What does Lymphovascular mean?

Drained6513

Hi, I was diagnosed with Stage 1A, 0/3 node involvement, Grade 2.  My pathology report also said I was positive for lymphovascular?  I should have asked my surgeon what that meant.  I may go back and ask.  But she didn't bring it up when I went in for my results from my mastectomy surgery, but I noticed it when I read the pathology report, so therefore, didn't know to ask.  I just was relieved I had no lympnode involvement, so what does lymphovascular mean?  Because of this my Oncologist recommended Taxol 12 weekly with Herceptin for a year.  The surgeon obviously, wasn't concerned enough about the lymphovascular? 

Also, I didn't have a tumour or lump, mine was just calcification.  So I didn't  need presurgery chemo.  The surgery removed all of the cancer and I required just adjuvant chemo.  No radiation.  Again, some women on here have radiation with their other treatments.  Should I ask about that too? 

Luckynumber47

Hi Drained,

I was hoping someone with more expertise would chime in. I can give you some basics. Lymphovascular (or LVI) is a pathway between the tumor and your lymph nodes or your bloodstream. My pathology said "focal LVI". My BS said I didn't need to be concerned because my nodes were negative but I asked isn't the second part of that vascular - the blood stream? She agreed but offered no other information. So I guess it is what it is. That why I take Femara, to take care of any cells that might have escaped.

It sounds like your cancer was small and intermediate grade. Since you had a mastectomy you probably don't need radiation. Generally, if you have a lumpectomy you also have radiation. If you have a mastectomy you get to skip radiation under most circumstances.

Best of luck with your treatment. Herceptin is very effective for HER2 positive

Kimm992

I also had minor LVI and my surgeon said it was not as significant as having a positive lymph node and he wasn't all that concerned about it.

That said, because of the LVI he suggested I have radiation as extra insurance. I was more comfortable throwing the book at it anyway so it was an easy decision for me.

BarredOwl

Hi Drained6513:

Here is a live link to the page on the main site noted above by KB870 regarding "lymphovascular invasion":

http://www.breastcancer.org/symptoms/diagnosis/vasc_lymph_inv

The presence of lymphovascular invasion in the vicinity of the tumor ("peritumoral") is not the same thing as lymph node involvement.

The circulatory system includes two types of channels or vessels for fluids: (1) the "vascular" system for blood; and (2) the "lymphatic" system for lymph fluid. The breast itself has small blood vessels and lymph vessels going through it. Either system may be used by invasive tumor cells to escape the breast. If they have the capability to do so, cancer cells may break into a nearby lymph channel in the breast or into a nearby blood vessel in the breast and travel elsewhere via the lymphatic system or bloodstream, respectively.

The pathologist looks at the lymph vessels and the blood vessels in the breast in the vicinity of the tumor for signs of lymphatic invasion (breaking into a lymph vessel) or vascular invasion (breaking into a blood vessel), and will note if present or observed. If they don't see signs of either of these in the sample, they may note "lymphovascular invasion" ("LVI") is not identified.

I would not be concerned that your surgeon did not emphasize the lymphovascular invasion. First of all, the surgeon's primary concern is local treatment (removal of the tumor with adequate margins) and axillary staging. Secondly, it is appropriate for your surgeon to defer to the expertise of your Medical Oncologist regarding the implications of various pathologic findings for systemic drug therapy (not your surgeon's area of expertise).

In this regard, clinical consensus guidelines for breast cancer focus on certain key pathologic criteria in connection with recommendations for systemic treatments: tumor histology (e.g., ductal, lobular, other); lymph node status; tumor size; hormone receptor status (ER, PR); and HER2 status. Other factors may be considered to some extent, including grade and lymphovascular invasion (if present). (The results of certain prognostic tests are also considered in the appropriate case.) However, as noted in a recent guideline from ASCO***:

"In addition, in the opinion of the ASCO panel, factors such as grade 3 and the presence of lymphovascular invasion should generally not be used to drive decision making when considered in isolation and need to be interpreted in the overall clinical context."

Under NCCN guidelines for Breast Cancer (Version 2.2017), the recommendation you received for chemotherapy (paclitaxel (Taxol)) plus trastuzumab (HERCEPTIN) is probably largely based on HER2-positive status and tumor size, in light of the results of this clinical trial regarding paclitaxel plus Herceptin for smaller, node-negative, HER2-positive disease:

Tolaney (2015), "Adjuvant Paclitaxel and Trastuzumab for Node-Negative, HER2-Positive Breast Cancer"

Main Page: http://www.nejm.org/doi/full/10.1056/NEJMoa1406281#t=articleDiscussion

Free pdf version: http://www.nejm.org/doi/pdf/10.1056/NEJMoa1406281

The presence of lymphovascular invasion, which has certain prognostic implications, was perhaps an additional factor in the overall clinical context that supported this recommendation in your case. Please do not hesitate to confirm it with your medical oncologist.

BarredOwl

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***Henry (2016)," Role of Patient and Disease Factors in Adjuvant Systemic Therapy Decision Making for Early-Stage, Operable Breast Cancer: American Society of Clinical Oncology Endorsement of Cancer Care Ontario Guideline Recommendations"

PDF version: http://ascopubs.org/doi/pdf/10.1200/JCO.2015.65.8609

Correction: http://ascopubs.org/doi/full/10.1200/JCO.2016.71.6175

This guideline document should be used as background information only to inform discussions with one's Medical Oncologist. Always confirm your understanding, as well as the currency and applicability to your specific case, of any outside information with your team.

Drained6513

Thank you all for your responses.  So I'm gathering it is very slight it could have gone through the blood stream?  I had mostly DCIS with some focal invasion with 7mm being the largest.  The DCIS was so extensive that breast conservation would have not left much to conserve.  I also had Paget's of the nipple which made me opt for the Mastectomy, to be a sure as I could be that it was all taken out.  HER2 and the lymphovascular were really what was defining for the Oncologist, along with 7mm in one focal area, which he states is large for a cancer doctor.  And thank you for those articles BarredOwl.  Much appreciated.