lymphovascular invasion question

nrb3

I'm sure this has been asked before, but I can't find it on the board.  Are all positive node 1 results accompanied by lymphovascular invasion?  Would the two together add anything to the prognosis? Does the Oncotype account for LVI with a positive sentinel node?

AEM47

Nrb3 - I had a lot of LVI but SNB was negative. The Oncotype does not take into account LVI. it does take hormone therapy into account . What did your score come out at?

nrb3

I don't have the Oncotype score yet.  I'll have it in a few days.  Was your chemo decision based on the score or the LVI?  I'm wondering if it  really makes a difference in prognosis to have a positive sentinel node with lymphovascular invasion over  just a positive sentinel node alone (if it's possible to have it without LVI).

Outfield

nrb3, I can't imagine how it would be physically possible to have a positive node without lymphovascular invasion somewhere in the tumour.  But pathologists don't examine the whole tumor under the microscope.  Tumours aren't necessarily the same throughout - different parts of a tumour may have slightly different characteristics because they are accumulating different mutations along the way.  So it could be possible to have a positive node without lymphovascular invasion noted on the pathology of the tumor.

Lymphovascular invasion is, in blanket terms, prognostic factor because it's a visual of the behavior of the tumor.  What it means is that the particular part of the tumor on the slide has gained the ability to enter the lymphatics and vasculature, and thus possibly send out cells to other places (like nodes).  But you already knew your tumour could do this because of the positive node.    

Timbuktu

I discussed this with a friend who is a pathologist.  He said once it's in the node, it really doesn't matter if they can "see" the lymphovascular invasion, it has to be there.  The hospital in which I had the surgery saw neither invasion nor cells in the node.  The second opinion saw both.  That was the difference between needing chemo or not, at least to the second opinion.  Others still said hormonal treatment would be enough.

AEM47

Nrb -my decision...since the oncotype came in at the "you make your own decision" score was based solely on the LVI - the way it was put to me was that microscopically it may or may not have entered my system..most likely it had. If it had...it may be gone..or not. If it entered and is not gone if I did chemo it was the best chance at never seeing any spread. Not an easy decision..but the MO called it somewhat of an insurance plan. According to her it was on the move. Sometimes I have second thoughts about the decision..but overall, I think I have more piece of mind having done everything.

mdg

I had clear nodes but LVI in my tumor.  Oncotype was 17.  The rest of my stats below.  I had one MO say chemo would not benefit me.  The other said she thought it would benefit me.  I had to decide because I was in such a gray area with LVI and grade 2 tumor.  I opted for chemo and did cold caps to keep my hair.  I got through chemo OK.  I was 45 at DX with a 4 year old child so I wanted to be aggressive with treatment. 

bdavis

I had one microscopic node and no LVI... I did not have the oncotype because my MO said the positive node was getting me chemo. I had 6tx of TC and had few issues. I did not use the cold caps because my MO said he wanted to protect me from getting scalp mets.

michellej1980

I had clear sentinel nodes but 'very extensive vascular invasion', a phrase which is still terrifying me. I think that cells must have escaped my breast and I am so worried about developing distant mets. I'm only 32 and just find it hard to believe that I can live another 40-50 years without the sneaky beast showing up somewhere else in my body.

AEM47

Michelle - I believe that was the exact same quote that I got..extensive! They were a little amazed that the tumor was so small and there was so much LVI and then the clear node. I have the same thoughts that you have on something showing up. It looks like we both did all we could so I'm hoping with time we can relax a bit :-)

bdavis

My understanding is that cancer can spread thru the lymph system or thru the blood, or both. I wouldn't get too worried about "extensive" as that's what the chemo is for. Michelle, are you on Tamoxifen? It can help with avoiding a systemic recurrance  regardless of the fact that you have had a BMX. Or I am guessing you are still in chemo??

Katarina

Nrb3 - you might want to use the search button on the left side. There has been a lot of discussion of LVI on the boards over the years and easier to find with the search tool.

LVI invasion is not included in cancer staging but needs to be. IMHO.

Hugs,

Kat

michellej1980

Andrea - it is on my mind all the time but my onc didn't seem to be that concerned! She said it isn't an "independent prognostic factor" but with a 4.5cm tumour and my age I can't help but worry.



Betsy - Yes, I am still in chemo. Having 6 x TC with #3 on Friday. Not sure yet whether I will be having tamoxifen or an AI as we haven't determined my ovarian function. I haven't had periods, apart from one or two random ones, for over 10 years but given my age they wanted to do a blood test to check and I forgot to ask at my last appt what the results were. I worry that the tamoxifen isn't for life and that I could recur after I stop it.

bdavis

Recent studies say that Tamoxifen taken for 10 years increases one's benefit of no recurrance. Of course, 10 years of T means more increased risk of uterine cancer and blood clots. But my MO says the risk is very low. I take a daily asprin to help prevent blood clots.

maryah930

I have searched this site and the internet and cannot find what "LVI: focally present" means.  It's noted in my path report, but I forgot.  I can wait until my next appt, but now it's driving me nuts.