MRI to decide lumpectomy vs mastectomy

[DSMom85]

The whirlwind began on 6/27 when my doctor (soon to be replaced) said my breast biopsy came back with "abnormal cells".  Not elaborating or explaining, he set me up with a general & vascular surgeon who I met with 4 days later.

Mr Surgeon finally informs me that I have Stage 1, in situ AND Invasive breast cancer.  Luckily, it has been caught early.  Options are 1)  lumpectomy w/radiation or 2) mastectomy.  My immediate response is to cut it off and be done with it!  Doc said that's a bit extreme and to help with the decision, I'm scheduled for an MRI tomorrow to determine if multiple areas exist.

Wondering if it is normal to have an MRI to help make the decision between lumpectomy & mastectomy?  All of this is new, no history of breast cancer but my Mom is a 27 year ovarian cancer survivor (she was diagnosed at 33 yrs of age).

Thanks for any insight.  Still feeling numb by the diagnosis and not sure what happens next.  Don't feel I have anyone really on my team yet, aside from family.

[DSMom85]

Forgot to mention....I turned 45 on Friday.  The 10 mm (1 cm) lump was removed with stereotatic biopsy but bad cells still lurk in the area.  Mr Surgeon suggests lumpectomy with sentinel node biopsy.

Although biopsy pathology report said I have cancer there was "no angiolymphatic invasion".  Since this means it hasn't moved into nearby lymph vessels, will the sentinel node biopsy be for naught?

[outnumbered]

This almost sounds like it could be my pathology report. I had an excisional biopsy 6/24.  DCIS and invasive carcinoma.
I am sceduled for MRI on Wed and I meet with a new surgeon on 7/21 (my old one went out on maternity leave).  After that consult, I will be scheduling rexcision and sentinal node biopsy.  I feel like you do, take them off!!  However, I am reserving my final decision for when I have all the data and pathology.  They are not really staging me yet because they need to do more testing. The "no angiolymphatic invasion" in my case is because they just did not get any lymph nodes so they cant check what they don't have, hence the need for the sentinal node biopsy,  at least thats how I understand it.  If nothing else is found on MRI, BRCA1&2, and clean margins and no node involvement on rexcision, then I think the recommendation will be conservation and radialtion.  Ultimately, the decision is mine though.  
Just know that you are NOT alone.  I have found this web site to be so helpful.  Here I have found people who are going through what I am and it helps to know that.  
You are in my prayers.  Let us know how you make out.
~Sara

[Rowena Santos, MD]

How are you? It has been demonstrated that MRI is more sensitive than mammography in detecting invasive breast cancers.  Researches also showed that there is better visualization of neovascularization that occurs with DCIS with Breast MRI. (http://professional.cancerconsultants.com/oncology_main_news.aspx?id=40348)

SLN biopsy is a procedure in which the sentinel lymph node is removed and examined to determine whether cancer cells are present. If SLN biopsy is done and the sentinel node does not contain cancer cells, the rest of the regional lymph nodes may not need to be removed. Because fewer lymph nodes are removed, there may be fewer side effects. ((http://www.cancer.gov/cancertopics/factsheet/Therapy/sentinel-node-biopsy)

Take care and keep us posted. All the best on your MRI.

[DSMom85]

Hi Sara,

How are you doing?  Yes, our reports sound very similar.  Let us know how your MRI went.  Aside from the contrast making me nauseous, all went well with mine yesterday.  Of all the stuff, that was the easiest so far.

I see a medical oncologist tomorrow for a 2nd opinion.  I didn't know what kind of doctor to consult.  Yes, I need a surgeon but I know he can't fix it all!  My family doctor was such a dissapointment that I don't care to ever see him again.

Dr Santos - thank you very much for the explanation and helpful links.  We're trying to learn all we can and there's so much info to decipher.

Will let you know how the 2nd opinion goes....

It's a blessing to connect with others who can relate.  My Marine son is on 2nd deployment to Iraq and I've found loads of support and strength through others.

MaryJo

[Irishgal2]

Hi MaryJo and Sara,

Aged 39 I was diagnoised with stage 1 breast cancer.  The lumpectomy route was recommended to me because my lump as 1.4 on the mammo and the lump was in a area away from the nipple.  The location of the lump sometimes helps dictate lumpectomy or masectomy.  What will be key for you both is the pathology report after the cancer has been removed.  You're future treatment will be determined from this.

My pathology report showed that my cancer was Grade 3 (fast growing), ER and PR positive (hormone) and Her 2 negative.

Because I was grade 3, it was suggested that I get all my lumph nodes removed rather than just a sentenial node biopsy.  17 nodes were removed and thank god all were clear.

Also because I was just 40 after my operations, pre menopausal and grade 3 cancer, I was given 4 cycles of AC chemo followed by 6.5 weeks of daily radiotherapy.

It is a terrible place to be at for both of us, the waiting and tests to get the full picture can sometimes but the worse part of it.  Whatever the outcome, I wish you both the best of luck with the treatment and know that there are many many women on this forum who have survived BC and continued full lives.