Multi focal breast cancer?

Hi Girls

Just wanted to know if anyone else has had the experience of 2 tumours? I had a lumpectomy, this came back as no node involvement, then I had 25 of rads. That was in the April / May, after I had finished the rads I found another small lump in the same quadrant. I then requested a full mastectomy, (I nearly ran down to the operating theatre!) I was give chemo of CMF & Epi. After 12 months I read something that indicated that having the ovaries out would be helpful, (either that or by then I was completely hooked on having some form of operation!) so now 3 years after diagnoses I am wondering about the ‘multi focal’ bit? My ‘lumps’ were grad 2 & 1 with no indicated nodes involved.

Anyone out there?

Many thanks
Debbie x

Hi Debbie
I had multi focal too. 2 tumours in right breast-one was DCIS the other an aggressive cancer. Had mastectomy in December, no node involvement so no Chemo or Rads. Just had reconstruction. No-one has mentioned ovaries out. It would depend whether you are ER+ or not? Are you taking Tamoxifen?
Good luck!
Gill x

Hi Gill
Thanks for your reply. Did they do the histology on both tumours? I was very much ER + her 2 neg. Due to me being oestrogen positive I was put on Tamoxifen at first (only for a few months) I then read about the ‘new’ drug Arimidex and pushed for it. I understood that, for me having my ovaries shut down would be for the best so I went onto Zoladex for 3 months, but I thought that if I had them out it would be done and dusted. I discussed this with the oncologist and surgeon who agreed. So no I am just on Arimidex. What about you?

Hi again
Yes had report on both tumours-DCIS was 21mm and the agressive cancer was only 6mm. Am ER+ so been on Tamoxifen since January-no side effects as yet!
How old are you? Maybe it depends on your age? I am 48 and my periods were going a bit haywire just before I was dx so was probably on way to the menopause! Have had some random bleeding since beginning Tamoxifen which is being investigated by a Gynae just in case! Awaiting results from biopsies taken and also a date for a scan of my womb.
Love Gill x

Hi Gill

I am 48 years old, 49 in November, I too was having a few problems with my period before I was diagnosed.
Let me know how you go on with your scans. Nice to know that there is someone else out there!
Debbie x

Hiya
I shall be 49 in October! Am planning one hell of a bash if I get to 50!!!
Obviously all the best people were born in 59!
Love Gill x

Hi Debbie

I had 3 x multifocal tumours in the same breast. Can I presume you were Stage 1. I hope no one thinks I’m scaremongering, but I too am very interested in the significance of multi focal and would like to share my findings:

My PS onc said I was originally a Stage 1 , Grade 1 - ie. they took into account the size of the largest tumour which was 12mm…Then I read about a trial in Oz that said that they think that multifocals should be added together and the combined length used for staging. (This would have made me a stage 2). I was not offered chemo or rads and I declined tamoxifen, (which probably proved to be a mistake as I ended up with a recurrence)! I tried to discuss this with PS Onc, but he totally dismissed it as irrelevant.

I would be interested to know whether the combined lengths of others’ multifocals would have changed there staging…

Nikki

Hi, I’m in the same boat as y’all, I had what was termed in my histology report as a bi-focal invasive ductal carcinoma in my left breast. The first tumour was 2.2cm in the upper inner quadrant and the other one was 1.5cm in the lower outer quadrant. I also had 9.6cm of dcis which extended from the 3 o’clock position right round to the 10 o’clock position.

Nikki, I think I was always gonna be stage 3 as I had a lot of spread to my lymph nodes (20/23 positive) but I’m also curious to know whether having more than one tumour site is significant.

Best wishes,
teacup

Hi All

Thank you girls for all your info. I think that I will now start to look at little closer at the multi focal side of the bc.
My first tumour was just over 2cm and was contained in the ducts, my second was much smaller. After reading bits on the internet, what I can’t understand is that one report states that the first tumour is the primary and the second comes from that one. My oncologist told me that the first lump was contained and hadn’t spread, so what does that all mean. They graded the first, I think because of it’s size as 2 and I remember the surgeon saying that it was ductal carcinoma in situ, then the next one was much smaller and they graded that at first as a 3, then my OH mentioned that I had, had rads and that could have affected it, after the histology it was down graded to a 1
If I had had a mastectomy in the first place do they search the whole breast tissue for other tumours?
There is quite a good article on the net if you just enter multi focal BC
Love Debbie x

Hi Debbie,

I’ll try my best to help you. Going by the info you mentioned, if the first tumour was contained within the ducts than it was a ductal carcinoma in situ (dcis).

This is a very good thing as it means that the cancer hasn’t spread outside of the ducts to the rest of your breast. Once it has spread to the rest of the breast, there is the possibility that it can spread to your body via your lymph nodes or bloodstream.

You say that it was graded as 2 which refers to the appearance of the cancer cells under the microscope. Grade 1 would be low grade, grade 2 would be intermediate and grade three is high. This means that grade 1 cancers are more likely to be slower growing and grade 3 to be fast growing. Grading is different to staging cancer though.

I wonder did they tell you whether your second tumour was dcis or invasive ductal carcinoma (idc)? Perhaps, since you had chemo, there was the possibility that dcis had spread or invaded the rest of the breast and that is why you had chemo.

Probably, you already understand all this but hoped it helped but gotta go now so chat later again, x

Best wishes,
Teacup

Hi Teacup

Thanks for that, it was really informative. The surgeon really didn’t label the second one, all she said was that it was small. She said that she didn’t think that chemo would give much extra protection being hormone sensitive and all that, but when I saw the oncologist who had been dragged out of retirement she said that because I had, had two tumours she wanted me to have chemo? I did agree to this, and I think that probably I’m glad to have done it, but I still would like a further explanation from my surgeon as to the histology report on both tumours. She didn’t class the 2nd as a reocurrence, and said that it was still classed as a primary?

I will ask about the invasive bit though, many thanks for that. I am due to see the surgeon after my hols in two weeks so I will get all my question together, (at least that will keep them occupied rather than prodding me!)
Debbie x

Hi Debbie,

You can ask for a copy of your histology report. Any bits you don’t understand, your onc or bcn should be able to help you out with.

I’m no expert but it sounds like they threw a lot of treatment at you - just to be safe. I would suspect that your prognosis is probably very good but as I said I am no expert. Your first tumour was dcis which is also sometimes referred to as pre-cancerous.

Have fun on fun holidays. x

Hi all

I too had multi-focal BC I had 3 tumours all grade 3 the largest being 3.8 then 2.6 and 1.2. There are 2 different schools of thought about the sizing and some oncs including my own believe you only go off the largest tumour, however more recent reseach indicates that the total size of the tumours is more accurate. I had 2/13 nodes affected So I am stage 2 according to my onc and stage 3 according to research, however which ever it is the treatment was still the same.

I had 4x EC and 4x Tax followed by 6 weeks rads, (which I hated more than chemo) I was ER and pr +++ I have had my ovaries stopped using zolodex inplants but in the long term I will be having my ovaries out. Am also on Arimidex for 5 years

Linda
x

Hi

I also had multi focal in one breast, one lobular and two ductal cancers, totalling 5.8. I had gone to the GP because of a dimpling in my breast - no lumps. Only one appeared on the mammogram and when having a ultrasound I spotted another one! When the path report came back, they had found another one as well!! I asked for a bi-lateral mastectomy - lucky I did as I had ductal cancer in the other breast which hadn’t shown up on any of the test, biopsies, etc. I was told it was Stage II. I had 2 out of 4 lymph nodes involved and had 3 FEC and 4 Taxotere followed by 20 rads. ER+ level 8, Herceptin negative. Am on Arimidex and calcium for my bones.

Sharon

x

Hi Debbie,
I was dx Jan 2003, after a recall from a 3 yrly mammo at a travelling unit - no reason to suspect cancer, even my GP checked both breasts just before the recall and couldn’t feel a lump. Turns out the invasive tumour was non palpable, so thank God for mammos.

I had an invasive ductal tumour of 2 cm, plus intermediate grade DCIS (path report only stated the id and DCIS total) Stage and grade 2, Nottingham Prognostice Index 4.4 - so not as good as I wished. During WLE, 8 sample nodes showed 2 nodes malignant, so went back a month later for total axillary resection - another one found malignant, so 3/18. ER+, PR not done, and only 2 yrs ago did I have a private HER2 test, as it was not done then at my Breast Care Centre of Excellence (some excellence in hindsight!) which thankfully was negative. Oncologist told me in no uncertain terms at the consultation that even if I was HER2+ he would not prescribe Herceptin, as I was too long out of chemo. I had 6 x FEC, 25 rads, and was on Arimidex for 4 yrs, but stopped it a few months ago because of bad joint pains in hips, hands and feet. Tried Aromasin, but pains came back in a week. Got a pack of Femara lurking in my bathroom cabinet, but still have to find the courage to take them. Also stopped Alendronic Acid, as they caused stage 1 oesophagitis, and exacerbated my Crohn’s so much I have been on an elemental diet (3 bottles of Fortijuice a day) as I can’t eat. What a mess this breast cancer wreaks. GP said to just continue with the Calcichew/Vit.D tablets to prevent my osteopenia turning into full blown osteoporosis. Broke bones in both feet last year, so worried about hips.
Gosh, sorry to be so down…not been a good day as best friend’s mother diagnosed with colon cancer, and she has been on the phone in tears to me tonight.

Your diagnosis and prognosis look pretty good to me…

Take care,
Liz.

Hi was told that this forum might be able to help me by lancslass( hi Debbie ) and I must say that I have learnt a lot and will be asking my oncologist a few questions when I see him on 18/9 (first visit) I had 2 tumours one less that 2cm the other smaller. Head was so upside down didn’t take in all facts and figures when I got results. Had mast and LAC all nodes clear. Been told by BCN that one tumour was ER pos and the other ER neg so not sure what I will be offered. Am really scared by thought of chemo as worried about possible other cancers later. Am very interested in number of ladies who have opted to have ovaries removed ( now know this is what your op was debbie!) which I presume means less medication.
A bit about me ( rather than my cancer) i’m 45 (46 in Oct) 2 kids boy 11 girl 10 OH a diamond!
Love Cazzb

Hi Cazzb
I’m glad that you have found this post, hope it helps a little? I went on Tuesday for my 12 month mammogram and then on Wednesday went back for results and 12 month check up, (I never did like to do things by half!) Thankfully the scan was ok and they were ‘happy’ with me. I only saw the registrar and although I had this list of questions with regard to the ‘multi focal’ I think that I will be better asking the oncologist in 6 months. She did check my histology report and both lumps were ER+ Her 2 neg, but when I mentioned the multi bit she seemed a Little fazed. I answered my own question because I felt sorry for her, I think that I summarised by saying, ‘well I suppose I have just been unlucky then’? (She said ‘yes’) in depth or what? Good luck with your questions, let me know what happened.
Debbie x

Hi

i have multifocal invasive lobular cancer. I’m 29 and had a vague feeling that something wasnt right in my left breast. By total fluke the ultrasound man found a tumour, which turned out after lumpectomy to be 3 seperate tumours. The biggest is only 5mm. I have just had a mastectomy however as the doc reckons there may well be more very early stage cancer. My concern is the other breast. He poo pooed the idea of double mastectomy as he said there was no indication of cancer there. But if it was such a fluke they found the first lot, AND lobular is often harder to dx AND mammograms dont work for me(breast tissue too dense) AND MRI only picks up tumours over 5mm then how am i going to be reassured it wont come back in the other one???

I think that docs in diff hospitals give diff advice and its hard to know what to push for. Obviously i dont want to lose both breasts, but i am so lucky to have found the cancer at such an early stage that i fear i might not be so lucky a second time.

Any advice?

Lou

Hi,

I also had a multifocal ductal carcinoma and I didn’t know it had a worst prognosis than the other kind of tumors. I have tried to look for information on the web about this particular one and it seems not to be that many.