Cutting through Ducts/Lobules

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cleomoon
cleomoon Member Posts: 443
edited June 2014 in LCIS (Lobular Carcinoma In Situ)

This sort of is like a seeding question I guess. When an excisional biopsy is done, I assume it alters the structure of ducts and lobules. So if you have a lobule cut open, what happens to the LCIS cells. Can they move around as abnormal cells? Do the poor cells get confused? Like do they say where did my Lobule wall go?

I ask mostly because the LCIS I had diagnosed was very very close to my chest wall. Can healthy/unhealthy breast cells exist on say the chest muscle or other places. Trying to be logical with BC is just not a successful endeavor for me. It's just uncertain...

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  • RITZGAL
    RITZGAL Member Posts: 18
    edited June 2009
    Hmmm, this is certainly thought provoking.  I re-read my path report and it said lcis present in two of 22 sections.  I thought the definition of lcis was that the lobule was filled with the cells rather than just having some cells, which then would be determined alh.  So how could it be determined lcis without having the lobule to examine under the microscope?  I assumed the lobule was included in the section.  No?  If they check margins and find no lcis or alh, then it doesn't matter if the whole lobe has been excised.  But does it matter anyway, because I read someplace that it isn't necessary to get clean margins with lcis, (although my onc was clearly pleased that my margins were clean).  That is the extent of my logic.  But I think I know what you mean.  If they left half a lobule with lcis cells free to travel about, or to adhere to nearby tissues, can they?  I think that most cells determined to be lcis do not have the capability to invade.  It's  recently been found that just some people may have a small portion of lcis cells with the capability of invasion.  So if those few cells that were able to burst through the wall of the lobule,  were set free prematurely with surgery, would they survive long enough to attach themselves to the chest wall?  There is probably some study that made or will make that determination. Maybe somebody reading this already knows.  Is this what you meant, or do I sound like I've been smokin' something?Undecided
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  • cleomoon
    cleomoon Member Posts: 443
    edited June 2009

    Hi Ritz,

    No it does not sound like you have been smoking something...LOL. I sure feel like I have been smoking something. Who knew dealing with BC could make one high. Thanks for chiming in here. Yes you understand what I was saying...phew I feel better.

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  • RITZGAL
    RITZGAL Member Posts: 18
    edited June 2009

    Hey Cleo.......so let's sit back and see if anyone else can understand what we're talkin' about.  I would really like to know the answer to your question.  Sense of humor can keep you going.  I know sometimes reading all of this stuff can get overwhelming, then somebody comes up with a wise crack and I feel better.  Glad I found this place!

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  • leaf
    leaf Member Posts: 8,188
    edited June 2009

    Hi there!  If I am understanding you right, you are asking about seeding in LCIS.   Is this right?

    Seeding means when cancer is spread during a biopsy/excision.

    You don't really care if cancer cells are dislodged during a biopsy/excision - as long as they die.  You are concerned if the dislodged abnormal cells survive and grow, especially if they grow faster than the surrounding, normal cells.

    I highly doubt if they have done studies on LCIS cells, but they have done studies on invasive cancer cells.  I would assume that LCIS cells are usually not more aggressive than invasive breast cancer cells.

    When they study biopsy washings, a substantial number of times, abnormal cells are found on the washings of the instruments.  http://www.ncbi.nlm.nih.gov/pubmed/19360459   But do the cells survive and grow?

    Most studies find that people with core biopsies do NOT have a significantly higher rate of recurrance over people who did NOT have core biopsies before diagnosis. http://www.ncbi.nlm.nih.gov/pubmed/16502019 

    So seeding probably occurs, but it is probably quite uncommon to get recurrance from the seeded cells. http://www.ncbi.nlm.nih.gov/pubmed/11328321  If you think that 3 cases is a lot at one facility, well, my local breast center (NOT a major institution) says it diagnoses about 400 cases of breast cancer per year, and if 20% of the biopsies are benign, then my local breast center does some 2000 biopsies per year.

    http://www.ncbi.nlm.nih.gov/pubmed/19167175  This study also states that there is contradictory evidence about seeding of sentinel nodes, but not about core needle biopsies.

     I have also read reports on conditions about growing breast cancer cells in tissue culture.  Apparently, if nothing in the environment changes, breast cancer cells behave like breast cancer cells.  But if these same breast cancer cells are transferred to a layer of NORMAL breast cancer cells, they often act like NORMAL cells.  So the environment of the breast cancer cells seems to be important for breast cancer growth.

    Since we don't see a lot of seeding in breast cancer, then probably our treatments for invasive cancer are controlling seeding fairly well.  (There are other aspects of breast cancer that are not so nice - such as the possibility of some invasive breast cancers metastasizing before they are large enough to be detected.)  It supports the idea that it is good to choose to get standard treatment if you do get breast cancer.

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  • cleomoon
    cleomoon Member Posts: 443
    edited June 2009

    Hi Leaf,

    You are one of my research heroines Smile

    The 1997 study looked at reoccurence after treatment with rads---standard of care. So here is where my thinking is going with my choice of treatment. I would feel much more confident if I were to have PBM if I had targeted radiation when abnormal cells (not just invasive cells) were found very close to the margins after surgery. Now I would not be able to have radiation, as that is not standard of care. I cant even imagine a doctor would approve of it, let alone an insurance company. Yes it is extremely overly agressive to even consider this kind of treatment for myself...but I am an overly aggressive worrier. 

    Oh how nice to see a recent 2009 study. "...ultrasonographically guided needle biopsies that were performed with a directional vacuum-assisted device and an automated core needle gun."Vacuum vs. punch gun. Makes sense commonly, not only statistically. 69% vs. 33% seems very relevant. And a p>.0001 is nothing to sneeze at.

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  • nash
    nash Member Posts: 2,600
    edited June 2009

    Cleo, good question, and I have no idea if LCIS likes to run amok or not after excisions.

    I do know, however, that my PILC was right up to my chest wall, with PLCIS extending into the pectoralis muscle, and the surgeon made sure that she removed part of the muscle in order to get a clean margin, even though there were no invasive cells in the muscle. Now, I don't know if I was treated aggressively b/c I have pleomorphic variants of everything, which is more aggressive than classic ILC and LCIS, or if the surgeon would have done the same regardless. 

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  • cleomoon
    cleomoon Member Posts: 443
    edited June 2009

    Hi Nash,

    I sure do appreciate the wisdom here. 

    I am glad the surgeon was so diligent with your PILC/PLCIS. I am relieved that they are studying pleomorphic variations. From what I understand about pleomorphic is that they find differentiated nuclei of the cells. Which means that there are different types of abnormal cells.

    May I ask if you had a lumpectomy/masectomy? Was healing more difficult since they actually took some of the pectoral muscle?

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  • cleomoon
    cleomoon Member Posts: 443
    edited June 2009

    Nash,

    I just read some of your most recent posts and realize you had some worries of recurrence. I hope your meeting with your onc and surgeon put your mind at ease...

    ((Hugs))

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  • nash
    nash Member Posts: 2,600
    edited June 2009

    Hi, Cleo--I had a lumpectomy, even though the tumor was 2.7cm and my boobs are small. The PILC was removed, the PLCIS was left in there. The PLCIS threw Tumor Board into a quandry--they ended up reviewing my case 4 times. First they recommended bilat mast b/c of the high risk of local recurrence, then they decided I was more likely to develop mets from the PILC and said I could just go with the lump. Not sure which course of action was more disconcerting. Undecided

    Anyhow, I don't know if the recovery was more difficult b/c of the muscle removal since I didn't have anything to compare it to. I do know, however, that the surgeon put a post-op compression garment on me specifially b/c of the muscle removal, so it must add a bit to the pain and swelling.

    And thanks for the good wishes on the recurrence issue. I saw the onc last week and she said the boob shrinkage is to be expected. I'll see the surgeon in a few weeks and see what she says. I am feeling better about it, although my tumor markers were 20% elevated in last week's reading. So that gave me something new to worry about, LOL. Onc was unconcerned, however.

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