DCIS w/microinvasion

K,

Generally it's considered that the line in the sand for chemo is an invasive tumor that is 1cm in size.  If a tumor has very favorable characteristics, then chemo might still not be recommended even for tumors that are a bit larger.  On the other hand, if a tumor has very unfavorable characteristics, then chemo might be considered for a tumor that is smaller than 1cm.  Unfavorable characteristics include tumors that are highly HER2+ (in which case Herceptin might also be prescribed) and tumors that are ER-/PR- (in this case particularly because the patient would not benefit from Tamoxifen or AIs as an alternative to chemo).  I have never heard of BRCA status coming into play on this decision and I was not aware that BRCA cancers might be different than any other breast cancer - I hadn't heard that.

Since you have a tumor that is considered to have unfavorable characteristics, the question is:  For someone who has an invasive tumor that is smaller than 1cm but has unfavorable characteristics, at what size of tumor should chemo be considered?  According to the NCCN treatment guidelines (which are used by most doctors in the U.S. and elsewhere), the answer is 0.5cm, if the tumor is ER-, PR-, HER2- and the patient is node negative.  You can follow through the treatment guidelines decision-tree in this file, on pages 11, 12 and 16:  http://www.nccn.org/professionals/physician_gls/PDF/breast.pdf

Given this, I could see that if you had a 0.3cm or 0.4cm tumor with very unfavorable characteristics, a doctor might be conservative and recommend chemo.  But with a 0.5mm microinvasion, you fall well below the chemo line.  For anyone who is node negative, the reason for prescribing chemo is the general assumption that the larger the tumor, the greater the number of cancer cells and the greater the chance that one or two of those sneaky cancer cells might have escaped the breast unnoticed.  So to put it in perspective, with your type of pathology, the base line for considering chemo is a tumor that is 10 times the size of yours (and therefore contains about 10 times as many invasive cancer cells).   

By the way, I notice that you mention that your DCIS is grade 3.  With only a 0.5mm invasive tumor, were they able to test it for grade?  My microinvasion was 1mm and while my DCIS was grade 3, my microinvasion was grade 1.  This was very comforting to me.  I'm not saying that it would be the same for you, but if your microinvasion hasn't been tested separately from your DCIS, it could be that your microinvasion is not as aggressive as your DCIS.

Hope that helps!  I'll be very interested to hear what the docs at Duke say.

Hello Hockeymom1,

The things I have come across in regard to being BRCA positive is that it would be best to have your ovaries removed to prevent ovarian cancer according to what I have read.  It seems that this gene can cause ovarian cancer as well.  Ovarian cancer is very hard to detect and is usually only caught too late, the statistics say.   This is what I have been reading on various medical websites.  I purchased a very informative book called Breast Cancer, Real Quesstions, Real Answers by Dr. David Chan, MD from the UCLA Jonsson Comprehensive Cancer Center.  It has answerd a lot of questions I had, not all, because each of us is unique, but 97% of my questions.

Anyone else diagnosed with DCIS w/IDC microinvasion beside Beesie and myself?

I would like to hear how you are doing and what treatments the doctors had you go thru.

Thanks,

Dee

Theres a few ladies out there with a Microinvasion & DCIS.

I am close.  But Technically I am not considered a Microinvasion since my IDC was 1.2mm. Microinvasion is less then 1mm.  I have had some Drs refer to me as a Microinvasion.

My DCIS was close in size to yours at 1.5cm

I had a BLM.   My ER is only 18%.  I have am Increased Risk of stroke So I choose not to take Tamox.

I see you are having Surgery on the 9th. What Kind of surgery will you be having?  Thats a Good Day.  It was My JazzyGirls (my Other Dog) Bday!

Good Luck Monday!

Pam

Ladies-

I just wanted to join in and say "Hi" !

At the age of 38, I was diagnosed with DCIS with a focus of a microinvasion of less than 1mm (stage T1mic).   As you can see we are not all that common since our cancers were caught extremely early.  I ended up with a lumpectomy, re-excision to clear a margin that was close to the skin so my surgeon removed extra skin, rads and taking supplements that my naturalpath advised for me take.

Bessie, you always come to the rescue with excellent research and information.  

Wishing everyone the very best.

Liz

Laura-

I have said that there must be an angel watching over me and my family many times.  I have gone thru soooo many challenges in my life since childhood and I swear that there has to be an angel watching over me and my family.  I am by far not some holly roller but if I didn't believe in Angels or in God I know I would have never gotten thru this.     Sending (((hugs))) your way.

Liz

Hi-

for those who had microinvasive DCIS that was her2+++, as of this afternoon we have our forum index (thanks to the moderators!).  Please feel free to post there. We can finally connect! The forum index is called Micro-invasive DCIS that is Her2+++.  Thanks!  Liz

I am! Although no bonus points for me ... highly ER/PR+. Although the micro-invasion was too small to test, I doubt it would be different.

I was diagnosed with DCIS w/microinvasion in August, 2016. No lymph node involvement (four were tested), and clear margins after lumpectomy. HER2+, er/pr negative, so treated with Herceptin, Chemo, and radiation. I was extremely sad when I learned I had to have chemo since I was under the impression DCIS was not treated with chemo, but because of my age (46 yrs) and HER2 status, MO strongly recommended it. At times, chemo was TOUGH, but that was only a few days out of the week for me. I am currently more than halfway through radiation (15 treatments needed), and will continue with Herceptin every three weeks until September. There's no doubt that cancer is scary, but be strong. You WILL get through it. God bless you.

I am scheduled for a lumpectomy with SNB the week of March 26th. I have been reading a lot of the threads. I have DCIS with microinvasions. Intermediate grade with solid and cribriforms with necrosis and lobular extensions. I appreciate all the helpful information and positive vibes that I am gaining from all of you. Thanks

Hi! Another one joining the "microinvasion gang". I am Swedish (living in Spain), I hope that is ok? I have been silently stalking this site since my diagnosis early January this year. I have just turned 46 and was diagnosed with DCIS 0.6 cm (grade 2, Er Pr+, Her-). No necrosis. No Vascular invasion. Solid and Cribifrom. Microinvasion 0.018 cm (0.18 mm). But, I had micrometastases in the Sentinel node, 310 cells (250-5000 cells are counted as Micrometastases here, below 250 it is considered ITC, and above 5000 it is Macrometastases). All in all, they took out 3 nodes. I do not really understand, but in my "papers" I am "clinically" node negative, but according to OSNA test, well, I had positive "micro" cancer cells in the SN. Oncologists cannot agree on whether the cells came from all the different biopsis I had to do (due to my very small breasts) or if they "seeded" durning surgery, or if the tiny micro invasion has "sent" them. Sadly they couldn't analyse the microinvasion for grade etc, they said it was too small... In the end they decided I shouldn't have chemo. But I have been through Lumpectomy and 25 sessions of Radiation, which was no big deal to me. A week after surgery I re-started my usual training, and continued training during Radio with no problems. Maybe a bit more tired, but nothing I really noticed. But now I am on the "magic pill" (Tamoxifen), that is supposed to save me, and feels like it is slowly killing me. I was hit by a truck 1996 with damages to neck and small brain and went through several surgeries to neck after that. In 2008 Melanoma and surgery. Then I was diagnosed with MCTD (Mixed Connective Tissue Disorder - Rheumatic disease) in 2012. So I have been living with severe cronic pain, internal organs inflammation, and neurlogical damage, medications, surgeries (basically, been in contact with way to many doctors) since 23 years back. I struggled my way back to life every time thanks to my dogs and training and competing with them. Kind of thought "what else can happen to me" after the MCTD diagnosis, but now; here I am! Well at least it seams I am in good company, considering what I have read so far, you seem like a very knowledgeable group. Sorry about the rambling... Thank you for reading this!

Thank you so much Falconer! Yes, I have been going through those threads. During the first two months after diagnosis, I was up all nigh just reading. Most Tamoxifen ones are quite deprssing...haha I would like to know where those micromets came from. But since 2 oncs, 1 onc sugeon, 1 radiologist cannot agree, I guess it will never know why!?

yes!! I was jus diagnosed Thursday with microinvasive breast cancer with one of two sentinel nodes positive!! My 1st diagnoses was dcis insitu but after the double mastectomy my path report revealed microinvasive breast cancer. I am now scheduled for body ct scans . Needless to say I am terrified!! There's not a lot of info out there about this diagnoses so I jus feel lost !!

Hi seeclearly I had a somewhat similar situation to you. Prior to my diagnosis I had two biopsies,one that came back clear and one that may have caught a small piece of an invasive cancer. So off we go to incisional biopsy/lumpectomy. At that time it was not clear at all what the outcome would be. The surgeon recommended a sentinel node biopsy which I declined. It was agreed if there was a need, a second surgery would be done to do the sentinel node.

My post surgery diagnosis came back DCIS so no need for a sentinel node biopsy based on best practices.

At a later time my diagnosis was changed to DCIS with microinvasion-(long story how that happened). But still if you read the literature it is very unclear as to whether a sentinel node biopsy is required or helpful for DCIS with microinvasion. So I continued to chose to go without. There you have it-best wishes as you sort this all out.