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Dr. David
Dr. David, Doctor (MD)
Category: Oncology
Satisfied Customers: 46961
Experience:  Board Certified Oncologist
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Hi, I have just had lumpectomy with re excision to be followed

Customer Question

Hi,
I have just had lumpectomy with re excision to be followed up with radiotherapy. However the margin is not completely clear and the treatment has changed to mastectomy with chemotherapy. I am 48, 26mm tumour, grade 3, number of +ve nodes 0, ER +ve, HER2 -ve.
Understanding radiotherapy to be extremely effective at clearing up any microscopic cancer left behind, I have wanted to discuss this with my surgeon/oncologist only to be told not up for discussion and no other hospital in the UK would offer this as a viable treatment in my situation?
My question is whether this is so and why radiotherapy is not an option when the long term benefits are similar to mastectomy, even though I accept there is likely to be a higher risk of recurrence?
KB UK
Submitted: 3 years ago.
Category: Oncology
Expert:  Dr. David replied 3 years ago.

Dr. David :

This is Dr. David

Dr. David :

it sounds like your doctors are very worried about leaving residual breast cancer in your breast.

Dr. David :

some breast cancers are multifocal and in the initial lumpectomy specimen, multiple sites of breast cancer are seen.

Dr. David :

this means there is a very very high chance that there is more large amounts of breast cancer still left in your breast.

Dr. David :

in these situations, lumpectomy and radiation has been shown to have a worse control of the breast cancer compared to mastectomy.

Dr. David :

if the breast cancer is in only one location and there is a slight positive margin, then yes, you can have lumpectomy and radiation therapy and not have mastectomy.

Dr. David :

I would get a copy of the pathology report from your lumpectomy procedure.

Dr. David :

I would be very happy to review it with you and let you know if you need a mastectomy or not.

Customer:

Hi Dr David,

Dr. David and other Oncology Specialists are ready to help you
Customer: replied 3 years ago.

Hi Dr David,


Thank you for replying. Just to add to what I said earlier, when the margin was not clear my surgeon said that the majority of the tumour was removed with only a tiny amount left at the "8 o'clock " position.


A cavity shave followed to gain clearance, which was only going to be a 20 minute or so operation. This is why I have asked about radiotherapy to clear up what may be a tiny amount of residual cancer rather than undergo more bigger surgery and then reconstructive surgery on top?


Regards,


KB UK

Expert:  Dr. David replied 3 years ago.
radiation therapy works best when the lumpectomy procedure shows clean margins

you should have another small lumpectomy procedure to gain negative margins without a mastectomy

and then have radiation

unless your breast are very very small, sometimes with very small breast, it can be hard to excise any more tissue and keep a decent cosmetic result.