- Question from Kitty: I had a lumpectomy that was close to the chest wall. My doctor said he could not have take more out if he had done a mastectomy. Should I worry about the margins? I have invasive breast cancer, grade 3 tumor.
- Answers —Beth DuPree, M.D., F.A.C.S.: When we perform breast-conserving surgery, we are only able to remove tissue around the tumor up until the point where we reach the chest wall. (the rib cage behind the breast, that's covered with muscle). We try to do whatever is possible to get clear margins. We also try to leave as much healthy breast tissue intact.
The deep margin, which is up against the muscle of the chest wall, is often our most difficult margin. Once we physically remove the tumor off the chest wall muscle, we have physically removed the largest limit of breast tissue that we can from that area. There is a layer between the muscle and the breast tissue that is called the fascia. This is a flat layer of tissue that separates the breast from the muscles of the chest wall. If the back (also called "posterior") margin was either close or positive, we need to enlist the help of our radiation oncologist. Knowing exactly where the margin is tight, can help the radiation oncologist plan their radiation therapy treatment.
- Marisa Weiss, M.D., president and founder: As a radiation oncologist, if the deep margin or posterior margin is positive or very close, I immediately pick up the phone and bug the pathologist. I need her to help me better understand if the tumor went to the back of the breast and stopped there, or if it went into the fascia and/or the muscle. Sometimes it's hard to sort all of these questions out.
I also call the surgeon to learn what I can from her. This week alone I've had 3 patients with a close or positive deep margin. Ultimately, we proceed with radiation, and I aim my boost dose to the area of concern. I also have the ability to go to a higher dose if the margin is clearly positive. If the surgeon is concerned during surgery around the deep margin, she might choose to place tiny metal clips to mark the area where she knows the margin to be close. This gives me a very accurate target to focus my radiation dose on.
- Beth DuPree, M.D., F.A.C.S.: This requires teamwork with your health care professionals to make the best treatment plan for the particular cancer with which you've been diagnosed.
On Wednesday, November 17, 2004, our Ask-the-Expert Online Conference was called Your Operative and Pathology Reports. Beth Baughman Dupree, M.D., F.A.C.S. and Ann Ainsworth, M.D. answered your questions about details of pathology and operative reports and the importance of discussing them with your doctors.
The materials presented in these conferences do not necessarily reflect the views of breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.
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Beth Baughman DuPree, M.D., F.A.C.S. is a general surgeon. Her clinical practice is located at Holy Redeemer Hospital and St. Mary Medical Center.
Ann Ainsworth, M.D. is a surgical pathologist at Paoli, Bryn Mawr, and Lankenau Hospitals in Pennsylvania.
Marisa Weiss, M.D., a Philadelphia oncologist, is the founder and president of Breastcancer.org.
