Pathology report

I just had an ultrasound guided core needle biopsy on a 1cm mass that was detected with mammography and ultrasound.  It is non palpable.  My family physician called me with the preliminary pathology report.  He said there were both Ductile In Situ and Invasive Ductile cancer cells.  I'm confused as to how there can be both.  Doesn't invasive mean that it's not confined to the duct anymore and therefore not in situ?  Or do I actually have two kinds of cancer?

[lhughes]

It means they found both.  One is contained still in the duct, the other has already broken out.

What do they recommend for you, mastectomy?  Are they recommending chemo, radiation, neither or both?

Sorry to see you are here.  But, life does and will go on for you.  You aren't alone, lots of people have been there and survived.  You are lucky that it's early.  Take care of it, ASAP.

Best wishes.

[BhumikaMD]

Hi,

Your breast specialist would be the best person to clear this out for you. from what you describe, it looks like they have found two different types of cancer cells at different sites.

Talk to your specialsit in detaila bout this and also about the further plan of management in your case.

Let us know how you are doing and what your doctor advises.

Keep us posted if you have any doubts.

Regards.

[Kelleen]

I just spent the afternoon with a surgeon discussing my options.  He is suggesting (but not recommending one over the other) these two courses:

1. partial mastectomy followed by a 7 wk course of radiation and possibly chemotherapy depending on the gross and pathological findings.

2. total mastectomy with immediate reconstructive surgery  Plastic surgeon  would be in on the whole procedure.  Again the possibility of chemo.

I'm meeting with a radiation oncologist and a plastic surgeon to discuss things further.

[Kelleen]

I would also like feed back on reconstructive surgery.  Feelings about immediate vs. delayed.  I'm leaning towards the total mastectomy with immediate reconstruction so I don't have to deal with the possibility of unclean margins requiring a second surgery and to reduce the emotional trauma of seeing myself without a breast.

[lhughes]

That'll be a personal decision on whether to go ahead with the reconstruction.  This is my opinion on it...  it seems to me like I had a better and quicker outcome than a few of the other ladies I spoke with who did the mastectomy/tram reconstruction/chemo route.  

The chemo will hender the healing process and these ladies I spoke with did have some necrosis and additional surgeries (not to mention one had a hole in her boob during all of chemo that she had to deal with...it's now fixed and can't tell anymore, but it was something she did not expect).  However, they won't have to use quite so much foreign skin (from the abdomen) to make the boob if you have the reconstruction immediately.

Mine had to be put off, but my tram was textbook clean and pretty.  I only had the one surgery to put back on the breast and then the nipple (which is in-office).

I went without a boob for almost a year and a half, used a prosthetic when necessary.  The prosthetic was ok, it was hot and you could see it at some angles when I bent over.  And with 2 babies, that was often.  So, I went mostly without it.  Most folks didn't even know I was boobless for that long (and yes, I asked).  It took me nearly 2 months or more to look at the spot where my boob was to start with.  After that, I got used to it.  Now I'm getting used to having a boob again.

There are trade-offs whichever way you choose.  There are benefits and there are potential issues that could happen.  Do what you think is best for you knowing more about what you might be facing.

I hope all goes well for you!

[BhumikaMD]

Hi,

In all such situations as yours, it is best that the decision about the further plan of management be taken after a detailed discussion with your oncologist, breast specialist. They are the best persons to guide you and rightly advise you based on a detailed account of your case.

But from what we know about your case, it seems a better option to go ahead with the total mastectomy and reconstruction surgery.

Do discuss the pros and cons with the plastic surgeon too and let us know what he /she has to say.

Let us know what you and your doctor eventually decide.

Keep us posted.

Regards.

[Kelleen]

I have an appointment with a plastic surgeon on Friday Mar 7 and an appt on Mon with a radiation oncologist to further discuss all my options.  My surgeon said I didn't need to see a medical oncologist unless something unexpected came back from the surgical pathology findings.  He did mention the possibility of chemo.  Isn't a medical oncologist the one to see for that?

[lhughes]

Yep, medical oncologists usually determine whether or not chemo should be administered based on the pathology report.  They determine what kind of chemo, how long, etc.  I'm surprised if there is an off-chance that chemo may need to be administered that you haven't spoken with one.  Perhaps the surgeon has done a consult and that's where he's getting his info.

Talk with the other docs and write back.  I hope everything goes well for you.  I would vote to go ahead and do the mastectomy, though.  That's just my opinion.  You need to think it all through based on what these docs are telling you.  Good luck!

[BhumikaMD]

Hi,

Ihughes is probably right about your breast surgeon already discussing your case with the medical oncologist, otherwise you would be required to meet one ideally.

Let us know about the meeting with the plastic surgeon and also the radiation oncologist.

Post us if you have any doubts.

Regards.

[Kelleen]

Any feedback on the diep flap procedure for breast reconstruction that does not require the us of abdominal muscle-just fat and skin?

[BhumikaMD]

Hi Kelleen,

What exactly do you want to know about the diep flap procedure? Could you elaborate on your question please?

How are you doing now? Have you mt with the radiation oncologist and plastic surgeon?

Keep us posted.

Regards.

[Kelleen]

I have an appointment with a plastic surgeon tomorrow and a radiation oncologist on Monday.  Of course I'll ask them all these same questions.  My curiosity about and attraction to the DIEP flap procedure is that it doesn't require the use of muscle tissue like the TRAM flap.  I've not heard from anyone who has actually had the procedure.  I would like to know the outcome of any one who has.

As far as how I'm doing... I'm on autopilot when it comes to getting through the day, going to work and raising children.  I can talk about this in a very disconnected sort of way but then the smallest little thing can bring me to tears.  It isn't real yet.  I cope by seeking out information endlessly.  I will be a well informed patient and in charge of every decision.  That is what I can control.  

One of my biggest frustrations so far is the confusing and contradictory way different women have been treated.  Perhaps protocol is different in the US.  I've been told sentinel nodes would be looked at during the breast operation then read about a woman who was having a SNB prior to her surgery.  I also read of a woman who was admitted the night before her surgery and one who stayed 4 days post op.  Standard procedure here is that even a total mastectomy with immediate reconstruction is an outpatient surgery.  That seems ridiculous to me!

You mentioned earlier that perhaps my surgeon had done a consult with a medical oncologist.  If he did he didn't tell me.  He seemed a bit aloof about my asking if I should see one.  Remember, at this point we only have  the preliminary report from a core needle biopsy that stated positive for DIS and invasive ductile cancer, no word yet on hormone sensitivity, Her 2 neu, and whatever else they can tell from that test.

Thanks to anyone who has feed back for me.  Kelleen

[harcando]

I left a comment for you on one of the other threads (where you were asking someone to respond to this one) - I am new to these chat rooms, having just been diagnosed with Breast Cancer. You can read it...but basically you and I have as similar diagnosis and are going through the same "decision" period of time.  I hope all goes well for you!

[BhumikaMD]

Hi,

Its always great to meet patients like you who read and understand there problems in detail and then make informed choices.

From a technical point of view, TRAM and DIEP differ on the level of the use of the rectus muscle in the reconstruction. While TRAM is a more robust procedure and gives more aesthetic results, DIEP is a more technical procedure requiring more skill, but with preservation of the muscle there is a potential for lesser pain and faster recovery.

I am not sure if there are any patients who have had DIEP here. Nonetheless, we will try and help you with any questions you may have.

All the best.