isolated tumor cell

Do a Google search for the 2011 NCCN breast cancer guidelines.  They will provide you with information regarding Standard of Care.  Once you meet with your medical oncologist, you may ask for a second or even third opinion.

Good luck.

I thought you had to have a suitable sample for oncotype dx, and a 5mm might be considered too small.  You might want to call Genomic.  They have experts on staff who will hopefully be able to answer your question about have the test done. 

Barbe, I think ITCs have been considered node negative for quite a while.  Similarly, I think micromets have been considered node positive for a long time.  The change to the staging guidelines this year is that micromets no longer automatically move a patient up to Stage II.

Previously, any node positive status (including micromets) was Stage II (or higher).  The change this year is that those who have micromets may be Stage IB.  This is a new classification within Stage I, which previously wasn't subdivided into "A" and "B". With this change, anyone who is node negative and has an invasive tumor that is 2cm or smaller (counting the invasive component only) is Stage IA and anyone with micromets and an invasive tumor that is 2cm or smaller is Stage IB.  This of course assumes M0. 

Did you have individual areas of cancer within your nodes that were greater than 0.2mm in size? That would be micromets and that would be node positive.  But if you had several areas of cancer that each individually were 0.2mm or smaller, that would be ITC and node negative.  I think that you can have up to 3 ITCs in a node and it will still be called ITC rather than micromets (but I'd have to look that up to confirm that).  

Barbe, the best explanation I've found for ITCs and micromets are in the Staging section of the physician's guide of the NCCN Guidelines (page ST-2 where they are discussing pathological staging).  You have to register to be able to view the guide, but there is no charge.  The only problem with the current version of the guide is that they have not updated their staging to move small tumor ITCs to Stage IB.  

The definition of micromets is "greater than 0.2mm, none greater than 2.0mm". 

NCCN Treatment Guidelines for Physicians - Breast Cancer 

Unfortunately the Patient's version of the guide doesn't go into those same explanations.  And the website that I have with the AJCC Staging guide (which is the official staging document) only has sample chapter downloads.  A couple of weeks ago when I last checked, Chapter 32, which talked about BC staging, was available for free but today all I can get is Thyroid and Colon cancer. 

The info on the AJCC site indicated that the staging change with regard to micromets only affects those diagnosed from January 1st 2010 onwards.  So that means that you would keep your Stage II staging based on having the micromets.  The good news however is that the reason for the staging change is because they've determined that the prognosis of those with micromets is closer to that of someone who is node negative vs. someone who is node positive.  Here's a quote that I took from the manual a couple of weeks ago when I was looking at it for a discussion in a different thread:

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Should nodal micrometastases be considered different from
nodal macrometastases for purposes of overall stage grouping?
The AJCC Cancer Staging Manual has traditionally grouped breast cancer cases with exclusively nodal micrometastases (pN1mi) as having the same prognostic significance as macrometastases with respect to assigning an overall stage grouping based on T, N, and M categorical classifications. A recent analysis of data in the United States Surveillance, Epidemiology, and End Results (SEER) national cancer database has demonstrated that when nodal tumor deposits no larger than 2.0 mm are the only finding in lymph nodes and the primary tumor is less than or equal to 2 cm (pT1) the incremental decrease in survival at 5 and 10 years was only 1% compared to patients with no nodal metastases detected. Patients with tumors no larger than 2.0 cm (T1) represented 70% of the total population in the analysis, and in this subset calculated 10-year survival decreased from 78% to 77% to 73% for pN0, pN1mi, and pN1a, respectively. This does not justify classifying pN1mi cases with Stage II tumors. This analysis included data from 1992 to 2003 spanning the introduction and widespread adoption of sentinel lymph node biopsy. In this edition of the manual, T1 tumors with nodal micrometastases (pN1mi) will be classified as Stage IB to indicate the better prognosis for the subset of breast cancer patients and to facilitate further investigation.

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That's an excerpt from from pages 20-21 of Chapter 32, Breast Cancer Staging (or pages 364-365 within the total AJCC Staging Manual).  And note that the survival rates incorporate all causes of death, not just breast cancer related deaths.

I don't know anything about mashed together nodes except that I thought this was a pretty common and was one of the reasons why sentinel nodes can be so hard to find (and why you want a expert at the procedure to do an SNB) and why SNBs often remove more nodes than expected (because the nodes are meshed together).     

Barbe, I've looked to see if I can find anything about matted nodes.  Did you have micromets in both your matted nodes?  If they were positive, then I believe that this would be considered "N2" which would increase the stage.  I'm assuming that this would apply even with micromets but I'm not sure. But that does suggest that matted nodes is considered to be more serious. So I've learned something new.  

N1  metastasis to movable ipsilateral axillary lymph nodes 

N2  metastases in ipsilateral axillary lymph nodes fixed of matted (N2a)  

From:  http://www.breast-cancer.ca/staging/stagingclassifications.htm

What might be helpful it to look at the CancerMath website.  They have a place where you can input "nodal detail". The detail is very specific - you can include that you have matted nodes and that they had micromets.  That might give you more information.  

http://www.lifemath.net/cancer/breastcancer/outcome/index.php   

Hi, I don't have ILC but IDC and path says isolated tumor cells in 1 of 4 sentinel nodes removed. My surgeon said I'm effectively node negative, but from everything I've been able to read, this is all very, very new, a case where technology has outstripped the data -  no one knows what to do with this info.  There are a few limited 'short term' survival studies, but that's all there is now.  It frightens me. I don't understand how a "few" cancerous cells can be ignored and classified as node negative. I'm very very uncomfortable with this. I don't yet have hormone and protein status on my cancer available yet, but the surgeon hinted that it's likely E+ and tamoxifen a likely scenario.  My oncologist appt isn't for a few weeks yet.

I had a .38mm micromet and my BS calls me stage 1B and my onc calls me stage IIa... all the same to me. They both say it is extremely unlikely there was further spread, but to be safe I am in chemo (TC x6).. My tumor was 1.9cm, so it was a larger stage 1 tumor.

MY BS says survival rate with micromet is same as Stage 1 with node negative... I am going with that, but am still considering PBMX to even further reduce my risk of a new cancer and to avoid radiation.

Thanks Chocolate!

BDavis, I'm still at an early stage of educating myself on all of this (diagosed end of Jan, surgery last week/bilateral mast), but my fear is that my cancer will not be treated aggressively enough because it turns out to be under 1 cm and because the node spread is something called "isolated tumor cells")...but I think your treatment sounds great (given which-is-worse options). I know this may sound crazy, because when I first thought my cancer was 2.1 cm (pre surgery MRI and U/S measurement), I dreaded the thought of losing my hair to chemo as the second to worst thing short of death. Now of course I am thinking: gee, so my invasive c measurement post surgery pathology is actually only .6 mm, and now I'm out of the chemo line of fire and squat into hormonal therapy should my tumor have hormone receptors...and I'm not comfortable with that. I'd like for my oncologist to treat my cancer as an aggressive cancer which has shown evidence of spread to nodes, even if the cancer in the tumor is under 1 cm, and the spread to node (at least the only one tested-SN) has "isolated" tumor cells.  Obviously I am open to being educated on this point-certainly the oncologist knows more than me- but it's where I'm at and where I'm feeling that I'd be most comfortable. Thankfully I have a couple of more weeks to read up on things before my oncologist appt! But if I were you I'd feel glad to have the guns fired so to speak on my illness. PS I actually thought anything under 2 cm., like your 1.9 tumor, would be Stage 1.Inthat sense, we both have 'stage 1' size tumors, and "spreads' to the node that a few years ago were never acknowledged as anything other than 'negative'. 

KSD... there is no way to know for sure if your node involvement is due to migration or had just made it to the nodes or if it went thru the node and has travelled beyond (which is unlikely).. But because of the uncertainty, I say treat it as if its worse case scenario, not best... then your bases are covered. Chemo is for a couple of months, and could make the difference in survival... Of course my onc said there was an 85% chance all cancer was removed and I was cured, but to take care of the other 15%, I am doing chemo and may even have a mastectomy.

Nothing in this cancer game is a sure thing, so we make the best decisions we can with the information that we have... Some women don't want chemo no matter what, some won't lose their hair no matter what, some are willing to take their chances with recurrance, and then there is me ... I err in the other side, and hopefully it will help me sleep at night and for MANY nights to come.

I asked my onc why I was having 6 tx rather than many who have 4 and he said it was because of my micromet... had I not had a micromet, he would have given me 4tx... of course, I wonder, because I was under the impression I wouldn't need chemo had my nodes been clean... so I may ask again about 4 v 6 treatments as I am having my third on Thursday.

Bottom line, my onc said the micromet either made it so I would have chemo or at least increased my chemo regime.

BD I am with you. Because very little can be sure, I want to operate on the worst case scenario. I suppose I'm having alot of anxiety in anticipation with my meeting with my oncologist; fear that there won't be enough aggressiveness because the bc turned out only to be .6 mm invasive etc. We'll see. I'll post after meeting in three weeks.

Chemo was my choice--at the time, my score was in the intermediate range--size really had nothing to do with it--- it used to be that size was a major determination, but not so much any more.... I think grade, nodes, etc. are more of a consideration now.... but every onc is different and everyone's biology is different.

 I have two young children and I was pre-menopausal--- so for me, the chemo decision took about a second...even though I had an excellent prognosis, I just felt that, for me, chemo was the right decision--- and I have never looked back..... 

chemo is a decision that you get to make-- you will find that most docs, unless the situation is dire, won't "tell" you to have chemo....do what makes you feel like you will be able to sleep at night.... 

I would like to know the difference as well... I had a bilateral mastectomy september 10, 2010 because my right breast had a 2.9cm IDC and DCIS but with all lymph nodes negative.  My left breast as per pathology #1 had DCIS and micromet in 1 sentinel lymph node.  The 2nd pathology of same breast tissue said DCIS, LCIS and isolated tumor cell 0.06mm or 0.6mm (can't remember)  My oncotype was 26. I did 4 rounds of TC chemo and am now on Tamoxifen. I'm considering having my uterus and ovaries removed.