isolated tumor cell

Chocolaterocks

I went to a 2nd onco for an opinion with stage 1, grade 1, onco 1, and a bilateral masect. My first said try  it. I was  hoping to put this chapter behind me. Instead, I saw an onco who basically told me that because I am pno+/- that I need to tammy for 5 years.  So I thought I would add this in- he basically dismissed the theory that the cancer cell in the lymph node was from the excisional biopsy or that they are insignificant. A study presented in San Antonio supported the displaced cells.  I really felt bad and disappointed- that he did not so today I took half of a tammy out of fear......side effects so quickly....

Again, anyone have any opinions on this and seen people with impressions regarding itc

thanks

chocolate

bdavis

Are isolated cells the same as micromets?? I have read they basically are... And if so, I have been told that they are positive but have the same survival rate as a stage 1...

Chocolaterocks

Hi Bdavis

My understanding is that they are smaller than micromets. Also what is the survival rate of stage 1? thanks

chocolate

bdavis

Survival rate for stage 1 cancer is very high.. i don't know the exact number tho... My micromet was .38mm...  Had it been .18mm smaller I was told I would be considered node negative... A micromet is sized between .2mm and 2mm and then MACRomets are larger than 2mm

Chocolaterocks

I wish I understood this but I was told that I had less than 200 cells all together which fit the definition of pno +/- which is the 1st category after 0.  My path reported did not have a size.

so Bdavis does that mean you  were considered node positive and you did chemo and hopefully are doing well.  Are you on tammy now? thanks for answering.

bdavis

I am considered node positive, and I am in chemo, and I am physically doing ok... mentally I am a worrier. I will be on tammy later. I am supposed to have rads but think I will opt for BMX instead, so that would be July... and then I am unsure when I start hormone therapy... and will probably also have oofrec in the fall.

I think isolated cells are a cluster while micromets are not... so you may have 200 cells in your cluster... but not sure how that compares to micromet size...

bdavis

Pulled this off the web:

micrometastases (>0.2 mm and 2.0 mm) and ITCs (<0.2 mm in the greatest dimension)

So if that's true, then ITC are considered negative

Chocolaterocks

Hi BD- the onco scared the hell out of me and basically put my life expectancy at 70% with out tammy, and 15 to 20  increase with tammy.... he was estimating having about 30 years left...

thanks

chocolate

barbe1958

ITCs are wandering cancer cells throughout your entire body. You can have so many "grouped" together without it necessarily being considered cancer. I guess that's where the 200 came from.

Micro/macro mets are cells in nodes. Chocolate, what makes you 1b?

Racy

Ladies

I don't know if this helps with understanding the definition of isolated tumour cells but I had isolated tumour cells described as follows in my path report: 'sentinel lymph nodes 1 and 2 both contain sparse, dispersed single carcinoma cells within the lymph  node subcapsular sinuses. These isolated tumour cells have been identifed with immu nohistochemical staining...'  I understand that from a staging point of view this is considered as node negative but my 3 doctors all referred to them as a reason for recommending chemo, as a precaution.  

Chocolate, you may find this link helpful -   www.lifemath.net/cancer/breastcancer/therapy/index.php

(sorry I coudn't paste it as a hyperlink). 

Happy Easter to all. 

barbe1958

On my path report the lymph nodes had micromets and the ITCs were in breast tissue, found as it was biopsied. Maybe they are interchangeable...?

bdavis

From what I have read, an dI think in chocolate's case because this is in reference to the nodes, ITCs and micromets are small trace amounts of cancer that can't be ignored but are also not as bad as full fledged positive nodes... my micromet is what got me 6tx of chemo instead of 4, but they aren't so bad they they needed to go back and do a full dissection... ITCs are smaller than micromets from what I also read and are clusters rather than a mass, if you call my .37mm a mass.

My take from what I've read.

Chocolaterocks

I was told that I was 1b-

nuclear plemo score 1

tubule form               3

mitotic count            1

Grade I

ptT1a

(I did not find 1b in my reports?)

this was the final report

I did cancer math and I come out great.

Have a great Sunday and Happy Easter to all who celebrate.

thanks

I really love chocolate

sent lymph node   150 cells in 2 blocks- clusters and single units

sent lymph node  25 cell in 2 blocks in small nests  in subcapsular sinus

jessica749

There's a great, thorough discussion of what is micromet vs itc at the beginning page 1 of these emails...

One thing I must say though is that my onc says that  ITC is node negative, and does not change your prognosis (as far as studies to date indicate)= same prognosis as node neg/no ITC patients.  So that's it for today. And therefore, yes, it can be and is ignored. You are not treated any differently from a node neg patient.  Wonder what is the source of what anyone has read that indicates differently...even Eric Winer in Q and A on this website says it is treated and considered  node negative, and won't be changing anytime soon....

I'm doing CMF cause I feel better doing it, but not nec because my onc thinks it's a great idea. For my individual case, the chemo cannot get any stronger, says MSKCC.

Also, B Davis I applaud your decision to do the bmx instead even though you've already been through the surgery once.  I had a small cancer but an elevated risk and one thing no medical person 'encouraged' me to do, but I am so glad I did do, is the pbmx. Good luck with the surgery and everything. It's kind of a big deal, but really was not at all to me considering the alternatives....

jessica749

re stage 1 survival: I would love to know real stats, but it's hard to find this and my onc kind of doesn't like to get into quotiing them, because frankly there are so many variables I think? I don't know. He's not that into it and maybe I'm not either...my question last time to him was: what kind of survival stats are we talking about? Whenever you hear stats, for survival, you need to know (and maybe you are all aware of this already!) How many years out are they actually referring to? So many stats refer to 5 yrs out. Sure, stage 1 has GREAT stats 5 yrs out, but we all hope for ALOT more than 5 more years...that's where I worry more...recurrence can occur (from what I've read ) at any point past 5 yrs frankly. This is the very scary thing re bc. It can occur 12 yrs later. 15. (though less likely). I learned from my onc, who knows this stuff quite well, that it is only after 20 years that your 'risk' resumes the risk of normal people. (I was asking when was it safe? how many years later can i be rid of the fear of recurrence?). So that was the best answer: you resume the risk of the 'average' person after TWENTY years. I'm sorrry if that's info you didn't want, but I'm interested in the stats adnd would like real ones-ones that have context.  ie. if they are survival stats, how long out are they?

Chocolaterocks

KSD- excellent posts. I believe that my 2nd onco believes in what you are saying that the risk is not now but it is later on 10 -15 years from now which is why the push for tamo. I have gone on cancer math and it did not reflect this, also the nccn guidelines for 2011 reflect adj therapy as to be determined by onco- so obviously there is not one opinion.

I have come to believe node neg with isolated tumor cells is the grey area. Your feedback was very much appreciated.

Chocolate

Timbuktu

why must you do cmf?  this is the first mention I've seen of cmf and i'm going to sloan monday tohave it myself.  IT's supposed to be milder than the others.  I hope as effective.

Chocolaterocks

I am not sure what you are referring to Timbuktu - i would need more information. However, I thought it was fasciniating that when I saw my surgeon this month he told me that they stopped the IHC staining looking for ITC since ITC are node negative and that studies have shown they are node negative. He felt that all this does is upset the patient. Wish that had been my experience but I will take it now.

Just thought I would throw this in to the discussion that comes up for a few of us.

regards.

barbe1958

I don't get it. Why do they say ITC are node negative? My ITCs were found in the breast tissue after my BMX, not in the nodes. I had micromets in my nodes. Those are considered node negative, but ITCs are in the tissue, not the nodes.

Chocolaterocks

Barbe

mine ITC's were in the nodes not in the breast tissue-  I also had two biopsies which may (hopefully) of been the explanation.

take care

CR

barbe1958

Hmm, in the nodes, aren't they called micromets? That's what they called mine. And the ones in my breast tissue were called ITCs.

What would two biopsies do?

Chocolaterocks

Barbe

the 1st one was done incorrectly and missed the calcifications - the doctor tried for an 1.5 hours with me in that weird posiition and I ended up with stitches.  The 2nd was an excisional biopsy......

The itc's were discovered after the bilateral masectomy when nodes were taken.

hope that makes some sense.

take care

bdavis

ITC is smaller than micromets... both can be in nodes and I assume breast tissue as well... ITC is considered like node negative, but micromets are not... but can be treated like node negative... I had a .38mm micromet, considered node positive, but treated as if I were node negative, but more aggressively... had 6tx rather than 4 tx of TC.

Kd6blk

My ONC said that one node with ITC was node negative but two or more nodes left me in a questionable place. I am taking anti-estrogen meds now. I still would like to understand what they mean if I had DCIS, with is enclosed cancer, why did I have ITC? I had a bmx, so they did not find other cancer...so I find this all very confusing and I am not stupid...I wish everyone was on the same page.

Kd6blk

My ITC were four clusters less than .2mm found in TWO nodes...