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Dr. David
Dr. David, Doctor (MD)
Category: Oncology
Satisfied Customers: 49178
Experience:  Board Certified Oncologist
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Hi, I have just had lumpectomy with re excision to be followed

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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

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 4 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

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.