Once again DCIS pn0(i+)

pN0(i+) means that the pathological assessment (that's the "p") of the lymph nodes shows isolated tumor cells (that's the "i+").  Isolated tumor cells (ITC) are cancer cells that in total area are smaller than 0.2mm.  The assumption when there are so few cancer cells present in the nodes is that they most likely were placed there by a surgical instruction and therefore do no represent do true nodal invasion. Therefore ITC is considered to be node negative (that's the "N0") but the notation that there were ITCs present is included in the final pathological staging. So someone with DCIS who has ITC would be have the pathological staging of pTis/pN0(i+)/M0. Although positive nodes immediately move someone from Stage 0 to Stage I, because ITCs are considered node negative, someone with DCIS and ITC would still be Stage 0.  

Yes, isolated tumor cells in the nodes are always classified as pN0(i+), whatever the stage of cancer.  Here is a link to the NCI explanation of staging.  The explanation of ITC is not quite 1/2 way down the page:  

Stage Information for Breast Cancer 

I think that Tamoxifen is regularly recommended for anyone who has invasive cancer, even if they have a BMX and even if they are node negative, because of the risk of distant recurrence. That's not an issue for those who have pure DCIS because there is no risk of mets from pure DCIS.  A 5mm grade 1 invasive tumor probably presents a very low risk but there still would be a risk and Tamoxifen can reduce it (by about 50%, I believe).  Has your oncologist told you what your risk is?

thank you Bessie

my oncologist indicates my risk is low but recommendation is still tamoxefen which I have agreed to start after I get some energy back from my bilateral mas 16 days ago. I am still confused if the itc are from the stero bio or excisional biopsy or are spreading cancer and I am not sure there is an  answer.

thanks very much

I appreciate it,

hi All

This PNO i+ really did add an added dimension to an already complicated situation. I am 20 days post bi lateral and I know that real soon I need to start the tamo and just hoping to sleep at night and for less pain first. The onco stated 5% without tamoxefen and bc surgeon stated 1 to 2 percent without tamoxefen as a chance of anything happeniing.  Both indicated approx 50% reduction with tamoxefen. They both indicated that I am still node negative.. Unfortunately, there are few studies out there to assist with making a decision regarding this.  Appreciate knowing that I am not alone with my concerns.

take care,

I love chocolate!!

Agada

hang in there.  Put a call into the gyn to see if they want anything before i begin this process

take care,

chocolate

Hi Agada -  So sorry to hear about your cousin.  I also have breast/ovarian cancer in my family and I cannot take tamoxifen.  Do you doctors recommend having your ovaries out because of the isolated tumor cells or because you cannot take tamoxifen or both? I am curious since I have both issues also with a diagnosis of DCIS.  I have an appointment tomorrow to see my oncologist so will ask him about the ovaries.