DCIS with Microinvasion - Stage 0 or 1?

lisaemma

I have DCIS with 5-10 CELLS microinvasion....the medical oncologist referred to this as stage 0 and my breast surgeon referred to it as stage 1.  I'm confused.  I know it ultimately doesn't make a difference; I'm being treated at Dana Farber in Boston and have the utmost confidence in them, but I'm curious what you ladies think about the staging.

Beesie

The American Joint Committee on Cancer, and their European equivalent, both classify DCIS with a microinvasion as being Stage I.

Stage Information for Breast Cancer 

http://www.cancer.gov/cancertopics/pdq/treatment/breast/healthprofessional/page3 

See the chart near the bottom of the page. Within the TNM staging classification, the "T" (tumor) definition for Stage IA is  "T1" with a notation that "T1 includes T1mi".  T1mi is defined as being a "Tumor ≤1 mm in greatest dimension", i.e. a microinvasion.

LisaAlissa

Essentially, the "microinvasion" is more important for staging purposes than the much larger DCIS.  DCIS by itself is always Stage 0, because it's "preinvasive."  When you have any invasive component, then the staging will be at least Stage 1.

HTH,

LisaAlissa 

Beesie

Birdlady54,

As LisaAlissa said, with staging, any amount of invasive cancer, no matter how small, trumps any amount of DCIS, no matter how large. My case is the perfect example of that. I had over 7cm of DCIS and  1mm of IDC, and I'm Stage I.  So I had 70 times more DCIS than I had invasive cancer but it's that tiny microinvasion of IDC that determined my staging.  Without the 1mm microinvasion of IDC, I would be Stage 0.

cycle-path

To put it another way: no, DCIS cannot be stage one. DCIS is always stage 0. But sometimes somewhere within the DCIS their lurks a little bit of stage 1 IDC.

Let's say someone gave you an oatmeal cookie that had one chocolate chip in it. You wouldn't call it a chocolate chip cookie, you'd call it an oatmeal cookie because that one little chip was hardly worth mentioning.

The oatmeal cookie is the DCIS and the chocolate chip is the IDC. The one chocolate chip is there, but it's mostly just an oatmeal cookie. 

Beesie

cycle-path, I love the cookie example!  Can I add to it?

For most of the people who get an oatmeal cookie and find out that there is one chocolate chip in the cookie, it really doesn't matter.  They may not have wanted a chocolate chip cookie but one little chocolate chip in their oatmeal cookie is no big deal.  But the problem happens when the person who gets that oatmeal cookie with the one chocolate chip is allergic to chocolate - for that person, the presence of that one little chocolate chip might make all the difference in the world.

That's kind of how it is when there is a microinvasion in with DCIS.  In most cases it doesn't change a thing.  But in a few cases it makes a big difference, if some cells from that small amount of invasive cancer had already started to spread into the nodes or the vascular system. It's because of this risk from the microinvasion - a risk that doesn't exist with pure DCIS - that DCIS with microinvasion is classified as Stage I.    

lisaemma

Thank you for everyone, for clarifying!  I found the cookie analogy very helpful.

I just came from radiation and my weekly meeting with the doctor.  She congratulated me on being near completion and I (strangely) almost broke out in tears.  I have this niggling fear that I'm not being aggressive enough and completing  therapy opens the door to worry.  My tumor was ER/PR-, HER2+.   Being that I had a small DCIS tumor and 5-10 cells microinvasion the physicians feel Herecptin would be unnecessary.  I suppose that I should be happy...but I'm oddly worried....

Or perhaps it's just the realization that being done with therapy means it's time to move on, and this has been so all-consuming it's almost as if part of my identity needs to be changed.

I should add that my sister had breast cancer and passed away six years ago.  No genetic mutations on my part, just some very bad memories.

AnewBeginning

Lisa

So sorry to hear about your sister.  I too was originally dx with DCIS stage 0 until after lumpectomy and path report discovered micro-invasion.  My surgeon explained that put me into a different category.  IDC stage 1.  I was really devastated and still worry because my nodes were never biopsied.

hugs to ya!

Jansd1

I have DCIS ( approx 9mm ) with microinvasion , my Dr. said the microinvasion was really

small , anyway I had 2 lumpectomys which I was upset about because the surgeon took out approx . 6" from my breast , I dont even know if she got the cancer out , she insisted I had to do radiation . I have done 18 rad treatments & my breast has shrunk so much , plus my lungs hurt . It is really depressing , I still 13 more rad tx ( 6 are boosts) , I want to quit everyday . The Dr. denies that my breast is shrinking & says that doesn't happen during tx , also denies that my lungs are hurting . I think they are overtreating me . I read that by law they have to offer breast reconstruction if lumpectomy leaves you asymmetric . But my Dr. said that is just for mastectomys but I read it included lumpectomies . The only reason I am trying to comply with tx , is so I will be allowed breast reconstruction , but scared they will refuse to do reconstruction & my breast will shrink to nothing . I have HMO insurance so I know they might refuse reconstruction . Has anyone had their breast shrink during radiation or have reconstruction after radiation , plus I don't know if I should quit radiation , think they are overdoing it , it is just so depressing -oh - I am 44

Anonymous

Jan,

Whatever you decide,  make sure that you seek out a patient advocate or social worker or support group in your area.  I think that you are right to suspect that you are not being treated properly or your observations properly respected.

bluepearl

With such a small microinvasion, I would think rads would be enough. The lask of horminal receptors and her2 positivity are worrisome factors if it were a larger tumor. Vigillance is the key word now!

Lbwagner69

I recently had a reccurence of dcis and had a bmx with reconstruction. The pathology report found a small area (.5cm) of invasive cancer that is Her2+. I am recovering from the first surgery despjte my catching staff in the hospital and now have a wound vac and pic line antibiotics. Once this is cleared they will have to do a lymph node disection and start herceptin....wow...totally thought I was in the clear after my original dcis/lumpectomy/radiation! I guess the reccurence was a little "post it" note from God to go back in b/c you forgot something! Not sure if I am in the right message board...have any of you had herceptin?

Laurie

Beesie

Laurie, you posted a couple of weeks ago in a different thread in this forum.  I replied at the time and suggested that you look at a particular thread in the HER2+ forum where you'll find a lot of women who've had a similar diagnosis to yours.

Here's a link to your previous post and my response; they are the last two posts in the following thread:  final pathology shows microinvation please help

Lbwagner69

Bessie

Thank you and I am sorry for the comfusion and double post. I think I posted soon after finding out that I had invasive cancer..was a little out of it in the hospital...best wishes. I did post on the site you recommended.

Laurie

Beesie

Laurie, no problem!  I'm just glad that you've now found your way to that other discussion thread. Most of the articles and studies that I've read don't have good information about small invasive cancers that are HER2+ because they claim that this type of diagnosis is quite rare.  But when you're on that other discussion thread, you'll find that there are a lot of women on this board who've had this diagnosis!

Good luck with the lymph node surgery and the Herceptin. 

cher1

I too was diagnosed dcis w/microinvasion.  ER/PR+.  HER2 not tested for.  I was told that I was probably HER2+.  I also am not receiving Herceptin but I do worry.  Not that I want Herceptin but I don't want cancer to return.  My sister was diag  a month earlier than I.  She was IDC ER/PR/HER2 +.  Of course, she is being treated for HER2+.  Too many in our family have died from breast cancer and cancer in general so it's just all very worrisome if I'm getting  'enough treatment' or maybe I should have had more.  Just need to trust my docs, I guess.

Beesie

cheri, 

I replied to your post a couple of days ago about HER2+ testing and Herceptin for microinvasions: 

Topic: Micro-Invasion too small to test for ER/PR/HER2

Beesie

Bumping in response to a private message question.