IDC Slow Growing?
I had my core biopsy that said DCIS but the MRI is now showing IDC. My surgery is scheduled for next Friday. What I don't understand is that if breast cancer is slow growing and I had my my mammograms loyally, how could it be IDC already? I'm just so confused.
Also, can the cancer spread to other body parts if it is not in the lymph nodes?
Comments
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Your MRI shows what appears to be IDC but until the breast tissue is examined under the microscope, there is no way to know if it actually is IDC. MRIs are very sensitive which is good because they show cancer that other diagnostic tools may not, but this also means that they produce false positives. What was seen on your MRI could be more DCIS or it could be a benign condition. You cannot be diagnosed via an MRI (or any other screening tool).
As for how it is that your DCIS could already have developed into IDC (if in fact you do have IDC), there is no single answer for this. It could be that your DCIS has been in your breast for years and years but simply wasn't prominent enough to be visible on the mammogram until this year. I had annual mammos too and by the time my DCIS was found, my breast was full of it and I had a microinvasion of IDC. Or it could be that your DCIS converted to become IDC very quickly. Some women have large amounts of high grade DCIS but no IDC; other women have tiny amounts of DCIS and larger areas of IDC. It's not known what triggers a DCIS cancer cell to undergo the biological change to become an invasive cancer cell or why this happens more quickly in some women than in others. But, this does not change the fact that most breast cancer is slow growing. Even as IDC, the cancer cells can be very slow to multiply.
As for whether cancer cells can spread to other parts of the body even if it's not in the lymph nodes, the answer is yes. How much risk you have of this depends on how large the area of invasive cancer is. For those who have 2cm or more of invasive cancer, even if they have clear nodes, they are almost always given chemo. This is to address the possibility that some of the cancer cells may have moved into the body - the role of chemo is to track down these cells and kill them. For those who have less than 1cm of invasive cancer, unless it is particularly aggressive (triple negative or HER2+), usually chemo won't be prescribed, simply because the risk that some cells may have escaped is so low. For those with invasive tumors between 1cm and 2cm in size, chemo is usually considered although other treatments such as Tamoxifen might be used instead.
I hope that makes sense. My advice is to not worry that you have invasive cancer until you have a pathology report in your hands telling you that you do. Until then, you just don't know.
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beesie, I swear you must be a doctor, no, I take that back, you explain this too well. I have read your posts on other threads and learned so much from you. Thank you so much for taking the time to help those of us who are lost in this world of BC.
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IDC can be very agressive. Mine grew at 60% rate. Dr. felt it had been growing less than a year and the orginial tumor was 10cm.
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nmi, thanks! And no, I'm not a doctor. I'm just a patient who's a research junkie. After almost 5 year of reading up on breast cancer and 4 1/2 years posting here, I've refined my communications a bit. When I look back at some of my early posts, I shudder at what I said and how I said things... I wasn't always the most sensitive or considerate!
KittyDog, yes, some cases of IDC can be very aggressive. But most - about 70% to 80%, depending on the source - are considered to be slow growing. There isn't a lot of consistent information out there about this, but putting it all together leads to the conclusion that most breast cancer is slow growing. The downside of this is that it means that it's possible to have a recurrence many years - 10 years, even 20 years - after an initial diagnosis. This is because some BC cells may remain in the breast or the body and it can take that long for them to grow to the point of becoming detectable. This is why BC is one of the cancers that is never really considered "cured". Recently I was looking up some info about triple negative and HER2+ breast cancers, which are two of the variants that are considered to be fast-growing. Recent findings suggest that while these types of BC have a higher short-term recurrence rate (because of this fast growth), in later years they have a lower recurrence rate than the slower growing cancers (ER/PR+, HER2-). It makes sense.
Here's some info on BC growth rates:
- Some breast cancers grow slowly, others quickly. Slow growing breast cancers double in size every 42-100 days or more. Quick growing breast cancers can double every 21 days. Pre- and peri-menopausal women tend to have faster growing, more aggressive breast cancers (about 10-15 percent of all breast cancers).
Post-menopausal women, who account for 60-80 percent of all breast cancer cases, usually have slow-growing cancers which rarely metastasize.
http://www.breasthealthcancerprevention.com/What_is_breast_cancer.htm
- Breast cancers with estrogen receptors, and possibly those with progesterone receptors, grow more slowly than those that do not have these receptors....Normal breast cells have HER2 receptors, which help them grow. (HER stands for human epithelial growth factor receptor, which is involved in multiplication, survival, and differentiation of cells.) In about 20 to 30% of breast cancers, cancer cells have too many HER2 receptors. Such cancers tend to be very fast growing.
http://www.merck.com/mmhe/sec22/ch251/ch251f.html
- Most breastcancers are relatively slow growing, with an average tumourvolume doubling time of 280 days. Assuming that each cancerdevelops from a single cell and assuming a constant doublingtime of 280 days, a tumour of 2 mm (the lowest mammographicallydetectable level) will have been present for more than 18 years.2A clinically detectable tumour will have been present for evenlonger.
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How do you find out if your cancer is slow growing or fast growing? I have dimpling at the cancer site and surgeons felt by looking at the mammogram, that it was infiltrating. I had a second surgeon say he believed it to be a 10% chance, then a third surgeon who agreed with the first surgeon. Then getting the MRI results seem to confirm this. They were trying to make the decision as to whether to do the sentinel node biopsy since if it was DCIS then it wouldn't be needed. The second surgeon told me that if it weren't for the dimpling that I told them about, then they probably wouldn't found the cancer until my next mammogram. That is why I just can't wrap my head around the fact that part of it is invasive already. I don't understand or know the breast cancer jargon yet so will have to read up to learn more. When they did the core biopsy since it was diagnosed as DCIS, they didn't do the testing of estrogen receptors, etc. They said that it will be done when I have the lumpectomy. I just don't feel comfortable going into this surgery for some reason and not sure that I want to do the surgery now but if the cancer has the chance to grow quickly, then I don't have a choice.
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Hello,
I had my lumpectomy and SNB done on 7-23-10. I am diagnosed IDC tumor 1.77 X 1.66 X 1.38 cm stage 1, grade 1 ER + and HER2 -....
During surgery they checked 1 main lymph node and it was negative so good news so far...I get that report in a wk so end of july...Dr. does not think I will need chemo..6 wks of radiation but will be confirmed once I see Oncologiest on 8-2-10..I am extremely sore on my right breast and it is swallen..
If my SNB showed any lymph node positive than dr. had planned to do Axillary Lymph node disection but it did not come to that...Thank god..I am just taking one day at a time and thinking positive..I will share my experience on a new topic how my day was spent from admitting-surgery-release...THanks to all for love and support...God bless..
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I also was dx by a core biopsy DCIS grade 3, 1.4 cm., today i got the path report back from my Lumpectomy and IDC was found 5 cm. grade 3. How come my ultrasound and mamo didn't see this? Untill now I was comforted by the statistics that were only about 5% chance of this IDC being found. Path also said Grade 3 with solid comedo pattern. I'm dealing with an agressive invasive cancer rather than non agressive non-invasive. What a shock. Was it that fast growing or was it just not there 2 years ago when I had a mamo which showed nothing? Still waiting for hormone status of ER and PR. The Her2 said negitive. Not sure if that is good or bad?
Cathy
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Hi Cathy,
So sorry for your news. I had a 3 - 4 cm IDC which hadn't been on a mammo I took 2 years earlier, too. I guess there are some that are just faster growing, or perhaps mammo's don't pickup everything. You're lucky though, that your doctors were very thorough and caught everything. We're here for you on this journey! Believe it or not, you'll feel better once your treatment (chemo, tamox, surgery, etc?) starts. Best of luck!
Sue
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Cathy,
Oh crap, 5cm of IDC is not what you expected to find out! It's true that mammos don't pick up everything (I think they are considered to be about 80% effective) but even at that, it's certainly unusual for such a large area of IDC to not show up on either a mammo or ultrasound. On top of that, you had the core biopsy and somehow all the needle samples had only DCIS and no IDC. With that much IDC in your breast, that's really strange. I wonder if the pathology was wrong on the ititial biopsy and if some IDC was present in the samples but not detected.
I'm so sorry that you find yourself in this situation. Believe it or not, the odds of this happening after an initial biopsy showing only DCIS are very small - in my years on this board, I'm hard pressed to think of anyone who had that much IDC after a DCIS-only biopsy. I know that's no comfort to you, since you are one of the few who landed on the wrong side of the odds. Here's hoping that all the news from this point forward is good news.
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Beesie:
Your help in understanding and getting the stats and just plain learning what we are dealing with is so valuable to us all. Yes I'm the odd man out here, but once in awhile I guess one falls thru the cracks and doesn't go with the odds. Already today I have been referred to the Regional Cancer Center to get an appointment with an oncologist so the tests, treatment attack etc. can be put into effect. At least they are not giving me the line "Relax - its only DCIS and its not spreading" anymore. I could tell during my Lumpectomy that something was up because it was suppose to be an easy "awake" surgery and I wasn't suppose to feel a thing. The surgeon kept telling me the "pictures didn't show this" and "sorry it didn't show it was this deep". Now all I can do is trust what they tell me and deal with it. Thanks Beesie for your help - from all of us.
Cathy
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HI Cathy--so sorry to hear about your DCIS then IDC. Although not on the same scale, I had similar "confusion" from ultrasound which after speaking with the BS--I did learn that surgeons generally don't put as much stake into ultrasound diagnosis. My original ultrasound did show--1.3cm and they checked my lymph nodes. Now I have 1.7cm and lymph node involvement--and time passed is only about 1 month. When I asked oncologist today about difference in size--he said--ultrasounds are not the best diagnostic tool for measurement. With that said, we can handle this...take care.
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Hi Cathy,
Sorry that you have to go through this. I wanted to share my story. My mamo and ultrasound were both inconclusive, they showed dense breast tissue. The MRI picked up two small focus areas, but one disappeared at the MRI guided biopsy which showed only ADH. I then had an excisional biopsy and a partial mastectomy, both showed small, low grade DCIS. I had second pathology opinion who said I have DCIS only, non invasive. Since I needed further surgery to get clean margin, I went to another BS in another hospital. That's when the third consultation told me that I have a 4 mm IDC found from my partial mastectomy slides, talking about surprises.
I sometimes wonder if the surgeries caused the DCIS escaped from ducts and become invasive. It seems the IDC is not very easy to detect if two world well recognized pathologist failed to see with their own eyes. I don't know what to expect after my next surgery since I've got so many surprises on my diagnosis. On my worse days, I felt so pessimistic thinking that this Breast Cancer thing is such a myth and we are so vulnerable just being a woman. I guess I'm still in denial, I can't believe that I have this invasive form of cancer. Looking back that I did everything right, live a healthy life style, eat healthy, fit, exercise religiously, breast fed, not to take OTC medicines for a period of longer than two days, and even made my own house hold cleaning spray with bleach and vinegar. What else could I do to stay healthy?
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Hi BostonLex: I could see clearly what showed up on the mamo and also the ultrasound. I wouldn't know how big it was. I just took their word for it. I'm wondering if maybe because it was deep in the breast (the part they didn't see) and the DCIS was dx from a core biopsy which did not get down deep enough. I was told the needle biopsy did not even show DCIS nor IDC but neither it or core was done with any wire locater or any method to find it other than by it being palpable. Also I think it is sometimes hard to get good pics of large breasts in a mamo without ripping you underneath. That had happened to me once. Who knows? I know it does take time to sink in. I hear that healthy lifestyle failed to save many from a cancer dx again and again. If you read what to do, not to do, eat, not to eat, drink etc. OMG it would take over your life and I think for me it is just better to try to be reasonably smart with my choices but I refuse to make myself miserable for the rest of my life trying to avoid what may not be avoidable. Should someone feel different than me then all the power to them. I wish them all the luck but for me I just want to carry on my life as known before cancer the best way I possibly can. Well at least after all the treatments of course. No I doubt there was anything you could have done but I'm sure its natural to look back and ask ourselves that.. I know I have too. Best of Luck to you.
Cathy
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Hi bostonlex and Cathy: You guys are making me scared me now for my surgery on Friday. I saw my BS on Monday who went over the results of my MRI with me and to answer any final questions. I kept asking over and over again...how can the core biopsy with 4 snips being taken show DCIS but they believe, 2 BS and one radiologist, based on how it looks on the screen and because i have dimpling, that it is invasive so quickly? His explanation was that the core biopsy snips only got the "root" where the invasive part was in the "flower". He said that this will be cleared up during the tests on the entire section itself after the surgery. Boston, did your new doc offer an explanation as to how the first ones misdiagnosed? Did you talk to the old docs and if so, what did they say? Should I ask for lumpectomy to be read by another facility?
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Janet: Sorry but I was thinking mine must have been like your doc was trying to explain- Root vs flower. I also had dimpling but the only thing my BS told me the day of my Lumpectomy was that just because they found DCIS didn't rule out IDC inside the lump. I understand this is NOT the norm if that is of any comfort. I suppose no one truly knows the correct dx until the path report comes in. I just kept reminding myself before the path and even now - that it is what it is and it has already been determined and all the fretting and getting upset over it won't do me a bit of good. Try to relax and let the doctors do their job. You always have the choice of a second opinion if it makes you feel better.
Cathy
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I'm sorry to hear about your case. Please excuse me if i sound ignorant, but what do you mean by "dimpling"?
Thanks.
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Hi NoBull;
Dimpling is a dent thats in the breast, mine was almost a crease that fell into my breast when I lay flat on my back. You know what a dimple is when someone smiles? Mine was just long. Hopes this helps.
Cathy
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Hi JanetfromPgh, I'm sorry if I made you worry. My misdiagonosis was because both pathologists overlooked my slides. I would get 2nd or even 3rd consultation on the pathology after the surgery just to get a peace in mind.
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Hi Lex..how could they overlook your slides? That is just unreal! Is it a women's hospital?
NoBull, my dimpling is the same thing as Cathy..an indentation in the skin but when I flex my chest, it resembles cellulite almost. The surgeons said that mine is "mild" but I noticed it 6 months ago and it happens to be in the area of the cancer which is another reason why they don't think that my tumor is DCIS.
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Hi..made it through the surgery and now the waiting until Thursday. My BS was to do the lumpectomy and to take the sentinel node, however, he told my friend afterwards that he took two lymph nodes. Does this mean anything or is that how many they take with the sentinel node?
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They took 4 from me, as they were close together.
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Hi Janet--I had lumpectomy on July 19th and BS removed 7 sentinel nodes -- did not do axillary dissection. Have received pathology results from oncologist, but meeting BS next week as they may/may not take more nodes. I am hoping not as I have heard many bad stories about axillary dissection so I am hoping they will settle for the 7 sentinels.
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Beesie Reading your post answered a question I had about whether or not it was likely I would need to have chemo. Originally the surgeon only mentioned surgery and radiation but when I made the appointment with the oncologist, his nurse, did alot of talking about chemo. My cancer is IDC; 5.1 cm and my lymph nodes were all negative. My husband wondered why if the chemo is supposed to kill the cancer cells all over the body when why would I still have to have radiation. I told him I thought it was because they are just being very careful and want to use the radiation on the breast because of the chance of some being left behind. I guess it is a double attack compared to just the chemo. Any brilliant thoughts?
Deb
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Deb, after a lumpectomy, radiation is the norm. The role of radiation is to kill off any stray cancer cells that might be left in the breast. It's only if the surgical margins are really wide - 1cm or greater - that sometimes radiation can be avoided but with a tumor that is 5.1cm in size, I would think that every surgeon, radiation oncologist and general oncologist would recommend radiation.
While radiation is given to attack any cancer cells that might be left in the breast, chemo is given to search down and attack any cancer cells that might have moved outside of the breast. Even with negative nodes, with a 5.1 cm tumor, there is a risk that some cancer cells might have escaped the breast, either undetected through the nodes or possibly through the bloodstream. So again, it would be unusual for any doctor to not recommend chemo for anyone who has a tumor that is 2cm or greater in size, and highly unusual for chemo to not be recommended for a tumor that is 5cm in size.
So, based on your tumor size, the standard of care would be both radiation and chemo.
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So you can more than one sentintel node?
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Janet, in many cases (probably most) more than one node is removed during a sentinel node biopsy. And yes, there can be more than one "sentinel" node however if there are more than 2 (or maybe 3), then really what it means is that there is no sentinel node. Let me explain:
Prior to SNB surgery, you receive injections into your breast, usually 4 (sometimes 6). The injections might be around the nipple or they might be around the tumor. The key is that each of the injections should be aimed in a different direction. The injections may be a radioactive tracer or they may be blue dye or they may be both. I had both. Once the injections are done, you have to wait. The minimum waiting time is around 30 minutes but sometimes the injection is done up to 24 hours before surgery. During this waiting time, the injected substance moves through the breast to the lymph nodes. When I had my injections, I was lying under some sort of camera that was able to view the radioactive tracer as it moved through my breast. I was actually able to watch it on a computer screen that was by my side. I saw all four injections, which originally headed in different directions, wind their way up to the lymph nodes under my arm, and all converged at exactly the same place, which was the sentinel node. In my case this took only about 20 minutes.
"Sentinel" means "guard" and this is the node that guards all the other nodes. The idea is that everything that enters the lymphatic system in that part of the body enters through this sentinel node. In my case, I had a clear sentinel node - all the injections converged at the same node. However, the injection and dye continued to move on to the next node. So in total I had 3 nodes removed. On my pathology report, two were identifed as being "sentinel nodes" (these had the tracer and blue dye) and one was an axilla node. This third node was removed as a precaution; my surgeon's preference is to always remove the sentinel node and then one or two nodes that are lined up right behind the sentinel node. This is just in case some cancer cells have moved through the sentinel node without leaving any trace.
For some women, when they get the injections, the dye moves to a single node. Some surgeons will remove just the sentinel node and others will remove the sentinel node plus one or two that follow. For other women, the injections move to a couple of nodes. Here again some surgeons will remove just those two nodes while others will remove the two sentinel nodes plus one or two that follow. And then, for other women (about 10% of cases), each injection moves to a different node. In that case, it's assumed that there is no sentinel node - there is no single guard node that captures everything that is entering the nodal system. When that happens, more nodes need to be removed, usually the entire first clump or first level of nodes. My surgeon did warn me in advance that while he planned to remove 2 or 3 nodes, if there was no clear sentinel node, he might have to remove more. In those situations, you in effect are no longer having a sentinel node biopsy because the radioactive tracer and/or blue dye went to a bunch of nodes rather than a single sentinel node.
Hope that makes sense.
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Beesie thank you for the information. It is pretty much what I am expecting too. I just want to do whatever I can to keep this from recurring.
I don't know why I am so sore right now. I think I am possibly more so now than I was the couple days after surgery. My lymph node incision is big, lumpy and tender and I feel a lump under the incision (scar tissue no doubt). My breast incision looks so much better than the lymph node incision. There is just a spot or two that is lumpy, but the breast itsself is tender. It feels full and is visibly (when standing nude in front of mirror) larger than the other breast. I guess it is swollen but I just wish it would get back to normal.
Anyway, I guess I shouldn't complain, I'm really not doing so bad. Feeling pretty good most of the time.
Deb
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Hi all--I have a question that hopefully someone can answer. I had lumpectomy with sentinel node biopsy on July 19th. The BS had approval to do Axillary Dissection at same time and in consultation indicated that he may go ahead and do Axillary if there shows need to avoid another surgery. I had 7 nodes removed. Fast forward to July 27th, met with oncologist where I was diagnosed with IDC, Grade1, Stage2, 1/7 (1 tested positive). Treatment will be: Chemo FEC-T for 4 months, 1 month rads, 5 years Tamoxifen. They have not started yet until I meet with BS this week as Oncologist needs to know if there will now be an Axillary Dissection because if so, chemo cannot start until 2 weeks after surgery (at least-based on recovery). From what I read on other profiles, this seems like a lot of nodes removed in a "sentinel node biopsy". Also, from what I read and based on my slow recovery from this surgery--there is discussion about the need for additional node removal (risking lymphodema) because will it actually change the treatment plan? I did not see surgeon post-surg as he was back in surgeries and didn't get out until after I was released. Does anyone know if I will need Axillary Dissection--for some reason, I am more nervous of this than chemo, and can I refuse based on the treatment plan already prescribed? Thanks in advance, Rachel
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Rachel, I can't advise you but can tell you what I did. My surgeon took 4 nodes and I told him no axillary dissection. He told my DH the nodes were clear but path found a micromet in one. He and the rad onc felt confortable that rads would get any stray cells and so did I.
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Rachel: It is a tough decision - try to get as much solid information as you can from your doctors. Pros and cons. Every woman's preferences and experiences are different, but for what it's worth, here's mine...
My SNB path report showed micromets in 1 node, a few isolated cells in another, 2 clear. I consulted with my med onc who couldn't see why I was considering foregoing the ALND surgery - my concern was not so much the risk of lymphodema (by the way, you should be aware that radiation also increases your risk of lymphodema) but delay of chemotherapy for my aggressive triple negative cancer. Med onc said studies show up to 12 weeks delay is okay (though I wondered about that for trip negs); she also said that I might not qualify for clinical trials now or in the future if I did not follow standard of care (which at that time was, and still is I believe, to do the ALND). I then met with my rad onc and went over a lot of research I had done showing that rads and ALND seemed pretty equivalent in efficacy. He spent a lot of time with me going over the stats and came up with a treatment plan. There is definitely a trend away from doing ALNDs. After that meeting I was pretty convinced I would NOT do the ALND. Finally, I spoke with my BS, a woman I liked and trusted implicitly, who said that with an ALND, I could be correctly staged -- though that didn't matter much for treatment decisions as I knew I was getting chemo anyway. By far, the most compelling argument she gave me was this: If there were cancer cells in my nodes, the ALND would get rid of it (you can't ever be certain with chemo or rads). An alternative she suggested was going ahead with chemo and doing the ALND afterwards if I wanted. My med onc was on board with that too. But as it happened, my BS had a cancellation in her calendar and got me in for surgery two days later. 10 more nodes removed, all negative. I healed up quickly and had chemo started 3 weeks later. The scope of my radiation was scaled back since my axillae had been removed, so I benefited from less rads. I haven't had lymphodema though I take precautions. I will say it was an agonizing decision for me. Feel free to PM me.
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