Calling T1mic, T1a, T1b sisters

jadeblue

Doctors in my region seem confused about how to treat early stage 1 BC. Luckily I'm able to see a big city specialist for a case consult in June and I honestly have no idea what she'll say. Are you diagnosed as T1mic, T1a or T1b? If so...

How large was your area of invasive cancer?
What is your ER/PR and HER2 status?
Did you have oncotype testing or other profiling?
What was your treatment protocol?
How have you been doing since your DX?

I know I'm fortunate to have cancer caught at the early edge of invasion, but I find the lack of information and clear treatment protocol disconcerting. Until recently, it was unlikely we'd be diagnosed this early, so there's not a large body of evidence on the best way to proceed. What are you doctors telling you? What are the differences and similarities in our treatment plans? How do you find balance between over- and under-treating early invasive BC?

Thanks for your replies and the very best to all!
-Jade

pejkug3

The official pathology on my tumor was that the area of invasion was .5cm.  Actually, there was no invasive cancer to remove during my lumpectomy.  It was all removed during my core biopsy (8 samples taken at that time).  It was very, very small.

I'm ER+/PR+/HER2+++.

No oncotyping done.

I had a 3mm invasion into one of my nodes.  So, despite a very small tumor, I was still node positive.  And I was very, very blessed to find such a small cancer so early since it was already on the move.  I just had my 4th round of TCH.  I'll have 6 rounds in all and one year of Herceptin.  Additionally, I'll have 6 weeks of rads.

I answered your question because I was pN1a.  But still stage II.  I would balance my treatment options with all other factors considered.  If I were an older woman, I believe I would be less aggressive.  But younger women have more years to go through and (typically) stronger bodies to go through treatment without significantly damaging their quality of life. 

I'm 35 and have 4 kids at home.  I'd err on the side of caution and throw the book at it. 

Maja2213

My tumor was 4 mm, and weakly ER+ PR+, strongly HER2 positive.    I was sent to a "big city" specialist for a consultation and even she told me that it was very rare to have a Stage 1a HER 2 postitive combo because they aren't usually caught that early.  Mine was actually only caught because it was sitting like a cherry on top of a 1 cm DCIS.

My first oncologist ordered an Oncotype test at the same time as a FISH test for the HER2 only because it was getting to be the end of the year and I had met my insurance deductible for the year.  Normally, he would have waited til the FISH test came back because being HER2+ really throws off the Oncotype test.  

My ER+/PR+ was present in 70% and 50% of the cells but only at a low intensity.  Since  I was stongly HER2 also, the oncotype test came back as a 75!  

Being triple pos, I had a lumpectomy in Nov 2010; chemo of only Taxol for 12 weeks (explained to me as helping the Herceptin for the Her2 work better);  Herceptin started with the Taxol and now every 3 weeks til Jan 2011; 33 radiation treatments.

Each step was easier than feared.  I am only on rad 20/33 right now.

TifJ

My pathology states .7cm of DCIS and 1cm of IDC. I am triple negative stage 1b. I had 4 treatments of Taxotere and Cytoxin. Since I had a mastectomy and no nodes I didn't have rads. Chemo is almost always suggested if you are a true triple negative. I am almost 22 weeks past my last chemo and doing well. Mild nausea quite often, but i think it is just stress- always worrying if it is going to come back.

I wish you well!!

tea

I was orginally diagnosed with just DCIS, but a second opinion on the biopsy found 2 small areas (1.5mm each) of IDC.  No additional invasive cancer was found after the mastectomy and SNB.  HER2-, but ER/PR + so I am on Tamoxifen.  I had my surgery done at a major cancer center and also had a second opinion on the slides/protocol at another NCI rated center.  I didn't do the Oncotype test. 

jadeblue

Well, my second opinion visit with the big city breast cancer oncologist confirmed that mine is a true microinvasion. She said they found only a few cells (one small cluster and a couple invading singly) of invasive cancer -- less than 1/10 of a MILLIMETER total -- and she doesn't recommend chemo or other adjuvant therapy for a microinvasion that small. Wasn't sure what to expect because of the ER-/PR- status, but she said that it doesn't matter much at that early stage and my prognosis is roughly equal to someone with pure DCIS.

rgiuff

I had a lumpectomy with SNB, followed by radiation.  Oncotype score was 14, so no chemo, and I've been on tamoxifen for 2.5 years.  Oncologist wants me to take AIs next, but blood tests show I'm not postmenopausal enough to take these, which is just fine with me.

Busybee

I was diagnosed Feb. '09 with <1mm microinvasive IDC & 5mm DCIS and LCIS. I had a lumpectomy followed by mastectomy because the margins were not clear.  My microinvasive cancer was T1mic, Stage 1, Grade 2, 0/3 nodes, ER+/PR+, HER -,.  I didn't have radiation or chemo. 

MarieKelly

I was diagnosed in February 2004 at age 49 and in menopause. Single tumor about 1 cm and a mixture of DCIS 40%and IDC 60% - both components grade 1 with low (5%) Ki-67, node negative and ER/PR positive. Had biopsy track removed and wide margin lumpectomy  Did not have any oncotyping done - wasn't available at the time and wouldn't have needed it done anyway since no chemo was necessary and none was offered. Refused tamoxifen, aromatase inhibitors and radiation. No recurrence and no new tumors thus far.

Sugar77

Hi, I was diagnosed in Oct. 2009. My invasive cancer was 3.5mm (T1a) in with some DCIS (don't know the exact size). My invasive tumour was triple negative so I did four rounds of Taxotere/Cytoxan and then did rads because I had a lumpectomy. I'm doing well and trying to live each day to the fullest and hope it never returns.

dancetrancer

Hi, just found this old thread and thought I'd pull it up.  I was just recently diagnosed as T1a, 3 mm IDC.  I don't know the grade yet, waiting to see my path.  I initially had my BMX in 9/2011 and was told it was DCIS only but just now after another opinion they found the small invasive component.

Tamoxifen recommended - nothing else yet.  Have asked onc if need HER2-neu testing and/or oncotypeDX and waiting for response.   

jadeblue

Good luck, dancetrancer. I haven't logged on in a while, but happened to see your post from last week. I hope you've gotten your pathology report and the way forward is now clear. I think the waiting/not knowing is just the worst! Whatever treatment you need for T1a, you'll definitely find good support on these boards. All the best, Jade

dancetrancer

Thanks jadeblue.  I just found out today that it is Grade 2.  They are running the Her2 test still on it.  I'm not sure how long that takes.  You are right - as always, the waiting is the worst!   I was told it is too small to run an oncotypeDX on it. 

jaggirl61

anyone out there that had T1cmic and chose a second lumpectomy over mx or bmx? I had one margin that was not clear after lumpectomy and also found 1.1mic in one of two  nodes taken.Confused regarding mic and response to that vs. totally positive node. Must go back for additional removal of tissue or MX/BMX. waiting for oncotypedx test results. 

cc4npg

I was dx in 2010 with triple neg, 3 mm idc.  My FISH test seemed to take 4ever, but it came back negative for HER2.  I was 43 at dx, so they did genetic testing.  Although no real family hx, I am brca2+.  I went from considering lumpectomy/single mx, to needing bilat mx.  Like Sugar, I had 4 rounds of Cytoxin and Taxotere and hope it never returns.  I also had bilat ooph (just ovaries) and am in instant menopause (not fun).  Chemo is often recommended for tiny idc, but yours is microinvasive so it's poss no chemo.  I personally am glad I hit mine with all I had because I have a 4 yr old who needs me. 

SewStrong

Hi cc4npg, I, too had a small triple negative IDC and have chosen to do chemo, although the onc said I didn't have to.  My tumor after surgery was 6mm. I feared that since it was invasive, it might have gotten into my blood, which three oncologists agreed with. I will start chemo next week, then radiation. Not looking forward to it, but would worry myself crazy if I chose not to do chemo. I will only have two chemicals, and I have forgotten what they told me the names were. I haved ordered a wig and I'm ready to get this done. Sharon

JaneB1

I had mx for DCIS (lumpectomy not an option due to multi-centric DCIS in more than one quadrant). I chose a bilateral mx as I couldn't bear the though of going through it all again.



Final pathology showed a 3mm tumor and numerous microinvasions, none of which showed up in the biopsies or MRI. This changed my stage to 1a. Cancer also turned out to be triple negative.



I was treated at a well known comprehensive cancer center. I was offered CMF chemo given the triple negative aspect as well as the multiple microinvasions. Nonetheless, my MO felt I didn't need chemo and shouldn't do it. A second opinion MO (whom I know to be generally very aggressive on adjuvant therapy) said don't do it -- not enough benefit from the chemo and too much risk of long term chemo brain. Finally, I saw a European MO considered to be one of the world's best breast cancer MO's. He said I could do CMF but that I didn't need it. No MO offered the taxanes which I understand to be most effective for triple negatives but carry more chance of long term side effects.



Dh did not want me to do chemo unless one of the doctors said I needed to. None did. So I did not do chemo. Instead, I concentrated on eating healthily, exercising and meditation (basically the Anti-Cancer approach).



The decision on chemo was agonizing for me. I agree it is hard for us Stage 1's to know what is the best approach. given the lack of research and studies. My BMI is now in the normal range. I am still following the advice in the book, Anti- Cancer, and am cautiously optimistic.

cassiecanada

Hey Marie-

its years i see since you posted and hope

you are well! in the off chance you

see this, given the time gap, i reach

out because you and i have same stats

and i agonize over my upcoming rad/femara

choices. Pls tell me how you feel now

about your choices .... you are a strong

woman