Possible micro-invasion

Emaline

What does this mean for someone with DCIS?  Does this mean it is invading the other area?  I had to see my original doctor again today (to drain my hematoma), and she said she read the pathology that my new doctor did and said that they had not ruled out microinvasion?

I'm struggling to find any information on this.  If I have it, does that mean I will need chemo?

AnewBeginning

Emaline

I was dx DCIS stage 0, had lumpectomy and Radio Frequency Ablation, then pathology report said I had small nest of microinvasion.  Saw Oncologist and was told I did not need any chemo.  I was happy to hear that but of course I am still a bit worried but Im trusting the docs.  Now Im told I have DCIS with microinvasion stage 1.  Hope this helps but of course your Onco will know best. 

hugs to ya!

AJ

Emaline

AJ thank you for the response I've returned to the freaking out portion of our program here.  My doctor is not sending me to an oncologist until after the MX which is being done sometime in early May (waiting on BS and PS to coordinate).  I know I am having a SNB done but now I have this to worry about on top of that. I thought once I decided on the MX it was all done. I guess I was hoping that if I had anything else, it would show up on the MRI.  I guess not.  Gah!

shannonW

Well if it's any help, from my biopsy the breast cancer radiologist that did it and delivered the cancer news for sure the next day(2/9/11) said there was a possibility of microvasion(and  I sort of freaked out when I heard microinvasion as well!)) and stressed that the surgeon should do the SNB when he did my BMX surgery. Surgery was done~BMX and SNB 2/25/11. The final pathology report said "no invasive cancer seen." So if u can, wait to freak out until after ur surgery and they get that final patho.:) They really don't know the whole pic til they get in there during surgery. Now, with that said I had my surgery on 2/25 and did not see the onco for the first and only time on 3/8. Almost 2 weeks lapsed.  I'd recommend that IF your onco appt is a couple weeks out from ur surgery, for peace of mind call the breast surgeon and ask for copies of your final surgical and pathology reports before u see the onco. They should give those to you b4 no problem(either will mail or u shld b able to pick up at office) and you can read them and be prepared for questions when you actually see the onco. Hope this helps!

Emaline

Shannon, did your doctor call you and discuss the final pathology?  Or is that left up to the oncologist?  I know they are doing a SNB and if anything comes back positive, they want to take all the nodes under my breast and count if anything comes back positive. I am not sure how I feel about that.  I have heard good and bad.

Oops meant to add: Thank you all for your support. It means the world to me right now. I am so ready to move beyond this.

shannonW

The onco discussed the final patho with me on 3/8. To be honest I had full confidence in my surgeon BUT I work with many doctors secularly and many a surgeon have less user-friendly personalities. I'm not saying all, but I'd much rather discuss my final patho with a compassionate onco. Mine was. But your surgeon shld send you the reports. Just call a few days after ur surgery and ask for his nurse and request them mail u the final reports both surgery and pathos when they are ready. That way u can pour over them b4 u see the onco. I think this is very standard practice. Also as far as the SNB, historically they used to not even removed any nodes with DCIS. My radiologist told me to request that the surgeon do it b/c he suspected micro-invasion from the biopsy. Please remember that micro means small. So...from what I gathered they test the nodes during surgery with a dye and if it appears ok then they only remove 2-3 to completely test. I had 2 removed. If that dye test during sx shows cancer then they remove more. I'v generally not seen them remove more than 2-3 with pure DCIS. EVERY CASE is different and my knowledge is limited as I'm only 2.5 months into this. I initially had some right arm soreness and a pulling feeling when I extended my arm but this has greatly lessened to almost subsided and with only a couple nodes removed usually lymphedema is a non-issue. I'm glad I can tell u these things b/c really it makes me feel better to ease someone else's anxiety. I was where u r 2.5 months ago. This is all very scary, but do-able. You will be passing on your knowledge and experience with  a newbie DCIS sister in a couple months! I promise. There is the thread of DCIS with micro-invasion on here too. I've not been on it but u will surely find some additional advice and insight there. I'd just say don't worry about what you don't know for sure so wait for ur final pathology!

shannonW

Also I've not really read where anyone gets chemo for DCIS. From what I"ve seen it's lumpectomy, lumpectomy+radiation,  uni-mast and sometimes tamoxifen or bilateral mastecomies and no need for futher treatment(that was me). As long as the margins are clear that is. Now if they get in there and find something else, another type of cancer, that's another story. The thing is they only do chemo for certain cancers and b/c chemo has a whole hosts of side effects. At first I was like "Maybe they need to do a little radiation or give me tamo for just in case" But it doesn't work like that and good thing b/c likely many would get exposure and meds that wouldn't make their outcome any different.

Emaline

Shannon thank you so much. You have really eased my mind.  I don't think saying I'm still not freaked out, I am but a lot less. I am not heading south on the crazy train anymore. I will take a look and see if I can find that other micro-invasion thread.

Thank you all so much.  I don't think I could do this without you guys.

xtine

Generally a micro-invasion doesn't change your treatment at all. It means you have a slight chance of the cancer metastasizing, but that chance is so small that it's not worth the risk of extra treatment.

A micro-invasion is under 1 mm. It's possible they'll find a larger invasion (mine was 3 mm). If it's as large as 5 mm they might start thinking about chemo. If so, they can give you an oncotype test to see if it would be valuable. Also, if the pathology says HER2 positive for any invasion, you might want to talk to a doctor about herceptin and/or chemo.

jadeblue

I had grade 3 DCIS, ER-/PR- with mild comedonecrosis and was told I had approximately a 15-20% chance of microinvasion. Your odds of having it are probably less than that since your DCIS is grade 2.

So, did I have microinvasion? Turns out one hospital I consulted saw it in the biopsy and the other did not. I'm now going for a tie-breaking (I hope!) third opinion.

Seems "true" microinvasion is rare and often misdiagnosed in either direction (seeing it when it isn't there or under-diagnosing it when it is). Be careful and don't be afraid to seek other opinions if necessary.

Especially since mine is ER-/PR- (not a candidate for Tamoxifen), I really want them to get this diagnosis right, even if it means chemo. If the invasion is truly "micro" (less than 1 mm IDC), I'm told I'm unlikely to have chemo even though it's an "unfavorable" kind. There are other women on the board who say they did do chemo for microinvasion, so it really depends on the type, the aggressiveness of the doctor, and the choice of the patient.

Good luck! Keep us posted.
-Jade

Emaline

Thank you Jade and Xtine, I have to keep reminding myself that the DCIS is teeny tiny and micro-invasion, is just that, micro.   My old surgeon just threw me into a tail spin here. My new BS never mentioned it at all.  Said that his pathology team agreed with the old one (which my old surgeon tells me that means they were not able to rule it out either...). I guess I don't understand...do they think it might be elsewhere just not showing up in tissue that they sampled? It was no small sample. It was 7cm.   Obviously my boobs are bigger then that, so there is more tissue to sample, but wouldn't that be kind of the case for anyone?   This whole thing is making my head spin more then it should.

I had a breast MRI, does micro-invasion show up MRI's? 

I realize that anything is possible between now and when my final pathology report comes in.  But oh boy boy boy...they don't make this easy!

bdavis

No test, including MRI is perfect... but its probably the best of the big three...

I wanted to comment on the nodes.. I am not sure what the standard is for DCIS, but if they do a SNB, they usually take one node... and if its positive, they would take more (while you are on the table already open), but with DCIS, if it hasn't left the duct, then it hasn't left the duct... If it had a microinvasion, then I guess it could have gone to the node, but one node initially should be ample to sample... making rhymes here....

I had microscopic NODE involvement and they still didn't take more nodes... So, I wouldn't be concerned about taking many nodes with DCIS...

xtine

An MRI probably couldn't detect a microinvasion. You need the final pathology for that.

Regarding the nodes. The sentinel node biopsy might take 1-4 nodes, as multiple nodes might "light up" from the dye, making it hard to isolate just one node. In my case I got 4 out, and none were positive. If any is positive, which is possible with a micro-invasion (though unlikely), the standard has been to take out more nodes. However, very recent studies indicate that probably for early stage cancer you shouldn't take more nodes, as the resulting treatment (you would probably get chemo and radiation if any nodes were positive) would be the same regardless of # of nodes and take care of any spread. So before you sign off on taking more nodes if one is positive, ask your doctor about these studies.

bdavis

xtine... that's what happened with me... I had a stage i tumor and one micromet node, so the newer studies say to leave the rest and blast with chemo... the odds are very low any more are positive in my case and the side effects of LE are more of a risk than positive nodes... its kind of a crap shoot but with the chemo and the studies, I have to trust it

agada

Is a microinvation the same thing as nanoinvasion?  If not, what is the difference between the two?

Agada