Pain

Sandra, I'm sorry that you are having this pain.

You say that you had DCIS but your signature line indicates that you had 2 positive nodes. Is it correct that you had positive nodes?

DCIS cannot travel to the nodes. So if any cancer was found in the nodes, then in addition to the DCIS, you must also have had some IDC (invasive cancer).  Often DCIS and IDC are found together so it wouldn't be unusual to have both. When this happens, the diagnosis and prognosis is based on the IDC.  The presence of any amount of invasive cancer, or a finding of positive nodes, means that the diagnosis isn't DCIS Stage 0, even if some DCIS is also present. The presence of positive nodes always moves the diagnosis to Stage II (or possibly Stage IB if there is only nodal micromets).  

Obviously as you are facing your current concerns, this is a very important difference that you need to have clarified, i.e. whether you had Stage 0 DCIS with no nodal involvement, or whether you were Stage II with positive nodes.  In either case, I wish you the best of luck and hope that your pain is being caused by something like a pinched nerve. 

Ah, you had ITC - isolated tumor cells. That explains it. Technically that is node negative and it would keep you at Stage 0. ITC means that the size of the invasion in the nodes is <0.2mm and less than 200 cancer cells - extremely tiny.  The reason ITC is considered to be node negative is because the usual assumption is that the cancer cells were accidentally placed in the node by a surgical instrument when the node was being removed. 

With a small grade 1 DCIS tumor, it makes sense to assume that any cancer cells in the nodes were accidentally placed - it would be extremely rare to find a hidden area of invasion with that type of DCIS pathology. I have to admit though that it's also odd, and quite rare - to have two lymph nodes with ITC. That seems awfully sloppy on the part of the surgeon. Did you ever have the nodes with ITC re-analysed? The line between ITC and micromets is a very fine line; if the number of cancer cells exceeds 200, then the diagnosis changes from ITC to micromets, the staging is no longer Stage 0 and the assumption is made that there was a hidden invasion. 

It's impossible to know which of the very rare occurances is the one that happened to you.  Did you truly have two cells with ITC that were accidentally placed?  Or did you actually have some invasive cancer in your breast that was never detected and that lead to a very small invasion in two of your nodes?

Hopefully it's the former.  And all that aside, the pain that you are experiencing, with the feeling of electric shocks down your spine, does sound more like it might be a pinched nerve.  When will you be seeing your oncologist?  And which doctor ordered the ultrasound and Xrays for you? Have you had a chance to review the results with that doctor yet, to discuss what might be causing the pain, given that the tests haven't uncovered anything?

FYI, the following website provides an great explanation of ITC vs. micromets, from the standpoint of a pathological review:  Protocol for the Examination of Specimens From Patients With Ductal Carcinoma In Situ (DCIS) of the Breast

Page 17: Isolated tumor cells (ITCs) are defined as single tumor cells or small cell clusters not greater than 0.2 mm and numbering less than 200 cells. They may be detected by routine histologic examination or by immunohistochemical (IHC) or molecular methods. ITCs do not usually show evidence of malignant activity (eg, proliferation or stromal reaction), but micrometastases may show these changes.
Almost all tumor cells present in lymph nodes of patients with DCIS are isolated tumor cells or the cells may be artifactually displaced from a previous procedure. Isolated tumor cells detected in cases of DCIS have not been shown to have prognostic importance.If a larger metastasis is found, additional tissue sampling and review of slides are helpful to determine if an area of invasion is present.

Page 7:  pN0 (i+): Malignant cells in regional lymph node(s) no greater than 0.2 mm and no more than 200 cells (detected by H&E or IHC including ITC)

Note: Isolated tumor cell clusters (ITC) are defined as small clusters of cells not greater than 0.2 mm or single tumor cells, or a cluster of fewer than 200 cells in a single histologic cross-section.# ITCs may be detected by routine histology or by immunohistochemical (IHC) methods. Nodes containing only ITCs are excluded from the total positive node count for purposes of N classification but should be included in the total number of nodes evaluated.

# Approximately 1000 tumor cells are contained in a 3-dimensional 0.2-mm cluster. Thus, if more than 200 individual tumor cells are identified as single dispersed tumor cells or as a nearly confluent elliptical or spherical focus in a single histologic section of a lymph node, there is a high probability that more than 1000 cells are present in the lymph node. In these situations, the node should be classified as containing a micrometastasis (pN1mi). Cells in different lymph node cross-sections or longitudinal sections or levels of the block are not added together; the 200 cells must be in a single node profile even if the node has been thinly sectioned into multiple slices. It is recognized that there is substantial overlap between the upper limit of the ITC and the lower limit of the micrometastasis categories due to inherent limitations in pathologic nodal evaluation and detection of minimal tumor burden in lymph nodes. Thus, the threshold of 200 cells in a single cross-section is a guideline to help pathologists distinguish between these 2 categories. The pathologist should use judgment regarding whether it is likely that the cluster of cells represents a true micrometastasis or is simply a small group of isolated tumor cells.

Hi,



I'm so sorry you're going through such a difficult time. You had asked about whether a soft tissue I jury would show up on an xray, it would not.



I am not sure if you have ever seen a physiatrist, a doctor that specializes in joint and muscle conditions of the whole body (not just a specific joint). If you're open to it, I recommend trying to find one to take a look at you.



Personal experience: I was in a car accident 16 years ago, and only just developed pain (electric and shooting with numbness and tingling) in my hip. It's possible for old injuries to get exacerbated later in life, or it could be something

else. I hope you do t give up hope. I've had chronic pain since birth and it can be quite disabling emotionally at times. But usually, there is light at the end of the tunnel. You could try alternative therapies for the pain to see if that helps, acupuncture, reiki, massage, etc... I wish you all the best and hope that you don't mind my attempt at offering recommendations. Be well, and tale care.