Confused about histology (DCIS & Invasive)

So having been diagnosed with BC in June, I had a mastectomy and reconstruction in August. I got the histology back from the mastectomy last week and unfortunately I had 1 of 5 lymph nodes with cancer present so am now awaiting axillary node clearance. I didn’t take the news overly well (had a bit of a breakdown in the consultants office) so basically blanked out on a chunk of what he was telling me. Anyway, I’ve now received the summary letter and it states “15mm area of intermediate grade DCIS, within which there was a 38mm Grade 2 invasive ductal cancer of no special type”. 

I may be being a bit dim here but how can the 38mm be within a 15mm area? Or is it likely to mean there was just some overlap where some of the invasive cancer had been within the DCIS?

Hi

I think your final suggestion makes more sense. You have two different types of breast cancer, DCIS and ductal. Fortunately it’s grade 2 which is not overly alarming and, with the right adjuvant therapies, you will recover. I always say thank heavens for lymph nodes. The fact that one (so far) is infected means that it has contained the spread of the malignant cells, which is its purpose. There may be more nodes infected which will be revealed by your FAC and determine what comes next. But unless the majority of the nodes are infected, it shouldn’t be a major problem. I had 19/21 infected - which turned out to be a different matter altogether.

What I would suggest is that you ring your breast care nurse immediately and get her to explain the letter. Tell her you blanked out a lot of information while reeling from the news - it’s a common reaction. She should be able to explain it better. Meanwhile, I wish you all the best for the FAC (expect a drain!) and the rest of your treatment xx

Hi

That result does seem a bit strange, I would definitely do as Jaybro suggests and phone your breast cancer nurse for an explanation.

 I also have a mixture of DCIS and IDC although my results are only from a vacuum assisted biopsy so far, I am due to have surgery on Monday and things may change after that. My initial diagnosis is 23mm of high grade DCIS plus 2mm of grade 3 IDC with no evidence of lymph node involvement. I am not sure how they can tell the exact size of each type of cancer from just biopsy results so I am expecting it to change, just hoping they are right about the lymph node involvement.

 I hope you get the answers you need and that your further surgery shows no more lymph node involvement xx

I thought I had DCIS along with IDC so I had done quite a bit of research on it. What you are describing is not uncommon. Probably means your DCIS came first and IDC developed later. The good news is that studies show a little better prognosis with that. Not a lot of studies mind you since it’s not been studied in depth but a theory is that the DCIS makes the spread of IDC harder. Maybe the environment isn’t as favorable. At any rate DCIS along with IDC in no means makes your diagnosis worse. It might make them recommend a mastectomy instead of a lumpectomy but that’s it. It will not affect your treatment and they are only concerned about the IDC once the DCIS is removed in surgery. Your IDC will remain the focus.

I don’t think you are dim, and I suggest you raise the same question with the pathologist or yr link with him /her. They don ’t always get it right.

Seagulls