I just heard from the surgeon that the pathology report showed my lymph nodes were negative (no cancer in them). The blood vessels were also negative and the margins were clear, meaning there was healthy tissue completely surrounding the areas of cancer (i.e., he got it all).
There were two areas of invasive cancer, meaning the cancer had gotten out of the duct. Both were about 6 mm in size…about pea sized. So two pea-sized blobs of cancer had managed to get outside the duct.
The only thing that detracts a tiny bit from this happy picture is that the report says there was evidence of “extensive DCIS.” What the surgeon can’t tell me until he talks to the patholgist is what “extensive” means in this case.
DCIS, by its very nature is cancer that’s confined to the duct. We know from the mammogram and MRI that there was a tumor INSIDE the duct measured at about 1-2 cm in size (about the diameter of a nickel at most). But we don’t know if their idea of “extensive” is limited to the one duct sampled in the biopsy or whether there were multiple ducts containing DCIS.
Thinking of the ducts as being like trees, the DCIS would be like cancer contained completely inside the branches where we can’t see it or touch. It could be one little blob in the branch or it could fill up the whole branch from the trunk to the tip of the branch. The invasive cancer, on the other hand, would be tumors that broke through the branches and could be seen outside them. In the body, invasive breast cancer means the cancer is outside the duct where it now can potentially reach efficient avenues of travel, such as the bloodstream and lymphatic system.
What we don’t know is whether the “extensive” DCIS was merely the expected 1-2 cm mass contained within the one duct/branch…or was there more than that, perhaps filling up more of one branch than the 1-2 cm. OR…(and this is the big question for me) did more than one duct contain cancer?
The pathologist may not be able to answer that question. The surgeon didn’t know if the slices they are looking at have any kind of spatial registration marks to tell them if all the slices they’re seeing are from the same duct or are from more than one duct.
If there were tumors in more than one duct, then I need to consider the possibility that the other breast may eventually reveal tumors in it. If it’s just one duct, then this could have been a fluke. However, if cancer independently formed in multiple ducts in this breast, then it is possible, maybe even likely, that the same conditions that triggered them might have triggered (or will trigger in the future) similar tumors in the other breast.
Right now, our best tools say there are no such tumors in the left breast, but if any are in there, they could still be too small to detect. Thus, I will need to be extra vigilant with my mammograms in the future to catch any new ones while they are still small and confined.
If it turns out the pathologist can’t be more definitive and can’t tell me if it was one duct or more than one, I’ll err on the cautious side and watch the other breast carefully. In fact, I’ll be watchful either way…I just may sleep a little easier if I know this was just one lonely tumor in only one duct.
I still feel a bit tense, so I think it may take a day or two to really breathe a sigh of relief. But intellectually, I’ve gotten the good news I’d hoped for. I can’t ask for more than that.
–BTW, I apologize if this posts in a small font. The program wouldn’t give me line breaks and it displays in a tiny font size in preview mode.
