final pathology shows microinvation please help

jpmercy
jpmercy Member Posts: 189
edited June 2014 in DCIS plus HER2-positive Microinvasion

i was dx with DCIS grade 3 mulit-focil i am 30 years old and have a family history but am BRCA negative. i opted for a bilatral mastectomy due to age, family history and high grade and i was not comfortable with chance of recurrance. anyway, my final pathology shows a .2cm microinvation and reads .2cm invasive infitltrating ductal carcinoma 0/5 nodes were negative.  pathology stage states pT1, pN0, pMX. what does this mean, stage 1a? and what treatment is next, i meet with the doctor next week. is chemo recommended or am i in a grey area and it is too snall to worry but not small enough for me to personally not worry? can i request an oncotype test? any incite would be greatly appreciated, i was trying to be so strong for me and my family i have a seven month old baby thought doing BMX was best decision for me and i do not regret it now at all but now im terrified it could travel somewhere else! thanks for reading please respond.

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  • Beesie
    Beesie Member Posts: 12,240
    edited September 2010

    Jennifer, from what you've explained, your stage is Stage I.  There are no subcategories in Stage I but there are subcategories for the tumor size, the "T" in the TNM staging classification.  At 0.2cm, your tumor size is T1a.  Here are the 4 subcategories of "T1" sizing:

    T1: Tumor not larger than 2.0 cm in greatest dimension
    • T1mic: Microinvasion not larger than 0.1 cm in greatest dimension
    • T1a: Tumor larger than 0.1 cm but not larger than 0.5 cm in greatest dimension
    • T1b: Tumor larger than 0.5 cm but not larger than 1.0 cm in greatest dimension
    • T1c: Tumor larger than 1.0 cm but not larger than 2.0 cm in greatest dimension

    As for treatment, with a 2mm invasive tumor, it is highly unlikely that your treatment will be any different than it would have been if you'd had pure DCIS.  Chemo usually isn't recommended for invasive tumors that are less than 1cm in size, unless the pathology is unfavorable (ER- / PR-negative and/or HER2+).  Even with a unfavorable pathology, treatment guidelines suggest that chemo be considered only for tumors that are greater than 5mm in size (although sometimes it's given for smaller tumors).

    As for your prognosis, anyone who has invasive cancer unfortunately faces the possibility of mets. That's the one difference vs. someone who has pure DCIS.  Realistically though, for those of us who have such tiny invasive cancers, the risk of mets is very very low.  I had a 1mm microinvasion and was told that my risk is 1% or less. 

    With this news about your pathology report, it's normal to be scared and to start worrying that the cancer could travel somewhere else.  The fact is however that your risk is likely low enough that you shouldn't spend time and energy worrying about.  Still, it may take a while for you to get to that place. It's natural to worry and in my case, it took quite a few months before I stopped thinking that every ache and pain and headache was mets. But after a while, I just stopped thinking about it at all. Hopefully you'll find the same. 

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  • AsiaYM
    AsiaYM Member Posts: 2,216
    edited September 2010
    Treatment OptionsSTAGE I

    Tumor less than or equal to 2 cm; no lymph nodes involved

    Treatment to the Breast

    Modified radical mastectomy; radiation after mastectomy only occasionally needed

    OR

    Lumpectomy plus radiation

    OR

    Very occasionally, lumpectomy alone, with or without internal radiation -- only for a limited subset of women

    Treatment to the Lymph Nodes

    Axillary lymph nodes removed by traditional approach

    OR

    Sentinal approach (for people without enlarged nodes)

    Chemotherapy

    May be given to reduce the risk of recurrence

    Hormonal Therapy

    Used for people with hormone-receptor-positive cancer

    Targeted Therapy

    No current role

    Treatment to Other Parts of the Body

    Does not apply

    Jennifer- certainly you can ask for oncotype test.  Knowledge is powder.  Discuss options with your doctor.   

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  • jpmercy
    jpmercy Member Posts: 189
    edited September 2010

    Beesie

    thank you for your post it made both my husband and i feel better. still scary but on the bright side i still feel blessed to have found this as early as i did. im anxious to talk to my doctor tomorrow. i am er and pr positive 50% awaiting HER2 results. does that usually require hormone therapy? thank you for your post!

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  • jpmercy
    jpmercy Member Posts: 189
    edited September 2010

    i just wanted to update regarding my first and second opinion regarding treatment for my 2mm invasion that was found after BMX and initial dx of DCIS Er/Pr+ Her 2 +++ pathoogy, first opinion from a well known highly respected oncologist second opnion from Roswell Park Cancer Institute, both feel that a short round of chemo and one year of Herceptin is my best bet for a good long term prognosis.  they mostly feel this way bc i just turned 30years old so my prognosis is different than many and i know they are treating more aggressivly because of this but i just wanted to post in case anyone was in a similar position. so im going to take the year and do what i have to do!

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  • happymom8285
    happymom8285 Member Posts: 205
    edited November 2010

    Jennifer, was thinking about you.  How are you doing?  You must be in your chemo treatments by now.  Hope you're handling things ok.  Let us know!

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  • jpmercy
    jpmercy Member Posts: 189
    edited November 2010

    HI Happymom,

    just saw you posted. i am doing very well! i am doing weekly taxol 12 weeks with herceptin and then herceptin for a year. very well tolerated just more of a pain to go each week and some stomach issues...i have been working full time accept infusion day each week, caring for my 10 month old and have not lost any hair thanks to penguin cold caps! i am 6 weeks in 6 to go!! thanks for thinking of me! almost to the finish line with the chemo!

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  • BackpackMakayla
    BackpackMakayla Member Posts: 1
    edited May 2011

    thanks for sharing...

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  • Lbwagner69
    Lbwagner69 Member Posts: 45
    edited February 2013

    Just had double mx and reconstruction via tram flap...pathology report shows area of invasive (.5cm her2+). This was obviously removed in surgery. Will do lymph nodes after infection goes away in abdomen....a little worried but glad to be ahead of things....

    Laurie

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  • Beesie
    Beesie Member Posts: 12,240
    edited February 2013

    Laurie, if the size of the invasive lesion was 0.5cm, that's the same as 5mm.  That's larger than a microinvasion, which is never more than 0.1cm (1mm) in size. It's a t1a tumor, and unfortunately it changes your diagnosis to IDC Stage I.

    An HER2+ invasive lesion of that size sometimes warrants additional treatment, such as chemo and Herceptin.  Here's a link that might be helpfu to you.  This is a discussion thread in the HER2+ forum that talks specifically about these smaller HER2+ invasive tumors:  calling all t1A (> 1 mm but < 6 mm) sisters who are HER2+

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