Lumpectomy as good as Mascectomy on Agressive tumor with cancer lymph nodes ?

[judiw]

I have been diagnosed with stage 2 breast cancer.  I have a weakly positive ER and negative PR.  My nuclear grade is 3. I am HER2- .   On 11/8/2005 I had a clear mamogram and then on 6/7/06  there was a 3 cm tumor and my lymph node was 5 cm.  I was quite alarmed and had a biopsy & lumpectomy within 10 days.
The Lumpectomy also removed 12 lymph nodes, 2 of which were cancerous. There were some questionable margin tissue so I had a re-lumpectomy.  I am being told by one DR that the clear margins indicated by the 2nd lumpectoy along with the chemo and radiation should provide the same survival results as a Masectomy would.  This sounded great.    THEN I a told from another surgeon (out of the state, and has only seen my path reports, who is a friend of mine) that I should have a mascectomy because of the fact that the tumor is nucleor grade 3.   Also the first path showed 2 areas of disease that needed more clear margin.  In the 2nd path, one of those ares showed they got the 1 mm of disease and all the clear margin and the 2nd area they only got clear margin, so my friend(surgeon) is concerned that they might still missed removing the other small disease area since all they got there was the clear margins that without the rest of the diseased cells.   She is extremely econcerned about the agressivness and size of the tumor and that is why she is saying I should have a mascectomy.  What do you recommend I do ?

[wiggy161264]

A related discussion, mastectomy was started.

[angelaone]

A related discussion, lumpectomy or mastectomy?? Two Opinions? was started.

[judiw]

I was mostly concerned with the agressiveness of the tumor, in that there was NOTHING showing on my mamogram on Nov. 8, 2005 and then just 7 months later it was 3 cc tumor.   Also the fact that it is nuclear 3 grade.   Does this have any relavance to the effectiveness of the lumpectomy vs the mastcectomy  for survival and reoccurance ?

The tumor is a single tumor and the re-lumpectomy showed clear margins.

[CCF-RN,MSN-rf]

Dear judiw:  Without evaluation of the pathology, it is not possible for us to make a recommendation.  In cases where the disease is multifocal, a mastectomy is sometimes preferred.  Mastectomy is also warranted if the margins are not "clean" or if a lumpectomy is likely to cause a poor result.  In general, for smaller breast cancers which are unifocal (only one tumor), a lumpectomy (with clean margins) + radiation therapy has similar survival results to a mastectomy.  Chemotherapy and/or hormone therapy addresses the systemic component of the disease.  If you are concerned, you might have your case reviewed by another breast cancer surgeon and oncologist who may be able to advise you and help you with this decision.