different types of tumours in one, & margins

[nancy555]

Hi. I've had my lumpectomy and some of my lymph nodes removed (as precaution) and am now looking at the next step. My surgeon had thought I'd do radiation, but I can't. As I do research, I'm wondering, what do I look under, since I have more than one type of carcinoma? My path report says: a) invasive adenocarcinoma tubualr growth pattern, grade 1, max. tumor diam. 1.1cm, margins clear, est + in >90% of invasive cells; prog. + in 10% of invasive cells. HER-2 neg. and b)DCIS, low grade, no nec, nuclear Grade 1, cribriform & clinging growth pattern, diam. 1.1cm, not present at margins., and c) incidental single focus of LCIS. Which is the worst? and which should I use when reading? I can't find anything about txt for tubular, but it's the invasive one, not the DCIS.
Also, I'm thinking of taking tamoxifen (I'm 54); I read that when margins are 10mm, it's less risky to do just tamoxifen. Mine are only 5mm. Does it make that much of a difference that some people might go back into surgery to increase their margins from 5 to 10mm?
Thanks so much.
Nancy

[nancy555]

Thanks for replying!  So, tubular is a type of ductal, or comes under the ductal umbrella? Unfortunately I can't do radiation. I was really interested in Intraoperative RT, even if it's after the operation, but it's not offered in Canada, I guess (or do you know?).  It's the only way I could have done radiation; the radiation oncologist ruled out regular RT because of my twitching (sometimes drastically) shoulder muscles (unless I'm "out"), and I'm very concerned about small possibility of effect on my good lung (had lobectomy on other lung 6 wks ago), unless it has the protection that IORT seems to offer. So I think I'm out of luck. I wish they had it, but c'est la vie. I'm now looking at tamoxifen... arimidex has joint/muscle pain as a side effect, doesn't it? With severe fibromyalgia as well as arthritis, that additional pain doesn't really appeal to me. It's hard, because I don't have an oncologist, only saw a radiation oncologist but won't see her anymore because I'm not doing RT, plus surgeon, but surgery is over, plus my family doctor, who really doesn't take the time (walk-in clinic speed). Maybe I should phone the Cancer Agency, since I do have a number, and ask them...it's weird, to have 2 cancers, 2 surgeries (breast/lung) in the past 3 months, and I'm not seeing any oncologist anymore.
Thanks again..
nancy

[PaulMD]

Hi there.

The different pathologies reported represent a spectrum of disease progression of invasive  cancer.   DCIS is a pre-malignant lesion, while LCIS increases the risk of developing invasive cancer. However, the LCIS and DCIS at this point becomes irrelevant considering the finding of the invasive ductal cancer. I suggest that you undergo radiation (regardless of the margin status) therapy for this, since a lumpectomy without subsequent radiation have a higher risk of tumor recurrence.  You should also consider treatment with tamoxifen or an aromatase inhibitor (like Arimidex) since your tumor is hormone responsive.

I suggest you discuss all of these options with your doctors.  Regards and God bless.