Wide local excision for DCIS: pathology results

After a WLE, the breast tissue that has been removed is sent to the laboratory to be examined under the microscope by a pathologist. The pathologist looks to see whether there is an area of healthy cells all around the cancer – this is known as a clear margin. If there is not a clear margin, i.e. there are DCIS cells at the edge of the area of breast tissue that has been removed, there is a higher chance that the cancer will come back in the breast. More breast tissue then needs to be removed a few weeks later. Sometimes, the results from the laboratory after a WLE show that taking away more tissue from the area is unlikely to remove all the DCIS cells completely. In this situation, a mastectomy needs to be done.
A few weeks after surgery, the women we spoke with had an outpatient’s appointment with the doctor, who checked that the breast was healing well and talked to them about their pathology results. Some women found waiting for these results difficult. Many were pleased and relieved to hear that they needed no further treatment. One woman said she was calm on the day she went for her pathology results and, though the news was good, it took her a while to get used to it.

Although Carols friends and family were overjoyed to hear she was clear, it took her two weeks…

Age at interview 51

Gender Female

Age at diagnosis 51

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Then it was going back for the pathology results after the operation. And I was strangely calm. I’ve seen a lot of people on the forums say that the waiting for the results is the worst thing. And I expected to be like that and not be able to sort of get on with my life until I got that result. But, I don’t know for what reason, probably because I’ve been carrying on as normal and I trusted the surgeon and I knew they’d caught it early, I was strangely calm about the whole thing.

And then it came to the day of the results and you have to wait a long time, it was three weeks. But in my case, because I’d had a bad reaction to the anaesthetic, I think that was probably a good thing because by the time I actually went for the results I was feeling stronger anyway. And the relief, the absolute relief when he said they got clear margins and that was it, no further treatment. And I was like, Well I don’t even need radiotherapy And he said. No, no we’ve got good clear margins

No tamoxifen or anything?

No, no nothing whatsoever. It was just removed, clear margins and then we’re going to keep an eye on you and it’s going to be yearly mammograms for you from now on. And the absolute relief initially was like overwhelming really. I could have kissed him but I just shook his hand [laughs].

But then when you come out of there it won’t sink in. Everybody around you who you’re telling, your friends and your family and you know you’re ringing your brother up and saying, I’m all clear And your best friends you’re telling, and they’re all really overjoyed, but you’re cautious. You’re, it won’t sink in straight away because you’ve not realised that you’ve had this two months overall out of your life with all this inward worry, you can’t immediately just switch off and think everything’s great.

And I’ve got to say it took me a good couple of weeks of just biding my time, waiting to feel happy, I suppose. And that was that, before I did start really getting back to my normal personality, and thinking, Right, put that behind you now, get on with your life, enjoy it. Stop worrying, stop thinking it might come back, it might this, you might get something else, you’re prone to it, just stop it You know, you’re going to have yearly mammograms, if there is anything else, they’re going to catch it early again and just thank god for routine mammograms. And that’s the stage I’m at now.

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Women who had no further treatment were usually able to get on with life as normal. With hindsight, some said that their surgery had been an ‘interruption’ but they had got back to their routine soon afterwards.
Some women were told by the doctor that there weren’t clear margins and they would need further surgery. This came as a huge shock and disappointment. One woman said she ended up having three excisions but was grateful not to have a mastectomy. During one of the operations, some invasive breast cancer was also removed. Some women were also told they would need radiotherapy or hormone therapy (see Radiotherapy and our Breast Cancer section).

Pauline had three operations and, by the last one, felt calm beforehand and was very well…

Age at interview 52

Gender Female

Age at diagnosis 51

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The 18th of January came and I went in for the operation. And this time I was much, much more calmer. I realised how lucky I was because I had been meeting only people with mastectomies. And even though it was my third operation I was much, much calmer and the fact I met some of the nurses who were there before, that made me feel better.

But when I went into the ward in fact there was a lady who was very, very ill opposite- not opposite me, on the other side and slightly down a bit, there were only four beds in fact. And she was dying in fact, and her family were coming in and that was quite traumatic, you know seeing her in the ward. I felt it wasn’t fair. She didn’t have breast cancer, she came in for something else. And there was a lovely old lady there, she was 83 and had breast cancer. And I thought to myself it’s good in a way that they’re doing operations for older people, so at least when you get it when you’re older, you can still go in to get it done. And another lady had come down from Derry to have her operation, which is a long journey. But it wasn’t breast cancer. I happened to be the only one in that small ward with breast cancer and needed only a wide local excision.

But I was in good form. And the doctor didn’t come in the night before. Usually she did and I missed that and I thought Oh it’s usually nice to see the doctor, the surgeon She didn’t come in, the nurse told me that I would be having surgery on the Monday morning but she said there will be no localisation. I was so delighted, I was so delighted because I knew that was the worst part of the whole day.

So I went down for the operation and I saw the anaesthetist the day before and I told him about feeling really drugged the last time. And he said I can’t really change i, I said Could you not give me less and he said No I can’t really change i.

But anyway this time before the operation they weighed me, and they’d never weighed me before and somebody said to me later that they weighed me because of the amount of anaesthetic to give me.

So anyway I went into the operation and came out of it. I felt great. I had no drowsiness, no sickness, I felt really good and in fact I was walking round the ward talking to all the patients. And then they were saying to me Gosh, you look grea, I really did feel good.

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Several women who did not have clear margins after their WLE were given a choice of having more breast conserving surgery or a mastectomy (see Mastectomy: The operation).
DCIS does not generally spread to the lymph nodes in the armpit (axilla) but, sometimes, if the area of DCIS is large or widespread, the lymph nodes may be removed during the surgery and checked for cancer cells. This is because, for some women, there may be an area of invasive cancer cells within the DCIS which could spread into the lymph nodes. Before surgery, the doctor will discuss whether it is necessary to remove any lymph nodes. After having a WLE, one woman was told that the DCIS she’d been diagnosed with had turned out to be invasive breast cancer. She then had surgery to check for any more cancer cells and later had radiotherapy and hormone therapy.

Sandy had some lymph nodes removed. They were all clear but her arm was a bit sore and painful…

Age at interview 58

Gender Female

Age at diagnosis 58

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When I went to get the results I was told that it was DCIS. And that that was a precancerous lump. So I was pretty excited at the word precancerous because I thought nothing wrong. But the lump needed to come out. So went in January, which was I think about a week after I got the results. And had the lump removed. I think ten day later I got the result from that and, unfortunately, it had turned cancerous. But the lump was out and they had good clearance so there was nothing more to do in the breast. But they would take a sample of lymph nodes to see if it had spread. That happened two weeks later and it hadn’t spread. So I was clear.

They’d explained the procedure i.e. a blue dye would be injected into the breast, which drains into the lymph nodes so that they could find the first five and remove them and test them to see if there was any cancer in them. And they did explain that if the cancer had spread there then there would be a further operation to remove the rest of the lymph nodes. But if they were clear, then that was it.

So you went into hospital and, was it a general anaesthetic? Yes

Again, yes.

Again, yeah. And you came round the next day. How did you feel then, the next day?

Very sore. Very, very sore. And the wound had been bleeding during the night so there was quite a lot of blood in the bed. And the wound itself was painful. And that did come as a shock to me because after the first operation, where I felt no pain at all, suddenly I was, not in agony but it was pretty sore.

Where was the wound?

it’s, well if I show you. it’s just here. And it’s bigger than I thought. it’s about 2, 2 ½ inches.

So when you came round, were you in a lot of pain? Could you move very much?

No, I couldn’t move my arm. It was padded but it was very difficult to move my arm. And the back of my arm is numb. But I had pain from, shall I show you on here? From here to here. It was like a knife had been run up my arm. And I

When you came round?

Yeah, I couldn’t understand that. And I still get that pain.

And did you speak to anybody there about that or afterwards?

Yes, I did, yes. One of the consultant’s team came to see me, obviously to redress the wound because it had been bleeding and he did explain how it would affect the arm. And that I would have to keep doing those exercises to keep the arm mobile. And then I would have to go back again to see whether the cancer had spread to the lymph nodes.

Even after that operation?

Yeah. That was a sample. So they took five out to see if the cancer was in there.

And so then you went back for another appointment?

Yeah.

Yeah. And they told you that

There was no cancer in the lymph nodes so they didn’t need to do a third operation.

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For most women, the appearance of their breast after WLE is good. Women first looked at their healing breast either in the hospital or when they were back home, and most were very pleased with how it looked once it had healed.