the Crohn's flare. I have at last learned to be proactive in regard to what my gastro calls my "empirical health problems". Had to look that up in a dictionary - bright hubby said it just means there is no precedent for dealing with the two concurrent diseases and he is flying by the seat of his pants!  

I do hope your treatment goes well and you are soon in remission.
Liz.

[azile]

HI Liz;
I had a partial mastectomy Thursday. The plan was to do a sentinel node dissection but they couldn

[lizziecee]

Many thanks for responding and letting me know how you are getting on. I am amazed at the little time they keep you in hospital - I was in for 4 nights for the lumpectomy and sample node resection, then 6 nights for the total axillary removal. The drain bottle would not show empty and they have a protocol that says if the bottle has more than, I think, 50 ml of fluid, you will not be released - a bit like prison! I then got a seroma on the top part of my back (surgeon did say he had to be brutal in removing all the lymph nodes) and in the depths of winter on a small freezing foot ferry, had to go back every 2-3 days to get it drained - instant relief. Took almost a month of that to resolve - hubby and I figured we should have bought the boat by then!

When I look back 4 years ago, it was a terrible time, especially having to spend 4 months on hospital prescribed Frutijuice (9 flavours, all yucky) as I couldn't even eat home made vegetable broth with the solids strained out, without instant diarrhea. However, my husband did learn to cook then, as I couldn't bear to even see food, never mind eat it. Guess there is always a silver lining in the darkest of clouds.

Hope the pathology reports of the axillary dissection show no spread.
If you want to private e-mail me, you can do so at:***@**** - I am sure many of the people who come to this site don't want to hear all my complicated medical history. My GP said I was "dealt a bad hand of cards" when I was born. Seem to get some unusual problems - possibly because I was a twin and born in wartime, when food was scarce in England.

You have come a long way already and have educated yourself - which is power in itself.
love, Liz.

[boninclyde]

I remember you from a long time ago. How are you? I do hope you are doing well.

[MiracleB]

You have really been through a great deal. I will continue to lift you up in prayer that all gets better and better and better. I love your humor and optomism. Or, at least I hope some of it was humor. I have to try to find those silver linings and humor as much as I can. We are trying to get a bill passed hear in the US to make it madatory for masectomy patients to spend a minimum of 2 weeks in the hospital for all the needed care. Right now I have just signed a petition to get it on the voting curciut. Unfornately right now I hear most is basically done as out patient and drain your own drain and replace your own bandages. I really wish you the best. Keep looking for those silver linings. I was looking for one today. and found it. I

[MiracleB]

I just wanted to let you know, that on June 26th, when my oncologist said there was an abnormality on my MRI , that I was just so thankful, that if something was new or left over from my previous lumpectomy; that it was found and that nothing showed up in my right breast. Silver lining in my clouds!  My oncologist is of course anxious to start treatment but now we have to wait for this new or existing lump to be removed. He immediately called my surgeon and surgery, another lumpectomy, was done on Friday June 29th. Again, so thankful that it could be done so quick. No more lymph node involvement, so surgery went very well.  I am hardly sore at all. I am waiting for this pathology to come back as all removed with clear margins!
I hope all is continueing to go well for the both of you.
MiracleB

[MiracleB]

I just found out today that my 2nd lumpectomy was successful and all margins are clear!!! I Wish you both continual health and strength. I am off to California next week for vacation and then will start my radiation and tamoxifen treatments.

[Montana girl 06]

I'm glad to hear your surgery was successful. Have a great trip. I hope your treatments go well when you return.

[MiracleB]

Thanks for the reply. I hope you have a great 4th of July! Sit back, relax and enjoy