MRI and 2nd opinion

Hi All,

I was recently diagnosed with DCIS comedo type and had a excisional biopsy from a general surgeon. The general surgeon is recommending a lumpectomy with removal of the aerola and radiation treatment and horomone therapy. He got a .25 clear margin on biopsy. The mass was close to the aerola and he states he feels it needs to be biopsied to see if any cancer in or under it. He also advises to do Sentinal node test along with lumpectomy. He feels I need wider margins. I asked this surgeon if they knew if I could have this cancer or invasive cancer in another area of the breast he he basically said "we don't dissect you looking for it we look when we do the lumpectomy and do pathology on that and also see if lymph nodes involved. " If nothing is seen this way they hope they get any cancer cells with radiation. He stated there was really no test to check for this?!  I asked him if they knew if cancer was only in the one duct and he said basically if they don't see it when they do lumpectomy or if not in the lymph nodes they hope to catch it with the radiation. He wanted to refer me to oncologist but my insurance denied it. i since filed a appeal with insurance and won and told i could see oncologist for consult within my group.

I got 2nd opinion yesterday from breast surgeon at Loma Linda Hospital.  This dr states I need MRI test to see if cancer is anywhere else in either one of my breasts. He feels this test will show if aerola involved if it needs to be removed. He feels before any surgury we really need to know if any other areas of the breast are involved.  My path report stated no invasive cancer found but he said that is just from the area they tested with biopsy.  He also would like to do 2nd opinion on pathology and have his  pathologist review the biopsy slides, see my surgeon operative report and then meet with a tumor panel to discuss further treatment. He feels that is i truley have DCIS and no other areas involved I might possibly not even need lumpectomy but it would depend on what the entire tumor panel decides I need for treatment based on MRI results, path results and operative report.He said i may need a reexcision if the radiologist felt I needed a wider margin.  He is also referring me to a  Oncologist.  I would prefer to see Oncologist associated with this hospital as they do alot of cancer treatment. This surgeon feels I don't need Sentinal Nodes checked if MRI is clear and if i just had DCIS in this one area.  

Does anyone have any expierence with this?   THanks for all of your support. Hope everyone has a great weekend!

[tvacrat]

I've just been diagnosed with DCIS, so I'm pretty new at this. After the mammogram and ultasound, I had a stereotactic biopsy which gave me the diagnosis. But before the breast surgeon scheduled a lumpectomy, she had me go for a breast MRI to make sure that there were no other areas of concern. It's a fairly easy procedure.

[cin0619]

hi

If you don't mind my asking did the dr check your lymph nodes as well? my first surgeon thought I should do that but so far this breast surgeon doesn't think it is necessary unless the MRI shows something. Did you have more areas that had the DCIS? i"m afraid it is in more areas than the one area I had the biopsy.  Are you having radiation as well?
Sorry to ask so many questions just trying to figure out what my treatment might be.

Thanks for your help!
cindy

[SueYoung55]

Yes to the MRI. Absolutely. You want to know all the answers before you go in for any type of surgery so you choose the correct surgery for your particular circumstances.

A lot of women who have DCIS get lumpectomies until they get clear margins. That is usually followed by radiation to the affected areas.

I know many women who choose mastectomies with immediate reconstruction to reduce their chances of getting further DCIS or a cancer by removing as much breast tissue as possible. There would be no reason for radiation with this choice.

So many things to consider. Get your answers then start asking questions and research everything. Best wishes :)

[cin0619]

Thank you ladies.  I had asked my first surgeon if there was any way to know if the cancer was in any other portions of the breast and he told me no way to really know that they look when they do lumpectomy and hope radiation gets it. Its scary to think these are the people giving advice and i could of made my decision based on that. This is why i pushed my insurance company so hard for a second opinion.  I"m hoping I can get my insurance to pay for my car out of this hospital. I like the idea that it is a group of professionals all giving their input for my car rather than 1 person who doesn't even seem to be informed on standard testing! This website is awesome. I've learned so much already. Thanks ladies!

[cin0619]

Doctor called me with MRI results.  Now sees highly suspicious area on opposite side. Requesting compression mammo and ultrasound on that side. Had Mammo in July and didn't show anything but didn't on side lump was on either.  I think he said more blood or something vascular showing on that side. Need to get copy of report his call kind of caught me off guard.  Worried this side could be invasive. how common is it to have cancer or DCIS on both sides?  Thanks for all of your support ladies.  I can't believe I'm still trying to get answers this has dragged on since May.  New doctor seems much more on top of this.