post surgeryr radiation

[Caracola]

Hi

I had lumpectomy just 6 weeks ago. Invasive ductal carcinoma, 2cm in size, grade 1, negative lymph nodes. Pathologist found a DCIS in the margin of resection leaving only 1mm clear. Doctors are waiting for the genetic results to know what to do: if re-excision or mastectomy. The problem is that it's unknown by when genetics will be available. Please could you comment on this approach and let me know timeframe for genetic test outcome. As well, could you let me know which is the recommended period for having post surgery radiation to be effective and woth it.

Many thanks

[Dennis MD]

Hi.
Re-excision can be done in order to have adequate margins if you are not going to undergo radiotherapy now.  After re-excision, you will be given systemic treatment in the form of hormonal therapy using tamoxifen.  
If you will undergo radiation now, there will be changes in the breast and its architecture, making mastectomy difficult.  

[Caracola]

Hi Dennis

Many thanks for you answer. Estrogen and progesterone positive, Her2 negative. My mum had hormonal type twice in her life. She's 73.
I had an appointment yesterday. Decision has been to have re-excision and start tamoxifen now. The problem is that this is week 7 after first lumpectomy although doctor said that this is not trouble for having radiation - 3 months the maximum period said. Genetic test will not be available until June. An unexpected delay! Doctors now don't know if I will have re-excision and then later on maybe mastectomy if genetic is positive.
I have not started the tamoxifen yet. I'm confused. Protocol was changed already twice and it seems to me a bit late for radiation then...

Thanks again Caracola

[Dennis MD]

Hi.
You have breast cancer stage 1 (T1N0M0) diagnosed after a lumpectomy.  A 1-2mm margin is adequate provided adjunctive radiotherapy to the breast is added after surgery.  This can be done 6 to 8 weeks post surgery.  There may not be that much benefit after 8 weeks of surgery.
What are your estrogen receptor/progesterone receptor assay status as well as your Her2Neu status?  What other prognostic factors are present?  Your treatment protocol would also depend on the presence or absence of risk factors and also prognostic factors.  These should be discussed with your oncologist.
Good luck.

[marydenise]

I had the same diagnosis. IDC, 2cm, Stage 1, negative lymph nodes. Although, unlike you, in my case, all of my surgical margins were WAY clear.

In my case, I elected to not have the radiation. But it sounds like you want it.

And in that case, it's not a big rush, for the radiation. Have the re-excision, to get clear margins, say in 1-2 months. And then, start the radiation.