DCIS STAGE 0 pn0(i+)

Agada,

My oncologists told me that if you opt for double mastectomy, that they have confidence that there is no recurrance possibility for DCIS. I did not opt for one, but it did make me think twice, since the prognosis was so good for this type of treatment.

Hope that helps.

Peace to you.

pN0(i+) is a subcategory of pN0, meaning Node Negative.  The (i+) means that there were 'isolated tumor cells' (ITC).  Isolated tumor cells are defined as "single tumor cells or small cell clusters not greater than 0.2mm, usually detected only by immonohistochemocial (IHC) or molecular methods but which may be verified on H&E stains. ITCs usually do not show evidence of maligant activity e.g., proliferation or stromal reaction."  http://www.nccn.org/professionals/physician_gls/PDF/breast.pdf  (I think you need to register to be able to view this file.)

So what this means is that pN0(i+) is considered to be the equivalent of being node negative.  And what this means is that anyone with DCIS who has this pathological finding and who otherwise does not have any invasive cancer (i.e. no microinvasions) will be considered to be Stage 0 (i.e. pure DCIS).  The (i+) designation is noted next to the N0 simply to inform anyone looking at the file that these ITCs were found. 

There is some debate as to what the presence of ITCs means.  In many cases (most cases?) it's assumed that the cancer cells were somehow transferred to the nodes, possibly by the surgical tools.  When the diagnosis is pure DCIS with no evidence of microinvasion, that seems to be a logical assumption, particularly since by definition, ITCs show no sign of malignant activity (i.e. these are not active growing cancer cells).  For those who have invasive cancer, this explanation can be questioned and in fact recent research has shown that women with invasive cancer who have ITCs and who aren't given chemo have a less favorable prognosis than those who get chemo.  But I've searched about a dozen articles on DCIS and ITCs and there appears to be no evidence that the presence of ITCs in DCIS patients has any implications.  So the explanation that the isolated tumor cells landed on the nodes by accident, from the surgical instruments, seems to hold for those who have pure DCIS.

Agada, what that means is that your diagnosis is in fact pure DCIS, your prognosis is assumed to be the same as it would be with pure DCIS and your treatment will be the same.  After having a bilateral mastectomy for pure DCIS, normally there is no other treatment, except for monitoring.  The only thing that surprises me about what you were told is that your surgeon and/or oncologist is not continuing to follow you, at least for a year or two.  In my case, I wasn't turned over to my regular physician until 2 years had passed and during those 2 years, I had 6 month follow-ups with the surgeon (I also could have seen the oncologist but chose not to).  So while your treatment seems to match up with standard practice, personally I think you are being sent off too quickly.

Agada- I am so sorry you are going through this!

I would seek a 2nd opinion - I can't believe they won't see you for a follow up!!!  My oncologist wants to see me every 6 months for 2 years then every year therafter.  My BS wants to follow the same schedule!

I got a 2nd opinion at Mayo Clinic and was very happy with the level of service.  I tried to see someone at MD Anderson but they also refused to see me.  If travel is not an option for you, I would make an appt with an NCI center affiliated oncologist for a 2nd opinion.  You should be heard!  take care!

This is topic SOOOO interesting!! I had no idea about this kind of diagnosis. Thanks Bessie, as always so informative. I'm grateful you share your incite!

-c