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AskedPublicly Submitted Question
10/5/2017I am a breast cancer survivor who is providing patient support for a woman in her early 70s who was recently diagnosed with breast cancer. Between the biopsy and lumpectomy, she made a trip to Europe and developed a serious case of pneumonia (was in the hospital 5 days). After the lumpectomy, she was told that the cancer had grown between the biopsy and the lumpectomy (but no details on how much). The tumor was 1.2cm. The doctor said he didn't think it was necessary to do sentinel node surgery or axillary lymph node dissection (that there was very little chance of cancer in the lymph nodes). Yet her tumor grade was II/III and the pathology report showed tumor necrosis, tumor at the margins, and multiple foci of DCIS. Her total score was 5/9. The doctor now says that he will have to go in and remove more tissue but he can't guarantee he will get all the cancer so he might have to operate again after that. (He works in a teaching hospital and only operates once a week.) He has told her it is fine for her to take another foreign trip and wait three weeks for the next surgery. Is this appropriate standard of care? No lymph node dissection? Multiple surgeries, particularly on an older patient who has recently had pneumonia? Thanks for your help.
RepliedJHU's Breast Center Reply
10/5/2017If the cancer cells are all DCIS then not doing sentinel node makes sense. multifocal DCIS can make it difficult to get clear margins resulting sometimes in the need to actually do mastectomy. hopefully the cancer cells will be ER positive and if so she may be able to skip radiation is lumpectomy done as a re-excision to clear the margins is successful and hormonal therapy will be used for prevention of recurrence. grade 2 cells shouldn't have resulted in rapid growth between biopsy and surgery.

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