LCIS with chemo?
Hi everyone... I just found this subject in the discussion forum so thought I would check in here in hopes for some input/advice for those with LCIS experience. I am here for my grandmother who was diagnosed with LCIS 8 weeks ago. They did a lumpectomy, then a partial mastectomy, followed by a full mastectomy on the same breast a few weeks later. She has met with a radiation oncologist and she is going to be meeting with a chemo oncologist next week. I am very confused because it sounds like LCIS poses a greater risk for breast cancer, but is technically not breast cancer. Although her diagnosis on the paperwork was LCIS my family is under the impression that she has non-invasive breast cancer, but unsure of type or stage. If this is correct, why would radiation and chemo be necessary? Any information you can offer would be very appreciated. Thanks!
Comments
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kar0927----LCIS is an in-situ bc, stage 0; it IS bc, it is just a non-invasive type. It does NOT require chemo or rads. If they are recommending chemo or rads, then she may have an invasive component found in there also, which would then make her at least stage 1. Unfortunately, it is not uncommon to find invasive bc and LCIS together.( Actually, it is very uncommon to find LCIS by itself--my onc and bs both said I was very unusual, "1 in a hundred"). So if she has an invasive bc, her treatment would be directed at that, not the LCIS.
Anne
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Also, LCIS (with nothing worse) is often multifocal (there are several different spots of it) and bilateral (meaning it is in both breasts). They know these two facts, I believe, because up until about the 1990s, they routinely did bilateral mastectomies on women with LCIS and nothing worse.
Since LCIS usually doesn't show up on any kind of imaging or palpation, it would be very difficult to know 'you removed all the LCIS', unless you had bilateral mastectomies.
There is hardly anything that is *not* controversial about LCIS. This is what the NCI says about it. http://www.cancer.gov/cancertopics/pdq/treatment/breast/HealthProfessional/page6
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Leaf & awb - thank you so much for your responses. It all feels so overwhelming so it is nice to have a place to go to for community support. Best wishes to both of you!
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Hi, I'm confused. I've been told by more than one doctor, including my doc at sloan kettering that lcis is not cancer. It's just a precursor to cancer, increasing your risk. I had that 9 years ago, and they did nothing but take out the lump. They put me on tamoxifen, I did develop idc 2 years after that. I had lump./rads,, and had a recurrence this year , with a bilateral mast. I asked my new surgeon, the one in sloan kettering about it, and she agreed with my previous surgeon, lcis is not cancer, but dcis is cancer. too many opinions from so many docs..
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There are definitely two camps on the "is LCIS cancer?" question. There are also two camps on the "is DCIS cancer?" question. But one thing that is pretty much agreed is that DCIS always needs to be removed from the breast, whereas the removal of LCIS is usually considered optional. The other thing that is always agreed is that chemo is not required for either LCIS or DCIS.
kar0927, I'd suggest that you ask for a copy of your grandmother's pathology report, if you don't already have one. If chemo is being considered, then as Anne said, it's almost certain that an invasive component was found in your grandmother's pathology, in addition to the LCIS.
Here's a website that explains LCIS and DCIS treatment options. It does state that LCIS is not cancer - I hope that doesn't offend anyone here - but I included this site because it's current (2008), succinct and easy to understand, and hopefully provides kar0927 with information that she can use to perhaps question and get clarity on her grandmother's diagnosis and treatment plan.
Edited to Add: I just reread this post and realized that I forgot to include the link to the website that I mentioned. Sorry about that. Here it is: http://www.center4research.org/wmnshlth/2006/dcis10-06.html
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Current thiking is that LCIS is NOT cancer nor is it a precancer. It will not "turn into" cancer. LCIS is a marker for increased risk of invasive cancer in the future. Most women with LCIS will not get invasive cancer. There are studies that are looking at LCIS as a heterogeneous lesion meaning a certain subtype might actually be a precursor to invasive lobular carcinoma. The natural history of this condition, however, is still unknown.
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I'm sorry you are going through this. Best wishes to you and your grandmother.
There is controversy about almost EVERY aspect of LCIS.
This includes the what it should be called (some prefer calling it lobular neoplasia and grouping it with ALH), what category it should be put into (most oncologists consider that it is NOT cancer, but some do), how it should be best treated, what is its incidence, what risk does it pose to a woman with or without a bad family history or other risk factors, what cellular characteristics are typical of LCIS (in other words, how a pathologist should define LCIS), how many types of LCIS are there, do different types of LCIS make any clinical difference, etc.
The more recent thought is that *many* people now feel that in some *small, but unknown number* of persons, LCIS may, in some small number of cases, be an actual precursor for cancer.
LCIS (and nothing worse) is strange, because even *if* you have LCIS in one small spot in one breast, it puts not only that entire breast, but also the other breast, at risk of breast cancer. There is a lot we don't understand about LCIS.
It may or may not be a whole different ballpark if you have LCIS and something worse (such as invasive breast cancer.)
As Bessie said, I have never seen anyone suggest LCIS and nothing worse should be treated with systemic chemo. I have heard Dr. Susan Love suggest in the future, perhaps some people may be able to be treated with intraductal chemotherapy, for more localized results, but this has certainly not been established. There, of course, is the problem of getting any proposed chemo far enough into the lobules if you inject it into the ducts. There is also the big problem of trying to find out which lobules are connected with which ducts. As far as I know, this is still at the speculative stage, at best.
As Bessie said, it would be very informative to get a copy of the pathology report.
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Bumping
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im so confused . . . (and what does 'bumping' mean?). i had both breast removed due to lobular 'cancer.' now, are ya'll saying it ISN'T cancer? did i have my breasts removed (and all the hell that goes with it) for nothing? also, the doctor signed me up for taxol . . . i told her 'no thank you' and she 'fired' me. oh well -- then the other day, i read that taxol is not recommended for lobular! what's with this? she was out for the money??? it's been five years and other than i have a surgical 'MESS' on my chest (i came here to find out about cadaver skin for breast reconstruction), i have had no cancer signs. can someone explain the 'lobular' issue in layman's terms? i knew i shouldn't have had both removed, but they scare you to death!!
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one more thing, in this day in age -- seems more doctors would tell you to wait. surgery, medicine, medical 'ideas/trials' seem to be like electronics . . . wait a week and what you have is old news . . .
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Hi, Sue. First off, "bump" is a way to get a topic up to the top of the active conversations list by quickly posting a new reply to the thread. This week the site was hit by spammers who were posting multiple, offensive posts that had nothing to do with breast cancer, and community members were "bumping" legitimate posts up so that the spammer's posts wouldn't show on the active conversations list.
Now, regarding your bilat mast and chemo--if you had invasive lobular cancer (ILC), then yes, you had cancer. If you had LCIS, which is lobular carcinoma in situ, then you had abormal cells that are a marker for developing possible invasive cancer (ILC or IDC) in the future. You must have had invasive lobular--there's no way you'd be offered chemo otherwise.
Taxol is generally offered when there are positive lymph nodes or grade 3 cancer, as it is a strong chemo. I was offered it for my lobular cancer, but I opted for AC with 5-Fu instead. The debate about Taxol isn't so much about lobular specifically, but whether it's warranted for node-negative patients. There is a debate about chemo for lobular cancer in general, but that mainly applies to the lobular tumors that are grade 1, as grade 1 tumors divide more slowly than grade 2 or 3, and thus don't resond to chemo as well. Also, lobular tends to be hormone positive, and therefore respond better (in theory) to hormone therapies like Tamoxifen or Arimidex.
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And LOL, I like your electronics analogy! It's so true. After I finished my six rounds of CAF that was prescribed last August, my onc said, "Well, I went to a conference in October, and based on what I learned there, I probably would have prescribed TC for you instead." Sheesh!
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