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Surgical Margins

cisbell0902
Posts: 3
Joined: Oct 2002

Good morning...

I am hoping someone out there can help me. I was diagnosed with Breast Cancer in July. I had breast conservation surgery in September and am going through Chemotherapy right now. Three down, one to go. My radiation oncologist has asked me to think about going back in for surgery because he believes the margins aren't as clear as they should be. According to the pathology report, "There is invasive carcinoma at the cauterized edge of tissue. This could possibly be a crevic as there is not ink seen at that cauterized edge and the tumor grossly was 2 mm from the closest margin. Clinical correlation is recommended"
I am going in to see the radiation oncologist on Friday and have a follow up appt with my surgeon. IF anyone out there has a list of questions or some insight into this I would appreciate it. My husband and I have read as much as we can but I thought maybe I could get a personal opinion from someone who has been through it.

Thank you so much.

Carol Isbell
cisbell@cwnet.com

hummingbyrd's picture
hummingbyrd
Posts: 965
Joined: Sep 2002

Hi Carol, my first ? is how large was the tumor? did you have any + lymph nodes? did they do a sentinel node biopsy? what was the tumor type ER+?/PR+? and particularly HER2? and if so was expression of HER2 mild/mod or strong? HER2 is a more aggressive tumor type and may play a part in your decision making. Most importantly how does your surgeon feel about it? Does he think the margins were clear enough? It's real borderline, but if nodes, including sentinel, were negative it may be enough. Unfortunately, there is no guarantee either way. I'm impressed he did a lumpectomy to begin with (equal cure rate as mastectomy), but gotta get clear margins.
Best suggestion, above all else, pray!
Ask God to guide you and give you the treatment decision that you should make. Listen to him carefully and then go with what He says. He is the Greatest Physician of All! God bless. hummingbyrd

cisbell0902
Posts: 3
Joined: Oct 2002

Thank you for your response... The tumor was 1.1 cm..there were two other spots.. one was .4 and the other was .2 all in the same area. There was no node involvement. They did a sterostatic biopsy before the surgery. The tumor was Estrogen Receptor Positive and Progesterone positive. HER2 was 0 Negative. My surgeon has said it is up to me. He said if it was his wife he would let her decide.

Thank you for your help and I hope this answers some of your questions.

I am praying..

Carol

llange's picture
llange
Posts: 54
Joined: Dec 2001

Hi Carol,
I had a lumpectomy a year ago in Dec., for a 7mm tumor, and 2 other small tumors were found in the tissue, both 5mm, so it sounds like our cases were somewhat similar. I was also ER/PR +, Her2 -, with 2 lymph nodes involved. My surgeon recommended going in for clean margins right away, since there was invasive tissue within 2mm of edge, so I had it done 8 days after my lumpectomy. There surgery itself was no big deal - only 20 minutes, but I did have a general anesthesia because of the scar tissue (my surgeon didn't think he could numb it enough). It was agonizing waiting for the pathology report, but all turned out clear and I'm really glad I did it. I had strongly
considered having a mastectomy at that time, but decided to wait and find out the path. results from the re-lumpectomy, and I'm very happy with the decision. It may be worth it for peace of mind. See what your surgeon has to say (by the way, this is not at all uncommon).

Good luck!
Lisa

hummingbyrd's picture
hummingbyrd
Posts: 965
Joined: Sep 2002

Carol, I think I'd have to agree w/ Lisa, just to be on the safe side AND to put your mind at ease. Good news is you had really good report w/ HER2 - and no + nodes! If only the margins had been a little larger. Also, tumors were small so overall if you gotta have breast cancer you got a good one. Your next decision is sort of a coin toss so no one can decide that but you. Again highly recommend one on one consultation with God. He always has the right answer. Best of wishes and good luck making a decision! God bless. hummb

geral
Posts: 132
Joined: Sep 2002

Hi Carol!

I always feel uncomfortable trying to decipher pathology reports. You may want to contact the ACS oncology nurse at this site and get her take on it. Just click on 'Contact ACS' at the top of this page, enter your questions under 'General Cancer Questions', and an oncology nurse will respond to your personal e-mail address in 1-2 days.

I respect your radiation oncologist for his opinion. Many medical professionals will not 'stick their necks out' even if it might save one of us.

Good luck,
Geral

isaiah4031
Posts: 243
Joined: Jun 2001

Hi Carol,
I also had a tumor removed initially, and the pathology report also stated that the margins were less than 1 mm clear. So I opted to have the second surgery and get it all. My nodes were negative (Praise the Lord!) and I had 4 rounds of chemo plus the radiation. I am really glad I did that because I needed to know that I had done all I could that was reasonable. The second surgery was no problem at all...just a bothersome drain for awhile. But the healing was fine. The resultant chemo and radiation were not as bad as others have had, but I made it. Now, my hair is back and I am contemplating my first hair cut today! I wish you the best. Let us know what happens.
Love, Jayne

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