Why They Can't Tell You in Sugery If They Got All the Cancer

Women write me frequently annoyed they have had a lumpectomy and now have to return to surgery for a re-excision because "the doctor didn't get it all." This happens anywhere from 5 percent to as high as 50 percent of lumpectomies, depending on the surgeon. (A good question to ask the surgeon before you go under the knife is what his or her re-excision rate is.)

Some women want a frozen section of the tumor margins done while they are anesthetized during their initial surgery to ensure that the surgeon did get it all and they don't have to return for another surgery. This is unwise for several reasons:

  1. Your surgeon cannot see breast cancer cells with the naked eye. He or she relies on the breast imaging studies you've had done as well as the general feel of the tissue. The surgeon also is trying to avoid removing more tissue than is necessary to avoid a big cosmetic defect post-lumpectomy. (You'd be unhappy about that, too.)

  2. Breast tissue is made up primarily of fat cells, which do not freeze and slice well. Picture taking a block of lard, freezing it and trying to microslice it -- it will slip and slide. Under the microscope, this type of cell can go from being round to slipping and sliding to becoming an oval or other shape. This can cause a pathologist to misread what is and isn't cancer.

  3. There are 6 margins for each specimen. They each have to be looked at very carefully and the entire edge of all 6 margins must be inspected to ensure no cancer cells are present. Why would you want this done in haste when it is so very important to be accurate?

The bottom line: when the surgeon says it will be a few days before knowing for sure if he or she got it all, respond, "That's fine, doctor. I want the pathologist to take her time and get it right."


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