DCIS, Node(+) 0.5cm, Any info?

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coykoi
coykoi Member Posts: 4
edited June 2014 in DCIS (Ductal Carcinoma In Situ)

Hello all,

My mom was diagnosed with DCIS with microinvasion ~ 1 month ago. She had a lumpectomy, and they took out 2 sentinel axillary lymph nodes. Now they found 0.5cm metastasis in 1 lymph node, the other lymph node was clean.

She is also scheduled for another lumpectomy next week, because the superior border was found to have DCIS too. This confuses me a bit, I guess it is a separate focus? 

Not sure what forum this belongs on, since DCIS with microinvasion isn't common. And DCIS with microinvasion AND positive lymph node is even less common.

So her path report says pTisN1aMx. The original biopsy they took (pre-lumpectomy) is ER+ (100% cells moderate to strong nuclear staining). PR+ (2% cells have weak to moderate nuclear positivity)... still waiting on path report on the lump they removed. Don't know about HER2 yet.

Just wondering if anyone has any info on DCIS with positive lymph node?? I'm confused because I'm not even sure what stage of breast cancer she's considered to have... since she originally had DCIS. But now has a positive lymph node. 

Also, what is the prognosis of DCIS with (+) lymph node, vs. "regular" breast cancer with (+) lymph node? 

If anyone has any info on anything, please let me know! Thanks!

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  • cycle-path
    cycle-path Member Posts: 1,502
    edited June 2011

    coykoi, I think DCIS with a microinvasion is actually pretty common. If you don't get answers here, you might go on the next forum, called (I think) DCIS with a Microinvasion that is HER2 positive. The people there won't mind that you don't know the HER2 status.

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  • Beesie
    Beesie Member Posts: 12,240
    edited June 2011

    coykoi,

    DCIS cannot metastisize to the lymph nodes. Only invasive cancer can.  So it's the microinvasion that your mother had that has resulted in the positive lymph node. While DCIS with a microinvasion is quite a common diagnosis, it's much more unusual for an invasive tumor as small as a microinvasion to lead to nodal involvement - this only happens in about 10% of cases where there is a microinvasion.  Additionally, in your mother's case the invasion into the node is greater than 2mm in size (you indicate that it's 0.5cm, or 5mm) which means that this is greater than just a micromets - it's an N1 positive node.

    In the world of breast cancer, diagnosis, staging and treatment are all based on the most serious of the conditions that are found.  In this regard, IDC (invasive cancer) trumps DCIS because IDC is the more serious condition, and nodal involvement trumps pure IDC.  What this means is that your mother's DCIS is not the driving factor in her diagnosis. In fact the DCIS is pretty much irrelevant, except that it needs to be removed (and that probably means a re-excision to get clean margins).  Even the microinvasion is not the driving factor.  Your mother's diagnosis is not 'DCIS with a microinvasion' - because of the nodal involvement. 

    pTisN1aMx is Stage II breast cancer.  This is still considered to be "early stage breast cancer" but it is very different than DCIS and DCIS-Mi.  I don't know what the treatment would be with such a small invasive tumor and just one involved node - a lot will depend on your mother's hormone status.  My suggestion is that you check out the Stage I and Stage II Breast Cancer forum on this discussion board.  There may be other women there who've had a similar diagnosis.

    FYI, here is some information that explains staging:   How is breast cancer staged?

    edited to add:  kmmd, yes you are right.  I copied the staging from the original post and didn't really think about it.  The 'T' is pT1mi because of the presence of the microinvasion.  pTis would be pure DCIS.  The 'M' may still be MX rather than M0 if no additional testing has been done yet (such as a PET scan).

    And here's an even better explanation of staging:  http://www.cancerstaging.org/staging/posters/breast12x15.pdf  

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  • ktym
    ktym Member Posts: 2,637
    edited June 2011

    I'd agree with Bessie.  (Although I think the staging is technically  pT1(mic),N1a,M0, stage IIA).   Irrelavant I know Bessie--sorry--it just caught my eye.  However, I think you're right on in your information as usual. 

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  • coykoi
    coykoi Member Posts: 4
    edited June 2011

    Thank you so much for the reply. Her original biopsy report indicated she had a small area with possibly both DCIS & LCIS. This may be a stupid Q, but is it the DCIS or the LCIS that "got out" & got to the lymph nodes? 

    The path report just says there's a 0.5cm metastasis in 1 lymph node. Is there a more detailed path report on what was found in the lymph node ? Or do reports usually just indicate there's a metastasis of some kind ? Also, is it normal for the metastasis in the lymph node to be bigger than the original tumor? Her DCIS that they took out was only 0.2cm (!) I was talking to my mom, and we just found it very strange... not quite sure what's going on! 

    I will check out the stage I/II forum. Thanks again!

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