anyoneTN with DCIS and microinvasion with no chemo

Barbe,

- All DCIS is Stage 0. Within the TNM staging system, DCIS is Tis / N0 / M0.

- 'DCIS with a microinvasion' is not DCIS; it is the very earliest diagnosis of IDC.  DCIS with a microinvasion is Stage I.

- A true microinvasion is 1mm or smaller in size.  A 0.5mm tumor would certainly qualify as a microinvasion.  Within the TNM staging system, a microinvasion is a T1mic tumor.

- Often women who have slightly larger invasive tumors still call their tumors microinvasions however officially (within the TNM staging system) they are not.  A tumor that is greater than 1mm but no greater than 5mm is a T1a tumor.

- DCIS can be HER2 tested. So DCIS can be triple negative.  However HER2 testing on DCIS is currently meaningless, since there is conflicting information about whether being HER2+ for DCIS is a bad thing or a good thing.  And in any case, if DCIS tests as being HER2+ (about 40% does, much more than IDC), there are no changes in the treatment plan.  So many women with DCIS don't get HER2 results but certainly it can be tested.

- For those who have DCIS with a microinvasion, the HER2 testing should be done on the invasive portion of the tumor (i.e. the microinvasion), not on the DCIS.  In that case, the results are meaningful but still, unless the tumor is a bit larger than a microinvasion, usually the treatment won't change.  Once you start getting into 3mm or 4mm tumors (vs. a 1mm microinvasion), sometimes Herceptin and chemo is considered.

- 1 cm = 10 mm   So this mean that a 1mm tumor is the same size as a 0.1cm tumor.

- And, to your last question, no, I have always been Stage I with a T1mic tumor.

My apologies again to the TN folks - I don't mean to turn this forum into a discussion about DCIS!

Mary Louise, were your invasive tumors 0.6cm and 0.4cm or 0.6mm and 0.4mm?  I ask because if the cm sizing is correct, then you have a T1a and a T1b tumor, which are not microscopic foci of cancer.  Most oncologists probably would recommend chemo for tumors that size, if they are triple negative.  Certainly the NCCN treatment guidelines suggest that chemo be considered for any tumor that is 0.6cm or larger. 

But, if the tumors are 0.6mm and 0.4mm, then they are microscopic foci and then you'd be hard pressed to find any oncologist who would suggest chemo, even for someone who is triple negative or someone who is HER2+++.

Ellie, thank you for the PM, feel free to contact me at any time.

I'd had 3 other lumpectomy biopsies since I was 21 and though they were all benign, I'd never had a mammogram that I wasn't called back for. That's 30 years worth! Then I had a breast reduction when I was 48 or so and had perfect perky breasts. That's a lot of breast surgeries. So when I had the diagnosis of cancer in front of me I said take them off. I didn't have recon for various reasons, but if I'd had one off, I would have done some sort of reconstruction.

Keep asking Ellie!

Barrie is north of Toronto, Ontario. There is a big lake, Lake Simcoe that joins a whole bunch of other lakes with canals that you can travel quite far on. It is almost in "cottage country". We are moving to Alliston which is about 1/2 hour south to be closer to my kids who are having babies! It will be slightly closer to work, too.

It's good to eat healthy, but don't deny yourself the things you enjoy in moderation. Any doctor will tell you that. Think of the ladies on the Titanic that didn't have desert!!!

Ellie- I went into the tnbc site and found the thread you posted in. You did misunderstand Linda. Do you know how to start a new thread in that site, as Linda suggested? Use the "Start a new topic" button.

There are a lot of knowledgeable people in that site and if you post your question in a manner that they can see it (New Topic) you may get the answers you seek.

It's worth one more try. Take care.

Mary Louise, next time you see your oncologist, you might want to ask about the statement "Two microscopic foci of invasive carcinoma are identified (0.6 cm and 0.4 cm)"  I have never heard of 0.6cm and 0.4cm tumors being described as "microscopic foci".  What a doctor would call a microscopic foci is usually 0.1cm (1mm) in size or less.  Personally I'd put more faith in the words "microscopic foci" than in the dimensions  - typing cm instead of mm is a pretty easy mistake.  If your invasive tumors were really 0.6mm and 0.4mm in size, then your treatment plan  - with no chemo - would make perfect sense.  And the whole sentence in your pathology report would make more sense too.  To say that "bulk of the lesion consists of DCIS" doesn't make any sense if the total size of the lesion is 2cm at it's largest dimension and there are two areas of invasion that total 1cm in size.  If that were the case, the bulk of the lesion would not be DCIS - the lesion would be split evenly between DCIS and IDC. 

Something doesn't compute.  Getting your oncologist to explain might really ease your mind if it turns out that the invasive tumors were 1/10 the size that you've been led to believe.

If there is a gray area....I say go with the chemo.  It is so very doable.  It goes by so fast.  I felt so cleansed by it.  It isn't that bad.  Very doable.  For triple negatives....it works so well...it is our saving grace. 

Not sure if I am on the correct topic to ask this question.  I am trying to understand my path report.  I do see where it states I am ER-/PR- but don't see where the HER2 results are...  Shouldn't that be on the path report?  Is it under some other initials?  There was a news article in the paper about the Triple Negative Breast Cancer, so it has me searching for my results.  Thanks for any help or guidance for this.

Oops...now i see on this tread i wan't tested for HER2 due to it being DCIS.   

Ellie,

This is all new to me... on the path report I only see DCIS, Grade 3, High grade with comedo necrosis.  Don't see anything saying "microinvasion".  I am scheduled for a NSMX (think I got that correct) and immediate reconstruction Oct. 13th.  Was not sent to an oncologist, was told chemo or rads are not required.  

Thank you Ellie.  Hope you get good news tomorrow. Keeping my fingers crossed for you