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Suggest Treatment For Invasive Lobular Carcinoma
Question: Hi, I have been diagnosed with Grade 1 invasive lobular breast cancer 3cm, after underarm needle aspiration, was informed that two nodes were positive, and an ALND was recommended, my oncologist has said she will try a lumpectomy with clear margins, as it is placed at 6 o'clock and just on the cusp. I am extremely anxious regarding all this, but was told that this is now done as day surgery, but I am concerned regarding drain, post op pain etc, I am already an extremely anxious patient, and have undergone a total mastectomy in May, (contracting pneumonia) I did ask for a pre medication to help with my extreme anxiety, but was refused, and was told that this might delay my discharge, due to pre medication and anaesthesia making me unsuitable (groggy) for dat release. Please could you give me your comments on this surgery, and hopefully alleviate some of my anxiety. Thank you.
Brief Answer:
Lumpectomy is not a good idea.
Detailed Answer:
Hello!
Thank you for the query.
In my opinion the idea of lumpectomy is a very bad idea. Please note that breast cancer which has given already metastases to lymph nodes, can grow in multiply areas of one breast. Leaving the rest of this breast increases the risk of leaving the part of this cancer.
As you have lymph nodes metastases (at leas two, but there might be much more than just two), complete mastectomy and total lymphadenectomy (all armpit lymph nodes removal) is the right choice. You do not fight for cosmetic effect. You fight for your life.
Lumpectomy is a simple surgery which can be done as a day surgery. But lymph nodes removal can not be done in such way.
Fluid leakage (lymph) is the most common problem after such surgery. It can leak even few months. But sooner or later it stops.
The other thing is the upper limb mobility which can be injured during the surgery. This might need some rehabilitation after the surgery.
As a conclusion, the surgery is serious for sure. No doubt in that. You should receive some sedatives medicines. This medicines do not affect anesthesia or surgery. And you should discuss total mastectomy with complete lymph nodes removal instead of lumpectomy.
Hope this will help. Feel free to ask further questions.
Regards.
Lumpectomy is not a good idea.
Detailed Answer:
Hello!
Thank you for the query.
In my opinion the idea of lumpectomy is a very bad idea. Please note that breast cancer which has given already metastases to lymph nodes, can grow in multiply areas of one breast. Leaving the rest of this breast increases the risk of leaving the part of this cancer.
As you have lymph nodes metastases (at leas two, but there might be much more than just two), complete mastectomy and total lymphadenectomy (all armpit lymph nodes removal) is the right choice. You do not fight for cosmetic effect. You fight for your life.
Lumpectomy is a simple surgery which can be done as a day surgery. But lymph nodes removal can not be done in such way.
Fluid leakage (lymph) is the most common problem after such surgery. It can leak even few months. But sooner or later it stops.
The other thing is the upper limb mobility which can be injured during the surgery. This might need some rehabilitation after the surgery.
As a conclusion, the surgery is serious for sure. No doubt in that. You should receive some sedatives medicines. This medicines do not affect anesthesia or surgery. And you should discuss total mastectomy with complete lymph nodes removal instead of lumpectomy.
Hope this will help. Feel free to ask further questions.
Regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi thank you for your answer, it is much appreciated. I have talked at some length with my oncologist, and she informed me that a lumpectomy with radiation treatment is just as successful as a total mastectomy, so the choice was mine, in either case she would remove lymph nodes, when I asked her if this was a major surgery, she said that it was in no way as invasive as my total hysterectomy in May, were muscles are cut, this is just tissue, she assures he that this is now Gold standard practise here in the UK and she has worked as an plastic reconstructive oncologist consultant for over 10years, before that as a general surgeon, she is highly recommended. I have confidence in her. I just wanted to know if there is anything I could take prior to my op for my anxiousness as she has said this would delay my discharge. I am sure she would not put my life at risk in choosing a lumpectomy.
Brief Answer:
Estazoloma or Hydroxizine can be safely taken.
Detailed Answer:
Generally you can take Estazolam for example or even Hydroxizine. This medicines can make you sleepy, less anxious for sure. You wont be able drive a car in the day you take it, but for sure there will be no contraindications to send you home.
Estazoloma or Hydroxizine can be safely taken.
Detailed Answer:
Generally you can take Estazolam for example or even Hydroxizine. This medicines can make you sleepy, less anxious for sure. You wont be able drive a car in the day you take it, but for sure there will be no contraindications to send you home.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your quick response. I am now really concerned that you would go against the recommendations of a highly recommended on our plastic surgeon consultant, who advised that a lumpectomy plus radiation has the same success rate as a mastectomy, stating that even over the past two years, oncology has come a long way with treatments. I states that over the past 9 months I have had several conversations with my oncologist, and due to the letrozole reducing my breast cancer, it is hormone receptive, so it worked, she is now doing the lumpectomy and node operation, which I have been assured is day surgery only. In view of your comments that we have chosen, my consultant oncologist and myself the wrong option, I wonder why you have reach this conclusion? My consultant oncologist has obviously trained for many years in breast cancers to reach lead plastic reconstructive oncologist in her field with well over 10years experience in this field. She would not, in any way, compromise my LIFE for a cosmetic result! She has stated that she would need clear margins for this surgery to work, but has also stated that it has been, in her experience very rare for this to occur, she would not offer this surgery if she was not confident that this could be done. I am very distressed that someone that has no knowledge or records of tests etc, would suggest that we have chosen the wrong surgery online.........
Brief Answer:
Lobular cancer tends to be multifocal.
Detailed Answer:
I am sorry causing some distress. I didnt mean that. Here is why in my opinion mastectomy is safer choice.
Lobular breast cancer is more likely to be multifocal. This means that in one breast there can be two or more tumors. One can be visible and have 3 cm, another one can be invisible in the ultrasound or MRI. Imagine that you have this tumor removed, finish the treatment and after 2 year you will find another cancer in the same breast. Always cancer recurrence has worse outcome.
Even with clear margins, another tumor can be missed. It can be DCIS by now (pre invasive).
I agree that lumpectomy and radiation has statistically the same success rate than mastectomy. But it is also known that surgery can not be replaced by radiation. It can destroy some cancer cells, but not all of them. Especially if there is another tumor. Radiation affect cancer cells when they multiply. Yours do multiply slowly (grade 1). This means that some cells may never multiply at the time of radiation.
I do not question the skills of your surgeon. Not at all. I just want you to be sure this is the right choice for you.
Of course lumpectomy can be done. And in many cases it can be enough. But you never know that.
As lobular cancer can be hereditary here is my question to you: have you been tested for BRCA1 and BRCA2 mutations? Have you had both breasts MRI before the treatment?
Once again, I do not want to add more stress to you, I know you have it enough right now. I just want you to choose correct treatment. Statistics for G1 cancer are great for the first 5 years (called 5 years survival). But no one really tells to this patients that the late metastases can appear even 20 years after the diagnosis.
Lobular cancer tends to be multifocal.
Detailed Answer:
I am sorry causing some distress. I didnt mean that. Here is why in my opinion mastectomy is safer choice.
Lobular breast cancer is more likely to be multifocal. This means that in one breast there can be two or more tumors. One can be visible and have 3 cm, another one can be invisible in the ultrasound or MRI. Imagine that you have this tumor removed, finish the treatment and after 2 year you will find another cancer in the same breast. Always cancer recurrence has worse outcome.
Even with clear margins, another tumor can be missed. It can be DCIS by now (pre invasive).
I agree that lumpectomy and radiation has statistically the same success rate than mastectomy. But it is also known that surgery can not be replaced by radiation. It can destroy some cancer cells, but not all of them. Especially if there is another tumor. Radiation affect cancer cells when they multiply. Yours do multiply slowly (grade 1). This means that some cells may never multiply at the time of radiation.
I do not question the skills of your surgeon. Not at all. I just want you to be sure this is the right choice for you.
Of course lumpectomy can be done. And in many cases it can be enough. But you never know that.
As lobular cancer can be hereditary here is my question to you: have you been tested for BRCA1 and BRCA2 mutations? Have you had both breasts MRI before the treatment?
Once again, I do not want to add more stress to you, I know you have it enough right now. I just want you to choose correct treatment. Statistics for G1 cancer are great for the first 5 years (called 5 years survival). But no one really tells to this patients that the late metastases can appear even 20 years after the diagnosis.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your reply. No one in my family has a history of breast cancer, and there are two small grade 1 cancers that have been found so close together, almost touching that together they are just under 3cm, my oncologist told me that although some women want a complete mastectomy at the time of diagnosis to be sure that the cancer will not return in that breast, even that is not a certainty. I do not think my excellent oncologist would risk a lumpectomy if she was not certain she could do this procedure successfully, she is not in the business of giving people false hope, (her words) I know that cancer is unpredictable, but I am 99.9% certain that we are doing what is right for me. Other women want different options, but this is not because of vanity for me. I am 66years old and if I get another 20years of life I will be extremely grateful. I am extremely anxious of this surgery, especially the node surgery, but she told me that I would be in at breakfast time and home by supper time, she is extremely encouraging.....I think if you have a surgeon who is extremely capable at what they do, it must make a difference to the outcome, and she is highly capable. I appreciate your comments, but I was originally asking about a pre med due to my anxiety, which is not usually recommended here for day surgery. The nurses at the unit have all said that the patients that undergo these procedures (same as mine) usually have minimal pain from lumpectomy, and more discomfort from underarm surgery than pain - from the drain, and any pain that is felt is well controlled by pain medication. I am confident in the team, but obviously anxious in the surgery as well, otherwise I would not have posted here. I was also looking for some encouragement to help me through my pre and post surgery. Thank you.
I have had one MRI, three ultra sound scans, two ct scans, one dexa scan, one radioactive neuclear scan, and one mammogram, one needle auxiliary biopsy, one breast biopsy in different areas. Some on both breasts, some on whole body, i.e. ct scans, MRI scan (50 minutes) and radioactive scan also due a scan. Thank you.
I have had one MRI, three ultra sound scans, two ct scans, one dexa scan, one radioactive neuclear scan, and one mammogram, one needle auxiliary biopsy, one breast biopsy in different areas. Some on both breasts, some on whole body, i.e. ct scans, MRI scan (50 minutes) and radioactive scan also due a scan. Thank you.
Brief Answer:
You are in a good hands.
Detailed Answer:
The pain from the lumpectomy is minimal indeed. Drain does not hurt as well (only drain placed in the abdomen hurts). Underarm surgery can cause upper limb pain or even swelling indeed. But this is usually not very intense. So the surgery itself is not complicated or hard to get over it.
In my opinion you can take Hydroxizine 25 mgs before the surgery (if you need you can start few days before it). It should greatly decrease the anxiety.
You seem to be a good hands.
You are in a good hands.
Detailed Answer:
The pain from the lumpectomy is minimal indeed. Drain does not hurt as well (only drain placed in the abdomen hurts). Underarm surgery can cause upper limb pain or even swelling indeed. But this is usually not very intense. So the surgery itself is not complicated or hard to get over it.
In my opinion you can take Hydroxizine 25 mgs before the surgery (if you need you can start few days before it). It should greatly decrease the anxiety.
You seem to be a good hands.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your answer, (although not what you originally stated) wrong treatment, fluid leakage etc........but still if this is your expert opinion I trust that it is......thank you
Brief Answer:
I hope your treatment will be successful.
Detailed Answer:
I didnt say its a wrong treatment. I just mentioned that mastectomy is right choice. But didnt say lumpectomy is a wrong choice. Lumpectomy is a standard procedure with many successful results.
Fluid leakage is the problem. But does not cause any pain, therefore, I didnt mention it in my last answer. I do not want to cause chaos in your way of thinking. You need to be strong, you are in good hands and you must believe that the treatment will be successful. Fluid leakage is really not that big problem, neither is pain. Week after the surgery, you wont be feeling any pain at all.
I can tell much about the fluid leakage as I do not know how long do they plan to leave the drain. From my experience, it can be in the tissues for few weeks. This helps with fluid elimination so the fluid drainage is not necessary.
I hope your treatment will be successful.
Detailed Answer:
I didnt say its a wrong treatment. I just mentioned that mastectomy is right choice. But didnt say lumpectomy is a wrong choice. Lumpectomy is a standard procedure with many successful results.
Fluid leakage is the problem. But does not cause any pain, therefore, I didnt mention it in my last answer. I do not want to cause chaos in your way of thinking. You need to be strong, you are in good hands and you must believe that the treatment will be successful. Fluid leakage is really not that big problem, neither is pain. Week after the surgery, you wont be feeling any pain at all.
I can tell much about the fluid leakage as I do not know how long do they plan to leave the drain. From my experience, it can be in the tissues for few weeks. This helps with fluid elimination so the fluid drainage is not necessary.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Ok thank you, my oncologist has said that there would be more discomfort from drain than pain, and that after surgery the initial areas are usually numb due to anaesthetic from surgery, as this wears off then pain medication is given, but usually ibuprofen and codeine, I think that because I have waited over 9 months due to taking letrozole hormone therapy, my mind is in overdrive, and of course I am extremely anxious as a result of this, also, a premedication is not given for day surgery as they think it delays discharge from hospital, hence my question to you, would it be safe? My Gp has now recommended 10mg of diazepam to be taken on three consecutive night before day surgery in the hope that this will 'build-up' in my system to lessen my extreme anxiety. I certainly hope this works. Thank you for your comments.
Brief Answer:
Diazepam works for sure.
Detailed Answer:
It all depends how the drain is placed. You may have discomfort due to inability to move the arm because the drain is there. It really does not hurt (unless its not located on the axillary nerve). What you feel is that its something there. It does not hurt but it gives discomfort.
I am pretty sure you have had drain after hysterectomy. And its removal was slightly painful. But this time, drain will be almost right under the skin, in the muscles and fatty tissue. Its removal does not hurt. So really, drain is not the problem.
For sure there will be numbness due to anesthesia. And when it disappears, some pain can be present. We can compare it to any dentist procedure. When tooth anesthesia wears off, the area is hypersensitive and gives some pain. But this does not last for a long time.
And painkillers like Ibuprofen and codeine can greatly deal with it.
Diazepam is even better than Hydroxizine, however less safer. So if you have permission to use it, feel free to do that. Its a very good medicine. Can cause you sleepy, but anxiety should be gone for sure.
One more thing. If you are anxious very often, this might need to be treated similar to depression. Therefore, medicines called SSRIs taken daily should eliminate the anxiety. You may discuss it with your doctor.
Diazepam works for sure.
Detailed Answer:
It all depends how the drain is placed. You may have discomfort due to inability to move the arm because the drain is there. It really does not hurt (unless its not located on the axillary nerve). What you feel is that its something there. It does not hurt but it gives discomfort.
I am pretty sure you have had drain after hysterectomy. And its removal was slightly painful. But this time, drain will be almost right under the skin, in the muscles and fatty tissue. Its removal does not hurt. So really, drain is not the problem.
For sure there will be numbness due to anesthesia. And when it disappears, some pain can be present. We can compare it to any dentist procedure. When tooth anesthesia wears off, the area is hypersensitive and gives some pain. But this does not last for a long time.
And painkillers like Ibuprofen and codeine can greatly deal with it.
Diazepam is even better than Hydroxizine, however less safer. So if you have permission to use it, feel free to do that. Its a very good medicine. Can cause you sleepy, but anxiety should be gone for sure.
One more thing. If you are anxious very often, this might need to be treated similar to depression. Therefore, medicines called SSRIs taken daily should eliminate the anxiety. You may discuss it with your doctor.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
My Gp has told me to take 10mg on three consecutive nights before my op (therefore at 9pm if I usually go to bed at 10 30pm) he has given me 3 10mg tablets only - so if I follow these instructions and take the last tablet Tuesday night at 9 30pm - will it still be reducing anxiety at 9am the following day at the time of my surgery or will I need a top up about an hour before? Or is what my general practitioner advises sufficient to keep my anxiety at bay the day of my surgery which is at 9am the last 10mg diazepam having been taken at 9 30pm the night before? Thank you again
Brief Answer:
Diazepam works for more than 24 hours.
Detailed Answer:
Diazepam effect lasts for approximately 24 hours so its effect should be present before and during the surgery. So your GP is right. follow his instructions.
Diazepam works for more than 24 hours.
Detailed Answer:
Diazepam effect lasts for approximately 24 hours so its effect should be present before and during the surgery. So your GP is right. follow his instructions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your time, it is much appreciated.
Brief Answer:
You are welcome.
Detailed Answer:
You are welcome.
You are welcome.
Detailed Answer:
You are welcome.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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