Lymphatic invasion

Kate - I'm interested in the fact that your oncologist said he'd go over the Ocontype with you line by line.  I basically received a graph and a page showing the ER recepyor # and PR receptor #, but no specifics on the individual factors that go into them coming up with a score.  My tumor showed lymphovascular involvement, but my Oncotype score came back as a 12 with an 8% chance of recurrence, so I did not have chemo.  Let me know how you make out.

Sue

Interesting study, Orange. The theory that LVI is a precursor to node involvement doesn't fly, so they aren't very definite on the relationship between LVI and positive nodes. LVI seems most important for what it suggests about thre nature of the tumor, which isn't necessarily the same as what positive nodes might suggest.

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A lot of weight is given to the test results of our axillary nodes.  But we do have other nodes that cannot be reached or tested as easily.  Perhaps that is where the concern is.

Kate--There are two answers to that teeny nagging doubt. The first is that a recent event like a biopsy is not likely to release enough abnormal cells to cause a problem. The second is that even if some cells have been released, they are vulnerable to attack by hormonal therapy. Cells that travel probably don't survive very long, which is why so many of them get no further than the sentinel nodes.

Hello Kate

I am in a similiar position to you.Icm tumour,5 negative nodes er+ pr- Her2 pos.My understanding is that the histopathologist reports his findings but the oncologist decides what the treatment will be give certain factors.Each factor of the report will decide what treatment he gives you.In my own case lymphatic invasion is one factor but the greatest factor is the HER2 being positive,so therefore these all indicate chemo.I understand that in some cases looking down the microscope it is impossible to determin whether lymphatic invasion is vascular,as the capillaries are so tiny,or lymphatic so it is reported as vascular invasion.Once this has been identified there is a theoretical chance that some cells could break off and start their travels,they could easily have slipped through a lymph node without node being postive.All these things are theoretical but possible so it is advised to err on the side of caution and give these people chemo.So yes people with lymphatic invasion should receive chemo.

My understanding is that LVI is not a worse prognostic indicator than positive nodes -- still the most important prognostic factor -- but a kind of an intermediate indicator.  Keep in mind that lymph nodes are used as a kind of surrogate for the bloodstream, through which distant metastasis occurs.  If you have positive nodes you are more likely to have cancer cells in the bloodstream but not necessarily.  And sometimes the cancer goes straight for the bloodstream and avoids the lymph nodes altogether.  I was told that if you have positive nodes, you necessarily have LVI, they go hand in hand.  The grey area is your situation where you have LVI and no positive nodes.  To me this suggests your cancer cells may know how to travel and if you are in the grey area deciding chemo or not, it may push you toward chemo.  But it is only one factor.  It sounds like you have a very thoughtful onc.  Perhaps a second opinion will give you piece of mind.

If positive nodes and LVI go hand in hand, why is it so often the case that the path report shows one or more positive nodes, but no evidence of LVI? It would seem that they can either coexist or occur independently. As for nodes as prognostic incidators, that's a more complicated business than it may seem, A large tumor that had spent years getting cells to a sentinel node might be easier to deal with than a nasty little aggressive one that went straight to the bloodstream.

Kate,

I'd talk with your onc and get his opinion and recommendations but I'd also suggest that after that if you have any nagging fears, that you consider a 2nd opinion.  You have a relatively small window but 2nd opinions are VERY common in oncology.  Unfortuneately I can speak to being on both sides. For years I worked in the medical oncology side as a nurse/ nurse practitioner.  I have subsequently left the onoclogy field and moved into geriatrics and chronic care. I am a 9 year survivor of Hodgkins and have the exact date of diagnosis now with IDC as you.  I had a slightly different scenario than you.  I had a negative sentinel node during surgery and therefore the surgeon moved on to the bilateral mastectomy (1 side BC, other side prophylactic).  However, my final path report showed that I had 2 "micrometasteses" in the sentinel node. ASCO or the American Society of Clinical Oncology meets yearly in May/ June.  There were a lot of discussion on micrometastases but the bottom line is if the met in the lymph node i > 0.2 mm but < 2 mm that qualified as a micromet and was to be considered a + lymph node for BC.  Another oncologist may be able to help clarify the "lymphatic invasion" you identified.  Also there is a free but very helpful telephone number that is sponsored by the National Cancer Institute.

It is 1-800-4-CANCER. They also have a website which is : http://www.cancer.gov/ where you can do a live on-line chat.  The people who answer or assist you are not physicians but research librarians who search all the most up to date literature to find answers for you.  They'll also help you formulate questions for you to ask you oncologist.  I've used their services personally and professionaly for over 20 years and they are great. I hope this helps.  Please let us know.

Linda 

This issue also puzzles me and I still don't understand. In my path, there was no lymphatic vascular invasion in the tumor and there was no vascular invasion but I had 1mm micromet in one sentinal node.

My doc did tell me if Lymphatic vascular invasion is present in the path that means they can see it, then it means a bit poorer prognosis than those without seen lymathic invasion. What I don't understand is in my case no lymphatic invasion is seen in path but why I had 1mm micromet in one sentinal node? How did that get there? Anyone can help on understanding this?

Some how the 1mm micromet in one sentinal node bothers me. I like to know if anyone knows the prognosis for micromet in one node is same as node negative?

Kate and Carcharm, I am in the same situation.  I am 39 years old.  I was so relieved 0/4 lymph nodes, only then to see my pathology report that said lymphovascular invasion is present ("ectatic lymphatic channels with tumoral nests within their lumens").  My tumor is bigger (1.7cm), grade 2 also, but my original biopsy report showed high ki-67 (proliferation).  My oncologist had not gotten my final pathology report until during my consult with her, so she didn't really go over it, just gave me a copy.  I ordered the oncotype-dx test, but it won't be ready for a couple of weeks.  I don't want chemo and am terrified of neuropathy as well as any possible permanent side effects.  But I don't want to make a poor choice either - I have 5 children (including triplet 5 year olds) that I need to raise.

Still sitting here with drain tubes coming out both sides of me from bilat. mastect. and am tentatively scheduled for chemo (TC regimen) to begin Aug 13, but waiting to make final decision based upon oncotype-dx score.

Any comments/advice would be great - I also just needed to share.  Feeling a bit overwhelmed.  Thanks for listening.  It was helpful to read your posts about lymphatic invasion.

Shay

Kate, Thank you.  People like you on this site have made all the difference in me making it this far.  - Shay

mmm5, Thanks for the info.  What chemo regimen did you have?  Are you taking tamoxifen now?

Shay