bleeding nipple and vascular invasion

gandl · February 2009

This is something that is probably a silly question, but if there is blood with tumor cells in it coming from the nipple, wouldn't that mean that tumor cells could be carried by the blood to other parts of the body? The path report says "no vascular or lymphatic invasion", and the breast surgeon says that is a good thing, but I question the result. It seems to me that if blood is coming out, tumor cells could also be going into the bloodstream. Any thoughts on this?

Another thing, how can I have isolated tumor cells in the sentinal node without lymphatic invasion? I guess I'm just wondering if things are as good as I was led to believe.

Thanks for your thoughts on this. Smile

marshakb · February 2009

I think that just means none were found in the vascular or lymphatic system from what they removed or could see at surgery. My surgeon said my nodes looked clear but after the path came back I had 1 "micro" pos node. Doc said some consider that still node neg.

About the nipple, my guess is the blood coming out of your nipple was traveling in the breast duct, just like milk would, not thru the vascular system. Hopefully Nash will come along soon, she has alot of this kind of knowledge. Marsha

nash · February 2009

These are interesting questions. First off, it appears that one can have lymph node involvement without lymphatic invasion (and conversly, lymphatic invasion without lymph node involvement). I found one study that had this sentence in it--

Fifty-one percent of the 181 patients with lymphatic invasion had axillary lymph node metastases, compared with 19% of the 669 patients without lymphatic invasion.

So it would appear that it is not unheard of to have nodal involvement, even without lymphatic or vascular invasion.

As far as the bleeding nipple goes, I think Marsha is on to something with the theory that the blood came from the milk ducts. What is perplexing about that, though, is how did cancer cells come from your milk ducts when you have lobular, not ductal, cancer? Unfortunately, this will be a tough question to get the docs to answer, b/c frankly, I bet they don't know. You wouldn't have known about the cells in the blood except that you looked at them yourself in the lab, and unless a patient underwent ductal lavage, the docs wouldn't know the cells were there either. I really don't know where to go with this one. It seems that perhaps your surgeon might have the best handle on the significance of the cells in the blood, and whether that means the cells could be carried more grossly in your bloodstream

wayover20 · February 2009

As for me, I was all clear on nodes but 1yr 3mos later I get skin mets that looked like pebbles under the skin across my abdomen. I asked my onc what's up with that and she said "tiny cancer cells traveled along and deposited themselves there". So those buggers can do whatever they want seems like.

gandl · February 2009

Thanks everyone for your replies. You have some good ideas.

Nash, about the ILC cells being in the ducts, I had " extensive LCIS with pagetoid spread". As I understand it, the pagetoid spread means that it originated in the lobes but was traveling down the ducts toward the nipple. Maybe besides the cells invading in the lobes, the lobes were completely filled with cancer cells and they were taking the easy way out and traveling down the ducts. Every needle biopsy I had before surgery had atypical ductal hyperplasia. I had always thought that it meant that the cells were from the ducts, but maybe all the atypical cells were from the lobes. It's odd that they didn't clarify that though. I agree that the blood was traveling down the ducts. The thing I am questioning is that at some point there had to be an interface between a blood vessel and the cancer cells, otherwise they would not be coming out mixed together. So wouldn't that interface be a point of vascular invasion?

That was an interesting quote about the lymphatic invasion. My guess is that since the pathologist can only look at a few samples of tissue, there may be some things that just don't get sampled and seen.

nash · February 2009

Gandl, thanks for the clarification about the pagetoid spread--that would explain the duct issue then.

I would question the blood interface as well. I hope one of the docs can give you a well-thought out answer on this. But like wayover20 said, the buggers seem to do whatever they please anyhow, so it may not make any difference what the docs think about the situation. You could have extensive vascular invasion and never get mets, or you could have 100% terrific prognostic factors all around and still get mets.

Do the pathologists you work with have any thoughts on all of this?

Seabee · February 2009

Perhaps it depends on how the cancer cells and blood get mixed together. If the cancer cells are attacking and eroding the walls of the duct, they might conceivably cause some bleeding without getting into the bloodstream. And there may be a difference between getting trapped by a lymph node and using the lymphatic system as a means of transportation. Some cancer cells may just drift along after they are shed, get trapped, and keep dividing; others may actively invade lymph and/or blood vessels in search of some suitable place to colonize.

barbe1958 · February 2009

And here's me with a bleeding nipple that had absolutely nothing to do with my cancer except made us all look a lot closer. I, too have ITC's (isolated tumour cells) which are unexplained.

Did they say ITCs or some "cancer cells" in the lymph node? I think there's a difference.

bleeding nipple and vascular invasion

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