ILC 1mm - Benefits of Hormone Treatment?

Louise-Skippy

Hello

I was diagnosed with ILC in Nov 2016. After mastectomy it revealed ILC 1mm in size. I had isolated tumor cells in 2 of 3 lymph nodes, negative for malignancy. Oncologist is suggesting 5 to 10 years of Letrozole. I am trying to gather information as to the benefits compared to treatment risks given the small size of the ILC. Any information or guidance would be really appreciated. I live in Australia.

Best wishe

Louise

Bright55

hi louise skippy

Another skippy here!

Yep the leterzole regime is the standard first line treatment for post menopausal bc

Great site for info

Leterzole for me after starting 6 months ago has had no major side effects ...with hot weather now get pricklyy heat . Over time bone denisty is the major side effect

Some have been on it for years so their replies will inform you better

Al the best

Moderators

Hi Louise-Skippy,

Welcome to the BCO discussion boards.

As well as posting in this forum, you may like to read up on our main site content on Femara which includes the benefits of it and common side effects

Femara

Also, there is an active discussion thread going on in the link below that you may like to join:

Femara: Hormonal Therapy: Before, During, and After

We hope this helps!

The Mods.

Anonymous

You can also post in the ILC link...it's fairly active (if you post someone will answer). ILC, as long as it is ER+, seems to respond best to hormonals, and less to chemo. But I had everything I could find for tx anyway--I wanted it. My situation was different from yours, though.

Wicked

Louise-Skippy, my area of ILC was 1.5 mm, negative nodes, and I had extensive LCIS in both breasts. Had BMX 11/15/16. Diagnosed at 49 and pre-menopausal. Both my breast surgeon and oncologist felt I would not benefit from hormone therapy at all, so I'm not doing it. What benefit does your doc think it will give you?

BarredOwl

Hi Louise-Skippy:

Please seek confirmation or clarification from you Medical Oncologist ("MO") regarding the basis for the recommendation for endocrine therapy (Letrozole) in your specific case. Is the recommendation based: (a) solely upon the presence of the ILC; (b) solely upon the isolated tumor cells; or (c) on both the ILC and isolated tumor cells.

I am confused by your reference to "isolated tumor cells in 2 of 3 lymph nodes, negative for malignancy." For example, if they were "tumor cells" and had features that correspond to the ILC tumor, then they would be malignant cells. On the other hand, if they were "benign epithelial cells", then "tumor cells" would seem to be a misnomer.

Please seek clarification on this question, a detailed explanation of how the cells in each node were characterized by the pathologist, using cytologic and immunohistochemical staining (IHC) techniques, and what is known about the "tumor cells" in each node from each assessment performed. If the pathology report contains conclusory statements, then the pathologist may need to be consulted for full details.

Some possible information that may be available about the isolated tumor cells includes:

- Were the isolated cells determined to be epithelial cells, which would be consistent with breast luminal epithelial cells. Such breast epithelial cells could be either benign or malignant. Certain cytokeratin stains may have been used to assign epithelial origin.

- What was the cytologic appearance of the isolated (epithelial) cells in each node? Was their appearance consistent with benign breast cells or malignant breast cells (e.g., based on nuclear/cytoplasmic ratio, nuclear size, hyperchromasia, other features?)?

- Were any stains used to determine if the isolated cells were "ductal" or "lobular"? (e.g., peripheral versus perinuclear staining with CAM5.2, or other suitable stain) What are the implications?

- Was the ER and/or PR status determined on the isolated tumor cells and is it consistent with the ER and/or PR status breast ILC tumor? What are the implications?

How did they get there? Please confirm it with your MO, but the presence of isolated tumor cells in a node may have several possible explanations, including (i) displacement and transport of benign breast epithelial cells; (ii) displacement and transport of malignant tumor cells (due to "iatrogenic displacement" during biopsy and benign transport (clean-up of cellular debris from biopsy)); or (iii) true metastasis to the lymph node from an invasive carcinoma. In some individuals, cytology and IHC can be used to eliminate scenario (i) as a possibility. In practice, it is not possible to distinguish between scenarios (ii) and (iii). Because of this, endocrine therapy may be offered as an option or recommended.

The purpose of treatment, risk / benefit, and your personal risk tolerance will be factors in any decision.

If there is a multidisciplinary tumor board at your institution, perhaps they would consider your case? You may also wish to seek a second opinion, including pathology review.

BarredOwl

lekker

Louise - your tumor is tiny but it's already figured out how to travel to the nodes. Would you consider trying an AI and you can always stop if the side effects are worse than the potential benefit you might gain? Just something to consider.