DCIS, post 2nd lumpectomy without clean margin

[pooge1]

I have recently had a second lumpectomy for DCIS, the surgeon says the 1 margin is not clean.  It sounds like she is recommending mastectomy, but may still give me the option of rads + Tamoxifen.  I do have high grade type 2 cells with necrosis, but most of it has been  resected.  I feel that I can not bring myself to have a mastectomy.  How is is determined if the margins are clean, (of course in a broad sense?).  (she stated that on the one piece of tissue 8 of 11  slices were not clean of cells).  I am really upset and think that a mastectomy is overkill for DCIS.  It doesn't even seem as though they know if it would ever become invasive cancer.  












This discussion is related to DCIS Pathology Report.

[bluebutterfly2222]

Hi again,

No, I'm not a doctor, just a community member and regular contributer to the forum.

Yes, radiation is intended to kill remaining  atypical or malignant cells that cannot be removed by surgery, as well as  microinvasions that cannot easily be detected, but it is usually considered best to remove all of the lesion that you possibly can by surgery. There are limits to the amount of radiation that can be given, and if cells escape or return, radiation may not be an option the second time around.

In regard to your question about the  risk posed by DCIS, perhaps the following info from Dr. Susan Love will help:

" What is ductal carcinoma in situ (DCIS)?
As more women have gotten mammograms on a regular basis, DCIS has been found far more often. DCIS is a noninvasive precancer. It is not life threatening. If you have DCIS, it means that you have abnormal cells in the lining of a duct. While virtually all invasive cancer begins as DCIS, not all DCIS will go on to become an invasive cancer. An invasive cancer is one that has the potential to metastasize (spread). Right now we have no way to determine which DCIS will go on to become invasive cancer and which will not. That's why doctors recommend DCIS be treated. "

I agree that you should have full understanding of the choices and treatments available to you. Since you are having doubts, I would definitely encourage you to obtain a second opinion, from the best source you are able to arrange.

Best wishes...

[pooge1]

I really appreciate your feedback.  It makes sense.  The thing I keep going back to is  "What is the roll of radiation?" Wouldn't radiation take care of any stray cells?  That's what I thought the purpose was of radiation.  That is the part that confuses me.  It just seems like overkill if DCIS is precancerous and not invasive. I am thinking about going to Sloan Kettering for another opinion.  I just want to feel 100% that this is necessary before I do it.  I know there are ongoing studies and equipment being developed to differienate DCIS.  

Are you a doctor?

Thanks again,

pooge1

[bluebutterfly2222]

Sorry for the typo.

That, of course, was supposed to be "metastasize."

[bluebutterfly2222]

The pathogist carefully examines the specimen to see if there are any malignant cells along, or close to, its edges, which would mean they were touching, or very close to, the tissue remaining in the breast. (Not a good thing!)

To put it in simplistic  terms, imagine having an apple with a brown spot in it, and cutting very thin slices off it until you had no more brown at all, and then cutting  some additional slices to be sure all that remained was "healthy" apple.  If  however, every slice still had some brown in it, you would know you had not completely removed the brown spot.

When clear margins are not obtained, there is the posssibilty of malignant cells left behind that could (esp. with a high grade tumor) rapidly divide and form another tumor, and also that the cells could migrate, or metasize, to other parts of the body.  It is best, if at all possible, to remove the entire tumor, and some clear tissue surrounding it.