Anyone have a small grade 1 tumor that was node + ?

I had 2 grade 1 tumors. Was was stage I & the other stage II. My understanding is that grade 1 tumor can "learn" to travel to nodes & beyond. Some tumors never develop the ability to travel. My grade 1 tumors went undiagnosed for "several" years. Three years before my diagnosis, I was evaluated for a lump in my armpit. I was told it was an isolated node. Three years later it was found to be a positive sentinal node.

As for the sizing of tumors before surgery, I also got some discrepancies. The way it was explained to me is that, when you are standing getting your mamogram your breast hangs one direction. When you get an ultrasound, you are lying on your back & your breast hangs a different way. When you have an MRI, you are lying on your stomach & your breast hangs straight down. It seems that tumor tissue is pliable & that's why the variation in measurements. Mine(both) measured smaller on my final pathology.

Here's how my physician presented my tumor to me. Mind you, while Grade 1, it is a rare type of breast cancer, mucinous. He said that it was in my body for a very long time. Looking back at prior sonograms, it resembled a cyst. One of many in my breasts. So, like Coraliz, slow growing tumors can be in your body for some time before being diagnosed. Aggressive Grade 3 HER 2 + tumors usually develop quickly and travel quickly. In fact, they develop so quickly that there is very little research that helps dictate treatment for those sisters who have very small HER 2 + tumors because they are often diagnosed when they are bigger and often have node involvement.



My physician also mentioned that because mine is so slow growing, I will need monitoring longer. He said if I got a recurrence it would likely occur after 20 years and then we could treat it for another 20 years. That should put me somewhere in my 90's and I am more likely to pass from something else before then....



But getting back to the positive lymph node with a small Grade 1 tumor. At the end of the day, despite all the research, there is STILL no way of knowing WHY one person's tumor will metastize to the lymph nodes while another's tumor will not. And, until recently with the development of the Oncotype DX test, most Grade 3 ER+ tumors were thought to be aggressive and yet some of those tumors were found to have LOW recurrence scores putting those sisters in a quandary whether or not to have chemo. The bottom line is, while tumor grade has been a somewhat important characteristic in describing a tumor in the past, researchers are still learning about what makes a tumor active. Your situation describes perfectly how elusive cancer still is to researchers.

See, this is what I don't understand. If there is no LVI how does the cancer travel to the nodes? My tumour was right behind the nipple, far away from the nodes, Grade 1, no LVI and it still got to 2 nodes. The size of mine wasn't that small, about 1.3 cm.

bahamamom3, Our stats are very similar. I had a 1cm, Grade 1 breast tumor, but I also had a 5mm tumor in one lymph node.  I, too, have wondered how a small Grade 1 tumor could get to a lymph node while some larger, more agressive tumors do not. I am glad to have thrown everything available at the tumor. Chemo was not nearly as bad as I feared and radiation was doable. Here's to many happy, healthy years for all of us.

Awhile back, someone posted that the Oncotype score gave a lot of weight to the miotic score in its formula calculation. That semed to make sense whe I looked at my path report and compared it to my score. 

yorkiemom, My final path report said 'not found' for LVI, but he cancer still made it way to my node. That has been a mystery for me too.  The only thing I can think of (besides a report error) is the the biopsy took out the spot where the LVI connection was, so when they examined the tumor they didn't see any.

bluepearl...so true.  When someone asks me if they 'got it all out' or am I 'cancer free now', I just tell I'll let ya know when I hit 80. And in the meantime, I'm just doing the best I can to avoid those trucks.

Yes, I had a Grade 1 tumor that measured 1cm but managed to spread to one lymph node. There was no LVI or extracapular extension, but the lymph tumor was a macromet so I had four rounds of TC and 33 rads. I have no regrets. Good luck to you

I am kind of still in the process of being diagnosed.  I was diagnosed with DCIS on a biopsy.  I had two MRI's and there was a spot that lit up both times.  They did an US and couldn't find it and scheduled me for an MRI-guided biopsy.  I got the results of the pathology on that and they found both DCIS and IDC.  The IDC was very small, .5cm, grade 2, ER+/PR- and my HER2 score was a 2 which put me in the category of equivocal.  My results were automatically sent to a lab for FISH testing to ultimately determine whether I'm + or -.  The thing that scares me is that LVI was present.  I'm going for a lumpectomy and sentinel node biopsy next week, but am expecting the worst on the nodes.  I'm not sure how this happens with such small tumors either.  I read that positive LVI is positively correlated with larger tumors.  I have a tumor in the smallest category, a mitotic score of 1 and yet, LVI.  I have seen some posts here that said they had LVI, but no node involvement, which I think is scarier than having node involvement.  I'm guessing I will be somewhere in a Stage II diagnosis assuming my nodes are positive.  This is all so scary.

kyliet - Have Stage 2(micromet in SN) and Grade 1 bc and never heard anything like that about recurrence.  diane

HI,

I would like to get some more input on this thread. I was diagnosed with BC in Dec. 2012. Cells were classified as Grade 1. I hade a lumpectomy and sen. node removal  2/19/13. THe primary was about 1 cm, 3/4 lymph nodes were positive.

Bone scan OK, but CT scan revealed  uterus and 1/2 adrenal glands enlarged.

I am worried about adrenal gland involvement because I read that BC can metastasize to the adrenals. 

I am concerned that this is the beginning of a downward spiral.

I would appreciate any and all input. Especially would like to know how the previous posters are doing.

Scheduled to start chemo on 3/22/13.

Denise 51

Hi,

Thanks for the input. I will try and let you know the outcome of the scan. I am glad to hear you have finished your therapy. Congrats and hugs.

11Momto3 - I read your post with much interest.  I am having my SNB in 2 weeks and my BS also said she thought she would not find anything in the nodes, but I can't imagine why she would say this.  I also had a lumpectomy with another surgeon who thought my "thickening" - not a lump would not be cancer and it turned out that it was.  Mine was not large, but I am having a hard time believing she won't find anything - how would they know?  It's annoying because I could have had both surgeries at the same time and now need to go back.  She said margins were clean, but would like to make sure and go back in again. (this was a different surgeon and I ended up going to Northwestern after that and dropped this doctor).  I don't want to get too comfortable with her "hunch" and end up being shocked.  Did you feel this way?

Kyliet,

Just found out that my enlarged adrenal gland is also due to a B9 adenoma. Not so lucky with the uterine scan. Have thickening and now have to have a uterine biopsy. If it is positive, a hysterectomy will follow and this will delay my BC chemo.

Hate the waiting. I was mentally prepared for the chemo. 

Thanks for your input, hope you are doing well.

Denise51

kyliet - I have also read a lot about Grade 1 not being as responsive to chemo as Grade 2 & 3.  I was initially told my tumour was very small, however after lumpectomy it turned out to be 18mm and not with clear margins, and with micromet in sentinal node.

Had further surgery for axillary clearance and more taken to attain clear margins and had total of 30 glands taken out, with no more positive glands.  The surgeorn told me that when looking at the stage and size of tumour, he estimates it had been there at least 8 years, however I had been having regular mammograms but nothing ever showed up.

I have also read in various sites that there is a higher chance of late recurrence in low grade er+ pr+ breast cancer.

Ched

How ignorant some smart people can be.

Are you going to have chemo? I start today. A little nervous.

Hi Ladies- found your thread by accident, and read some of your comments. I am no expert, but this is what I understand.

Grade 3 tumours do respond more positively to chemo, as chemo works on rapidly dividing cells. That is the whole mechanics of chemotherapy. This is the reason your healthy cells get affected and your hair and skin more than anything else, as your skin and hair is constantly renewing itself. Normal cells get affected, these are the side effects you experience whilst on chemo. They get sick but the cells are not dividing rapidly enough to get killed, so they recover. On the plus side, if Grade1 tumours do spread they are growing much more slowly, so are easier to contain. The spread to the lymph nodes is probably governed by the time they have been there, and how close they are to a lymph vessel. Your lymph vessel is like a storm water drain, and your sentinel node is the mesh grating they put up to catch branches and leaves. Hopefully your "mesh" has stopped the cells from pushing past the grating. Grade 3 tumours are like "Special Forces" troops and Grade 1 are more like a slow foot soldier. Keep well ladies. 

Denise - good luck with your uterine biopsy. Hope it turns out to be a fibroid or something else benign.