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This question was answered on Sat 14, Jun 2008 08:29pm by Dr Paul S, MD

Breast Cancer Surgical and Pathological Merry-Go-Round


    
Asked by atomic age downwinder (Female; 55; Cervical cancer hysterectomy 1985, normal weight, excellent health besides breast cancer; Relevant drugs:Minimal amounts Ambien or alprazolam for sleep, quit estradiol 6 weeks ago ) on Sat 14, Jun 2008 05:35pm

I had a lumpectomy Monday. Diagnosed with two invasive ductal carcinomas, Grade 6, about two inches apart, MRI, biopsies, wire localizations, etc. Found larger 1.7 cm tumor myself, which never showed on yearly mammograms. Surgeon called yesterday; pathology said there's a bad margin on larger tumor, and other mass negative for cancer. Surgeon claims negative tumor (.5 mm on biopsy; "subtle" on MRI) must have been sucked out by biopsy. Is this MD BS? There was something visible there for wire localization 2 hours before surgery. I told surgeon not to be shy about cutting, but she was apparently more concerned about cosmetics. My fairly large breast looks exactly the same as before except for 6 inch jagged wound. Sentinel node biopsy negative. She says I need another surgery only to correct bad margin. Perhaps I should shop around for a more knife-happy surgeon? I want to ask for more cutting on negative tumor; is this reasonable? Linda Wood
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Answer by Dr Paul S, MD  on Sat 14, Jun 2008 08:29pm:

Hi there. This is not an uncommon situation, where in lumpectomy specimens would turn out to have inadequate margins, even if during surgery, everything seems OK. This commonly happens if there are multiple tumors in one breast, that's why some doctors would opt for a mastectomy. I believe that your options would include a wider excision of the lumpectomy area, or undergo a skin sparing mastectomy, nipple preservation, and breast reconstruction. I suggest that you discuss this in depth with your surgeon and hopefully come up with a concrete solution. Regards and God bless.

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Follow up:

Clarification by atomic age downwinder on Sun 15, Jun 2008 08:04am: 
Thanks for your help.  Just a little clarification...

I have a problem with the surgeon's claim that one of the tumors was sucked out by core biopsy.  This was
no orderly withdrawal of cells, but a violent beating and stabbing resulting in a giant hematoma and bruise
which remained a month later.  The neat little 5 mm lozenge on the first ultrasound had become an irregular
splotch when the wire localization was done.  I was alarmed that the surgeon ordered post-localization
mammograms to find and remove both tumors, when neither one ever appeared on mammogram.  Isn't she wrong
to claim that nothing further needs to be done about the missing IDC?  She only wants to fix the bad margin on
the other one. 

Highest regards and appreciation.

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