Expert: Claes-Gustaf Nordquist, M.D. - 7/28/2009

Question
I am 49 yrs old, diagnosis "right breast 1 o'clock 5 cm from nipple - invasie ductal carcinoma - ER/PR positive.  Have had lumpectomy - removed malignant tumour & had sentinal node biopsy - 2 lymph nodes tested & no more taken.  Am seeing my specialist on Thursday and want to know your opinion of further treatment i.e. I am considering mastectomy, as original report says this also: "..A hypoechoic lesion was also identified at 10 0'clock, 2 cm FN, measuring 4 x 4 x 3mm.  A second complex cyst/hypoechoic lesion was also seen at 6 o'clock, 3 cm FN, measuring 3 mm.  A simple cyst cluster was identified at 8 o'clock, 3 cm FN, measuring 4 mm, also in the right breast."  Please help.

Answer
How big was your tumor in the lumpectomy? Were the surgical margins free? Was your sentinel node biopsy free of cancer? If possible let me read your full pathology report from your lumpectomy. You can copy it here. Were the 2 nodes you mention both free of cancer? Before any decision is taken I think those hypoechoic lesions should be checked with ultrasound guided needle biopsies. If no cancer is found there and your cancer was small and its surgical margins free of disease and also your lymph nodes were free of cancer I do not understand why you are contemplating any mastectomy. That seems to me like a clear case of overkill in that case. In that case I instead suggest a combination of postsurgical radiation therapy followed by hormonal therapy. Good luck!