Lymph vascular invasion?

michela802

hi i am new here i had a lumpectomy and sentinel nodebiopsy on 12/29 i had path reportread to me and was told 1/3 nodes were positive. There was evidence of some lymph vascular invasion. Er/pr + her2- stage II. Tumor was 2.6cm.

I met with my surgeon who said we need to do an axillary node dissection.

The MO said I would need chemo based on my age 41and having the 1 nide and lymph vascular invasion. She suggested AC 4x and Taxol 12x.

I am scared. Wondering if I should get a second opinion? The MO said the oncotype wouldnt really help as it doesnt take into account my age.

Anyone else with a similar situation? Thanks in advance

fd1

I had a similar diagnosis and AC x 4 with 12 x taxol is pretty much standard care. Your diagnosis seems pretty "boring" as my onc would say - that's a good thing. I'm not sure how your health care system works in the US but if it's going to cost a lot to get a second opinion I personally wouldn't. Best of luck!

bravepoint

I had a similar diagnosis as well last September. I'm finished AC and have done 5 of 12 weekly Taxol treatments.

Good luck!

Jenwith4kids

I'm sorry you are scared! I was too; we all were. Mostly is was the unknown before each step in the process that tripped me up. I think with your stats that you'll find that the second opinion will be very similar to the first. But - you might feel differently at another doc office - consider it a job interview where you are the interviewer - you are picking a doctor that you'll likely have a long term relationship with.

Good luck!

Lisey

Both Oncotype and Mammaprint are effective indicators of the aggressiveness of the tumor - no matter your age. I'm 41 as well and got both tests done. Studies such as TailorX and the MindAct trials have shown these tests to be be prognostic and well validated.

I would get a second opinion on testing. With only 1 node affected, both tests are available to you and will give you more details about your specific genetics in the tumor.

http://www.agendia.com/new-england-journal-of-medicine-publishes-mindact-trial-results/

https://www.cancer.gov/types/breast/research/tailorx-low-risk

KathyL624

I got oncotype testing at 38

stephilosphy00

I was dx last Nov. Now I am more than half way through neoajuvant chemo. In my path report, it says "LVI identified". I am actually not too worried about it somehow.

BarredOwl

Hi Michela802:

If you were "clinically node-negative", and the lymph node involvement was first detected by sentinel node biopsy ("SNB"), then I would recommend that you seek a second opinion regarding the recommendation you received for completion axillary lymph node dissection. Such a procedure carries a significantly greater risk of lymphedema than SNB.

In this regard, National Comprehensive Cancer Network (NCCN) guidelines for breast cancer (Version 2.2016) indicate that for Clinical Stage I, IIA, IIB and lllA T3, N1, M0 disease, in patients who are "Clinically node negative at time of diagnosis" and who are found to be node-positive on sentinel node biopsy, that if all of the following criteria are met, then "No further axillary surgery" is indicated.

Meets ALL of the following criteria:

- T1 or T2 tumor, where

"T1" Tumor ≤ 20 mm in greatest dimension

"T2" Tumor > 20 mm but ≤ 50 mm in greatest dimension

- 1 or 2 positive sentinel lymph nodes

- Breast-conserving therapy ("lumpectomy")

- Whole-breast RT planned

- No preoperative chemotherapy

See NCCN Guidelines for Breast Cancer (Version 2.2016), Chart BINV-D (pdf page 39), which are available with free registration here:

NCCN Guidelines for Breast Cancer: https://www.nccn.org/store/login/login.aspx?ReturnURL=https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf

A 2.6 cm tumor (assuming that is based on surgical pathology) is "T2" in size. With a T2-size tumor, 1 positive node, a lumpectomy, and no "neoadjuvant chemotherapy" (given prior to surgery), then if you will also be receiving whole-breast radiation therapy, it appears that you may meet these basic criteria in which further axillary surgery is not typically required under NCCN guidelines.

Clinical consensus guidelines speak to the typical case, and there may be appropriate exceptions when in the clinical judgment of the physician, axillary surgery might be recommended. You may wish to inquire with your current surgeon on what basis axillary surgery is being recommended to you, since you appear to meet NCCN criteria for avoiding it. Then, in a second opinion, you can probe this view by specifically asking about whether those factor(s) support axillary dissection in your case or not.

For a second opinion at an independent institution, look for a comprehensive breast center and a "breast surgeon" who focuses on the treatment of breast cancer or those at risk of breast cancer as essentially all of their practice. If reasonably accessible, many patients in the US choose an NCI-designated cancer center for a second opinion:

Find an NCI-designated cancer center: https://www.cancer.gov/research/nci-role/cancer-centers/find

Best,

BarredOwl

michela802

@Barredowl

Wow!! You are so knowledge!

Thanks for this info. I am trying to get in for a 2nd opinion. If things need to be delayed a few more weeks then so be it. I want to put my mind at ease as best i can.

We are all on this journey together and no one signed up for it but we do the best we can while we are on this road, right?

I will be sure to check these links out.

Best to you

Peace13

Hello ampola36! My situation is similar to yours. I'm so sorry your going thru this, I was diagnosed in December 2016, I had double mastectomy January 4, this year, my oncotype is 16, I just turned 39 in December, so I guess I was diagnosed at 38. It's stage 2a, no lymph nodes but I do have angiolymphatic invasion😕 The info on that seems so confusing , I get really conflicting information ..... I'm going to oncologist tomorrow and will update! Hugs to all...... Peace13

Molly50

I agree you need a second opinion. I had a very similar diagnosis but was 54. I was initially told chemo due to 2 positive nodes but TailorRX came out and it changed due to a low Oncotype DX. I had "extensive" LVI and one node that was 1.6 CM. I had mastectomy and radiation.

mellee

Amapola, are you also going to get radiation?

michela802

2nd opinion with MSK today was no surgery. Start chemo 4x AC + 6x Taxol. Both every other week. Radiation to follow and then tamoxifen for 10 yrs.

Thinking this is the way to go.

I now will need to notify the other dr's that I am switching care. I feel bad about it - it is not personable just a slight different approach with treatment.

Thoughts?

BarredOwl

HI michela802:

Thank you very much for the update.

I seem to have no recollection of how I handled the switch to my second opinion surgeon. It is not uncommon for patients to seek further treatment with second opinion providers, regardless of the advice received. Professionals will understand the various considerations. No explanation that it's not personal is required.

Different approaches to informing the current provider are possible, depending on the strength of the prior relationship and your personal style. Because schedulers may have instructions to follow-up with you, it is helpful to inform the office that you have decided to proceed with the next phase of treatment at the second opinion facility. If you prefer to reach out to the doctor as well, a short email or after-hours voicemail may be an option (prepare what you wish to say in advance).

BarredOwl

mellee

Sorry to hear about the possible lymphedema. I have that too after my ALND, although it's mild and limited to my upper arm. I'm hoping I can reverse it for good!

MinusTwo

Mellee - be vigilant. LE can progress or may lie quiescent, but it does not move backwards once you have had it diagnosed in one area.

mellee

I will definitely be vigilant! I am very worried about it. Especially because I'm having wound healing problems that have prevented me from continuing PT for now.

But I have seen that you can reduce the swelling. That's what I'm hoping to achieve: to get back to baseline. Then I'll just have to be careful going forward to keep it from flaring up again.

vlnrph

Michela, congratulations on having a plan from MSK and avoiding another operation! My surgeon insisted on axillary lymph node dissection due to micromets, now I have LE. That was almost six years ago shortly prior to the newer guidelines coming out. I agree with BarredOwl about informing your initial medical team - don't feel bad: you made the decision that is best for you and they will understand.

Mumzy3

I had lymphovascular invasion as well, but clear lymph nodes. Still terrifies me as my tumour is Grade 3 & Her2 positive.

Would love to know how many women like me ended up with metsor how many have not.