Margins

Hello,

Could you tell me please if it is sometimes not possible for a surgeon to obtain clean margins and if so why that would be.

Many Thanks, Maggie

[CCF-RN,MSN-JS]

Dear Maggie, Yes it is sometimes not possible for a surgeon to obtain clean margins.  It may be due to the location of the tumor.  Another reason is the margins are evaluated microscopically.  When doing the surgery, the tumor is removed with what is hoped is a margin of healthy tissue.  Sometimes  when the tumor is then examined under the microscope there could be tumor cells within the margin that were not apparant during the surgery.

[surgeon]

It is possible. Usually it's because there is extensive spreading of cancer cells within the ducts of the breast (intraductal cancer, DCIS). There's no way for the surgeon to identify those areas as the surgery is happening, other than to ask the lab to look at selected spots under the microscope. The instant-read method done while surgery is taking place is less accurate than the final process. This occurrance of DCIS extensively in the breast can happen both in the situation where the only cancer is DCIS, or when there's an obvious lump of invasive cancer. It can also occur that in order to get clean margins, the lumpectomy needed would be so large that the amount of breast tissue remaining would be inconsistent with good cosmetic result. All of these scenarios can happen; fortunately for most women, they are relatively rare.

[maggiec]

Thank you ver much for taking the time to answer

Regards Maggie

[surgeon]

I should have added that even tho having extensive intraductal cancer may mean mastectomy is necessary, it doesn't make the prognosis worse. It's the size of the invasive component (the cells that are OUTSIDE the ducts) that has impact.