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Pathology report-approaching dcis

Hi,

My doctory just called me with the results of my biopsy. The report says APPROACHING the lowest grade of dcis. I asked my doctor if this means benign or malignant, and he said inbetween. I asked my doctor if I need a lumpectomy or a mastectomy and he said he doesn't know, and referred me to an oncologist. The report also says atypical ductal hyperplasia. Has anyone had the same result from a biopsy report ?  Does anyone know if my findings will require surgery?
115 Responses
25201 tn?1255584436
ADH is sometimes referred to as a "pre-cancerous" condition although it is NOT cancer. The standard treatment is lumpectomy with clean margins sometimes followed by Radiation and possibly Hormone Therapy. I'm sure the Oncologist will clear things up for you and advise you the best course of action in your particular situation.  Regards ....
Avatar universal
Hi,

After researching this a little I found out that the next step would be excisional biopsy, and that a lumpectompy and radiation is not always required. Has anyone had these findings?
1686908 tn?1307197390
It's very hard to tell the ADH and DCIS apart.  It's basically precancerous cells that could be approaching cancer.  The oncologist will be the one to decide.  If you have any relatives who have had breast cancer, your health, ect will play a part in what the oncologist decides.  The treatment is your choice, it's always your choice.  It may mean lumpectomy, it may mean radiation, maybe pills, you have to talk to your doctor about it, so to answer if the findings require surgery, it could be, but it might be, the oncologist should go over reports with you and together you'll make a decision of the best treatment for you.
25201 tn?1255584436
You have already had a biopsy and have a diagnosis; there would not be a need for another biopsy but sometimes the term "excisional biopsy" and "lumpectomy" are used to mean the same thing. Radiation and possible Hormone therapy (if it is proven that the specimen is ER/PR positive) gives the best chance to prevent the development of breast cancer in the future.  Regards .....
Avatar universal
I am so happy for you kate. This is great news. I've had 1 patient with this diagnosis and she went for lumpectomy and tamoxifen, she was ER positive.
Mary
Avatar universal
Hi, Kate,
I think you got a similar result as I did---not the best, but not the worst either with an LCIS diagnosis. I've seen it labeled pre-cancerous, non-invasive and pre-invasive at various web sites. I had an excisional biopsy that found it, but it tends to be in multiple locations and often in both breasts, so just excision isn't always possible. Some women opt for bilateral prophylactic mastectomies, but I'm not at that point and maybe never will be. For now, vigilant screening is my only treatment. I could take tamoxifen at some point, but my hot flashes are just too bad right now so my oncologist didn't want me to take it yet.
ADH is treated differently for each individaul based on their own history and family history. Based on my research at various sites, sometimes it's only vigilent screening but usually it's lumpectomy to  get clear margins and sometimes radiation and/or hormone therapy as japdip and Tinabudde indicated. Your oncologist is the best person to discuss all the options with and then you can make an informed decision on what's best for you. You can certainly get a second opinion, too, if you don't feel comfortable with the information you get or feel your questions aren't answered. The decision is always yours, but you want to base it on good, solid information.
As always, I wish you all the very best.
nc
Avatar universal
Hi,
I went to a oncologist today. She said I need a lumpectomy. She said she is hopeful that the area she has to cut will be small enough that I don't need a breast reconstruction, but she won't know for sure till during the surgery. She said she won't know till after the surgery whether I will need radiation or not. Also, she said she won't know till then if I need tamoxifen. My family history is okay. Nobody in my family had had any type of cancer. I am not sure what an lcis diagnosis is. My diagnosis is atypical ductal hyperplasia. Marybai I am praying that you will get a negative pathology report.
Avatar universal
Hi,

I am worried about what my breast will look like after a lumpectomy. The calcifications that need to be removed are in the top part of my breast. Has anyone had a lumpectomy in that area? Has anyone had a lumpectomy and felt that the appearance of their breast hasn't changed that much. I would love to hear from those who had lumpectomy's to tell me about their experience.
Avatar universal
Hi, again, Kate,
I'm sorry about not explaining LCIS---it's lobular carcinoma in situ, like DCIS, but in the lobes not the ducts. My understanding is that DCIS has the ability to become invasive, but LCS does not. However, along with all my other risk factors it puts my risk of invasive breast cancer at about 30%. That's why the oncologist said I was a candidate for bilateral prophylactic mastectomy. I understand your path report was ADH approaching DCIS.
As far as lumpectomies, I'm sure it depends on the surgeon, location and extent of excision,
but I've had four (they used the same scar for two)and  except for faint scars, my breasts look pretty much the same as they did before. In fact, I had a breast surgeon and when I went to my oncologist, he said he expected them to look a lot worse based on my medical reports! I had to laugh! I'm fairly large breasted, so I'm guessing if a woman is small or very small it might make a difference. Mine were in the top and bottom of my breast on the left and the largest one was in the middle of the outside on the right. All were very easy and the recovery was quick---I went dancing the evening after the first two (done at the same time). I used very little pain medication at home. Everyone heals differently and has a different pain threshold, but I thought mine were a piece of cake. I was out for all or them, woke up in recovery, stayed about an hour then went home. Like I've said before, the wait for the path results was the worst of the whole experience.
It sounds like you have a good oncologist and I'm hoping that your surgery goes well and your
recovery is smooth and easy. Hopefully, it'll all be behind you soon.
Hugs,
nc
PS:Marybai, I'm still hoping for benign results for you!
Avatar universal
Hi ncmichigan and Kate,
I had good news today, my biopsy was benign.  However, there are lots of microcalcifications that they need to watch, so I need another mammogram in 6 months. Since all of this has started I have been noticing how many patients I see that have breast cancer, and it is about 1 in 4 or 5. Of course, I see alot of older women that are near or post menopausal. All of them are cancer survivors. What is causing all of this? There is no consensus in the literature.
Much Love to everyone, and thank you for all of the support you gave me,
Mary
Avatar universal
Hi, Mary I am very happy for you. Nc thank you for sharing your experience with me. Unfortunately I am small breasted, and that is why I am concerned, but hopefully it will be ok. I have a very high threshold of pain, and usually don't take pain meds, so I think the surgery will be ok for me. I am more concerned about the appearance of my breast after the surgery.
Avatar universal
Hi, Kate,
I noticed you started a third thread-lumpectomy. It really is so much easier if you continue everything on the same thread, especially for the women who answer here a lot. It gets really confusing when you have to answer in different places---I know I'm confused at what I said where! ( Of course, that could just be senility creeping in!) Usually japdip tells everyone this when they start a new thread, but I thought I would, too. Any of your issues or questions can
be answered in the same thread because they're all related. It's appreciated by all here.
As far as your concern, I think some small breasted women have had no problems with appearance after surgery---hopefully some of them will respond to you. You previously mentioned  that your surgeon will be able to tell pretty much at the time---it seems like you'll just have to wait until then and try not to stress over it too much. The important thing is to reduce your chances of getting breast cancer and she's offered you reconstruction if it's needed, so you'll be OK.It sounds like you'll do fine during and after the lumpectomy, too. Like I said, mine were much easier than I anticipated.
I did read your lumpectomy post and you asked about the wire placement prior to surgery. It's sometimes called needle localization. A radiologist will do this so the surgeon knows exactly what needs to be removed. They use mammo or ultrasound films to locate the area, numb you up and then place a needle into the area. A fine wire is passed through the needle and through the lesion. The needle is removed but the wire stays and is removed in surgery. It sounds really scary but isn't as bad as it sounds. For my first one, I had my doctor prescribe a little Valium the night before and morning of the procedure and I did fine. The radiologists and staff are extremely kind and caring from my experience. My first lesion was palpable so they located it easily with ultrasound and by feel. The second one was for microcalcs in two areas, so I had to have them placed while sitting up in a mammo machine and that was a little rougher. I nearly fainted and really felt like a "wuss" but the doctor said that happens about 50% of the time. It was really anxiety more than pain, plus they kept telling me not to move, so I think I stopped breathing so I wouldn't move! Again, they were extremely kind and compassionate and it was as easy as they could make it. Since there are different types of neele locs, I would recommend talking to your surgeon so you know exactly what to expect---I really believe that patient education is so much better than just "doing" something to the patient without their knowledge.
I honestly thing you'll do just fine. Please keep us advised on how you do, OK? (But please keep it on this thread for continuity)
Wishing you all the best, as always,
nc
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