isolated tumor cells - node positive or negative?

capippy

Hi everyone. Would anyone have any light to share on finding of 'isolated tumour cells' in lymph nodes? Here's my situation - had lumpectomy on July 2nd for adh cells, pathology showed two small tumors (mucinous features, under 5mm each) as well as dcis and lcis cells. Had re-exicision to get clear margins on Aug 7th along with SNB.

Finally got results this morning. No further cancer found in sample (yea!) but surgeon said they found isolated cancer cells in lymph nodes, but that wouldn't affect outcome. I asked for a copy of my path report on the way out, and it said 'six sentinel lymph nodes identified, four with isolated tumour cells'. 4!!! I'm very confused - what stage would this put me at?My biggest tumour is <1cm, it is grade 2, but how can the nodes be negative when 4/6 have cancer cells? Doesn't that mean cancer is not possibly moving through my lymphatic system?

Unfortunately I now need to wait two+ more weeks to meet with the oncology team to decide on treatment. Waiting since July 24th (when first discovered it as cancer, not adh) to now has been quite un-nerving. To now wait another two weeks knowing that I have cancer in my nodes…too much. Can anyone shed some light so I know what I'm facing? Am I still stage 1 even tho there are cancer cells in 4/6 nodes? Do I consider myself node positive or negative? WillI now be asked to do chemo in addition to (I assume) radiation and tamoxifen?

If anyone can give advice I'd appreciate it. Or even just a virtual hug.

CA

Stacy7

I had isolated tumor cells in one node and doctor said they are gone now after surgery and considered node negative (all my opinions i requested said the same thing) however tamoxifen takes care of the rest if any stray cells ... Wait and see what your onc says but with all the research ive done i personally dont worry any more of the itc's. Take care and good luck:))

momand2kids

Hi

I had itc as well in my sentinel node. My surgeon and oncologist said that did not change my node negative status (there was nothing else). I am sure your doc will have an explanation that makes sense. I think I recall the surgeon saying that it could even be from the biopsy---- I don't think you need to worry about them--does not generally change the treatment options.

good luck

Stacy7

oh yes that as well.. My surgeon also said it could be from biopsy

SpecialK

Sorry you find yourself in this unusual position and that you have to do some more waiting There are a number of ways to consider ITC in the sentinel node(s). It may be viewed as the nodes doing their job and catching those cells so that they didn't get further, or that they are artifact cells dislodged by the biopsy. ITC are often regarded as clinically "node negative", but not always. These would be viewpoints to discuss with your oncologist. I had 20 ITC in my single sentinel node at the time of BMX. It was already known that I was triple positive, strongly Her2+, with a 2.6cm mass at the time of surgery. My sentinel was declared clear in the OR but the ITC were found later in the lab at the more thorough exam of the tissue. Both my MO and BS were adamant about ALND surgery, mostly due to the Her2+ aspect of the cancer. My BS was one of the pioneers of SNB, so he is not a reactionary that routinely removes all axillary nodes - but he was insistent that levels 1 & 2 come out. I had that surgery five weeks later and a much larger positive node was found. It did not change my treatment plan - I would have had chemo and Herceptin anyway, but I did not have rads due to the axillary clearance surgery. Since you have had the nodes surgically removed and would have rads anyway due to the lumpectomy, that may be all that you need. Hormonal therapy also offers you systemic treatment going forward. I think your staging situation is muddy - stage 1a has no lymph node involvement, and 1b has lymph node involvement limited to micromets. Since you have ITC and not micromets you don't really meet the stage 1b criteria, but your MO may regard you as such for treatment purposes. Wishing you the best.

capippy

Thank you so much, Stacy7, momand2kids and Specialk - this is incredibly reassuring and helpful. Truly - I was feeling quite defeated but your experiences are very positive and hopeful.

SpecialK - it also makes me quite happy to see that I could be stage 1. I was thinking much more advanced since it was in the modes… this is all so muddy to navigate. I wish I could see the onc team tomorrow and be put out of my mysery.

Thanks so much, CA

Stacy7

please keep posted on this thread about what ur onc says especially for itc .. I would like to know

Stacy7

special k im wondering why they didnt insist on removing more of mine too..Mine were also 20 itcs on pathology ... MO BS and RO all agree that its fine and tamox will take care of it IF there is mor

SpecialK

Stacy - the decision to do the ALND was tied directly to my being strongly Her2+ and the aggressive nature of that pathology. You always have to weigh the problems that can ensue from ALND versus the danger of additional potentially cancerous nodes remaining. This is definitely a situation where trust in your team is so important. I was very reluctant to do the ALND but it was the right decision in my case

Stacy7

thanks for your reply glad you made the right decision .. Im confident that ill be fine too xox

SummerAngel

I had ITCs in one node and this did not change my diagnosis at all, ITCs are considered node negative. I didn't receive chemo, didn't need it with grade 1 tumors and low Oncotype score.