Clear margins on lumpectomy

Surgical Margins, Clear

Get Some Expert Advice on Lumpectomy vs. Mastectomy

In order to understand more about surgical margins and treatment decisions, I looked up what the experts say in UpToDate - a trusted electronic reference that is used by many of the oncologists who treat breast cancer patients.

If you're facing this decision –- lumpectomy or mastectomy –- you will need to know how the state of your surgical margins comes into the total equation. Start by reading this excerpt to see why surgical margins are important for you.

Microscopic Examination of the Tumor: A Discussion on Surgery Options

"Microscopic examination of the tissue removed during a biopsy or during surgery may identify features that influence the recommendation for BCT [breast conserving therapy] versus mastectomy. One of these features is the presence of residual cancer cells at the edges of the tumor (the surgical margins). If residual cancer cells are present despite a large amount of tissue being removed, mastectomy may be preferable."

Getting the Message About Surgical Margins

Illustration © Pam Stephan

What Are Surgical Margins?

When your tumor is biopsied or surgically removed, your surgeon takes out more than just the tumor –- some tissue around the tumor is also taken. This border of tissue between the outer edge of the sample and the tumor is called the surgical margin. After your surgeon removes the tissue, it is carefully enclosed in a container and sent to the pathology lab. The pathologist uses a special ink to cover the outer edge of the entire tissue sample. Then the sample is sliced into thin sections and examined under a microscope. The edges, as well as the margins, are checked to see if any cancer cells have strayed outside the tumor and, if so, how far they have gone.

Understanding Terms Doctors Use to Describe Surgical Margins

Illustration © Pam Stephan

There are general guidelines, but the definition of negative or clear margins may vary from one hospital or clinic to another. These three terms are used to describe the margins:

  • Negative Margin: no cancer cells at the outer inked edge of the tissue
  • Positive Margin: cancer cells or tumor extends to the edge of the sample
  • Close Margin: any situation in between negative and positive

When Surgical Margins Contain Cancer

IllustrationClose margins after a lumpectomy might be treated by another surgical procedure, called a re-excision. Your surgeon would return to the original site and remove additional tissue to try and get negative (clear) margins. If that is successful, radiation treatment may be in line for you. Some women with close margins choose to have a mastectomy, rather than undergo one or possibly two more surgeries. Positive margins may indicate the presence of invasive breast cancer, and you may need to have a mastectomy in order to be sure that all cancer has been removed and to prevent a relapse.

Negative Margins and Treatment Decisions

If you've had a biopsy, your tumor is small (under 4cm), and your surgical margins are clear, then a lumpectomy may be all the breast surgery that you need (although, you may still elect for a mastectomy). If a lumpectomy is chosen, radiation therapy to the remaining breast is offered to prevent recurrent cancer.
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