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Lumpectomy now Mastectomy?
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Lumpectomy now Mastectomy?

On Oct 2/2003 I was diagnosed with infiltrating duct carcinoma - High Grade. I went for a lumpectomy and a sentinel node disectionwith axillary on Oct23/2003.My breast lump was 2.7 x 1.8cm and they removed 5.5 x 5.0 x 3.0 tissue. The sdid find a 1.4 x 1.0 cm metastatic adenocarcinoma tumor in 1 of the 6 lymphs, but the sentinel node was clear of malignancy. I a;sp had a full body bone scan on Oct 24/2003.
When my surgeon gave me my pathology report, he said I will be getting 2 rounds of chemo and my report will be sent for an automatic 2nd opinion.
I don't mean to sound impatient, but everything up until now has been pretty fast, I have not heard a darn thing all this week tho, and the surgeon had eluded to chemo starting in 2 weeks.
Would they really start the chemo in 2 weeks, or would I be looking at the masectomy first, followed with chemo and then possibly radiation? I am 41 and do not know what I tested yet for the hormones. I am another that was considered low risk with no family history.
Thank you
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Avatar_n_tn
Dear Barb, If I am interpreting what you have written above correctly, the cancerous area was 2.7 x 1.8, in the 5.5 x 5.0 x 3.0, specimen?  If the margins (area of normal tissue around the cancer) after the lumpectomy are adequate and radiation therapy is planned to treat the rest of the breast - further surgery would not necessarily need to be done.  Because one of the lymph nodes sampled was found to contain cancer, and the size of the original tumor was greater than 1cm, adjuvant chemotherapy(treatment given after surgery to try to prevent or minimize the growth of microscopic deposits of tumor cells that might grow into a recurrent tumor)  would be the standard of care.  

Chemotherapy is given before radiation therapy to treat any microscopic disease elsewhere in the body, and then radiation therapy is done.  Once the information regarding hormone receptors is back they will be able to advise regarding hormone therapy.

However, if there was additional cancer remaining in the breast (the margins around the specimen removed contained cancer) giving a couple of cycles of chemotherapy before mastectomy (neoadjuvant chemotherapy)  and then the remaining course of chemotherapy would be given following the mastectomy.   If the risk for local recurrence is high, such as in cases of a large tumor, radiation therapy after mastectomy may be recommended.

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Avatar_n_tn
the choices for the breast are lumpectomy with radiation, or mastectomy. It's rare to need mastectomy and radiation; the radiation is given to the breast tissue that remains after lumpectomy. You describe having had lumpectomy, and if the borders were free of cancer, there's not an absolute reason to have mastectomy -- but you didn't say how the rest of the tissue was, so it's possible there were things found in the lumpectomy that would lead to the recommendation of mastectomy. If a woman is going to have lumpectomy/radiation, and if she needs chemo -- which you do because of the tumor in the lymph node -- in most cases the chemo is done first, and then the radiation.
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Avatar_n_tn
Surgeon,  You wrote to barb that it is rare to need mastectomy and radiation.
I had mastectomy, Chemotherapy and radiation all. (Completed it all January this year)  Is this  "overkill.?"  I am getting along fine.  
My cancer was an aggressive kind, 5 cm,  14 positive nodes out of 15 removed.   stage 3. I am 70 years old now. I can do about as much work as I could before the mastectomy.
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