Focal cancerization of the Lobules = LCIS???

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buffyjc
buffyjc Member Posts: 61
edited July 2017 in LCIS (Lobular Carcinoma In Situ)

Hi, everyone! As you can see from my signature, I was diagnosed with extensive DCIS in February and had a SMX in April. I've reviewed my final/surgical pathology report a few times but, for some reason, I examined it once more over the weekend and I'm questioning this statement:

"There is focal cancerization of the lobules seen."

What exactly does that mean? I've tried using Dr. Google (shame on me!) and I'm even more confused. I also asked a Facebook group I'm a member of but it's mostly just DCIS members. I called my ONC's office for further understanding and to ask if this changes his non-recommendation for me to take tamoxifen. I was called back a little while ago and he still didn't change his opinion about tamoxifen for me.

So, again, does "Focal cancerization of the lobules" equal LCIS? If so, do I need to meet with ONC again and ask for a tamoxifen script? Of course, I'm thinking solely about the risk of a new primary in the healthy breast. FWIW, I realize this is just one statement mixed along with lots of others in this report but everything else I fully understand (ie., "No evidence of invasion"..."fibroadenoma is present").

Any insight would be appreciated.

Thanks!

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  • MTwoman
    MTwoman Member Posts: 2,704
    edited June 2017

    buffyjc, as you indicated, this is just one sentence, and putting the rest of the report so that we could see it in context might get you more informed or helpful responses.

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  • buffyjc
    buffyjc Member Posts: 61
    edited June 2017

    Thanks, MTwoman! My pathology report is 5 full pages...I'll try to condense.

    Right Breast Nipple Sparing Mastectomy: Extensive DCIS, solid type, nuclear grade 2 present. Focal areas of comedo necrosis. Focal cancerization of the lobules seen. No evidence of invasion.

    Extensive DCIS: the measured area containing DCIS is approximately 6.5 x 3 x 4.5 cm

    All 10 blocks from that area contain DCIS.

    DCIS also focally present in random sections of the upper outer quadrant, and the lower outer quadrant.

    Tissue beneath the nipple is uninvolved.

    Six other blocks from various quadrants also uninvolved.

    Histologic Type: Ductal carcinoma in situ

    Architectural Pattern: Solid with focal cribriform

    Grade 2 (intermediate)

    Necrosis: Focal comedo necrosis is seen

    Margins: Margins uninvolved by ductal carcinoma in situ

    Closest Margin:8mm

    Pathologic Staging: pTIS (Ductal Carcinoma In Situ only present)

    3 sentinal lymph nodes uninvolved by metastatic carcinoma

    Additional Pathologic Findings: Fibroadenoma is present

    Ancillary Studies: Estrogen receptors positive (70%, strong, favorable), Progesterone receptors positive (70%, strong, favorable)

    Tail of right breast, upper outer quadrant: Bland fibrovascular tissue present. No evidence of breast tissue or neoplasia.

    Right Nipple Margin: Fibrous tissue with bland breast ducts present. No evidence of skin, duct hyperplasia or neoplasia.

    Comment: In this case, there is a rather extensive ductal carcinoma in situ, solid type, nuclear grade 2 with focal comedo necrosis. All of the margins are widely negative. There is focal cancerization of the lobules seen. There is no evidence of invasion.

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  • MTwoman
    MTwoman Member Posts: 2,704
    edited June 2017

    djmammo? are you around? what do you think is meant by "focal cancerization of the lobules"?

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  • MelissaDallas
    MelissaDallas Member Posts: 7,268
    edited June 2017

    From Pathology Outlines:

    Definition of DCIS:

    Definition / general

    • Defined as "noninvasive or intraductal cancer"
    • Neoplastic proliferation of epithelial cells confined to the ductal-lobular system without evidence of invasion through the basement membrane into the surrounding stroma (Arch Pathol Lab Med 2009;133:15)
    • May extend into lobules (cancerization of lobules)
    • Represents 20 - 25% of newly diagnosed breast cancers (American Cancer Society: Cancer Facts & Figures 2016)
    • DCIS is not a single disease, but encompasses a heterogeneous group of lesions in terms of morphology, underlying genetic alterations and biomarker expression
    • Several clinical studies have corroborated the hypothesis that DCIS is a precursor lesion of invasive breast cancer (Breast Cancer Res Treat 2010;123:757, Cancer 2005;103:2481)

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  • MTwoman
    MTwoman Member Posts: 2,704
    edited June 2017

    Thanks MD, so that just means that the dcis extended into the lobules. What confuses me, BuffyJC, is that your onc isn't recommending Tamox (or an AI) with hormone receptor positive dcis. I thought that was pretty standard of care. Have you given any thought to a second opinion?

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  • buffyjc
    buffyjc Member Posts: 61
    edited June 2017

    Thanks for the replies. So, it sounds like the difference between DCIS that extends into the lobules and LCIS, is that LCIS actually *starts* in the lobules. Is that correct?

    MTwoman-My ONC said that he didn't feel that tamoxifen would have a great enough overall benefit for me in either protection against an recurrence in the mastectomy side or the healthy breast. He met with me for a full hour and talked about A LOT of percentages (which I can't say I remember) and risk reduction, etc., but at the end said that he didn't feel like it would greatly reduce my risk. He told me that if his own wife were to have the exact diagnosis, at the same age and have the same treatment as me, he wouldn't recommend it for her either. He told me that when he reviewed my report, he consulted with his colleagues, as well, and they both agreed with him in his opinion. His nurse that called me back yesterday said that he still didn't recommend it because it wouldn't change survival...only a slight risk reduction. She said I'm at a 3% risk over the next 5 years. She added, however, that if I wanted to take it, he would be happy to meet with me again and write the prescription.

    I'll admit, I've gone back and forth a few times in my head about this. What scares me...COMPLETELY SCARES ME...is the possibility of DVT with tamoxifen.

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  • MTwoman
    MTwoman Member Posts: 2,704
    edited June 2017

    and that is a real risk. It sounds like he spent quite a good amount of time explaining the risk/benefit scenario based on your personal profile, and that he consulted with others about it. The side effects of Tamox are pretty well documented, doesn't mean everyone get them, but the risk is real. In this case, do no harm means not recommending a treatment that presents higher risks than the benefits conveyed. This doc sounds like a keeper. I know it can feel scary not to do everything available to fight the bc beast. Trust your gut, but also trust your team.

    Oh, and lcis and dcis both arise in the same place, the "terminal lobule ductal unit". They are different in several ways: dcis is associated with calcifications on mammo and lcis is not; typically lcis is bilateral and dcis is not; and microscopically they look different (dcis is cohesive, it sticks together, while lcis does not). per pathologystudent.com http://www.pathologystudent.com/?p=5166 Also, DCIS is considered stage 0 bc, while LCIS is not considered cancer and is not an immediate threat to your health, it is a marker that you have a higher than average risk of developing breast cancer in either breast in the future.


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  • buffyjc
    buffyjc Member Posts: 61
    edited June 2017

    Yes, it IS scary and I'm trying very hard to let this go. He truly is a great dr...very skilled and came highly recommended.

    Thank you for that explanation and the link. Seeing the images and some of the description on that site helps, as well. I appreciate it!


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  • leaf
    leaf Member Posts: 8,188
    edited July 2017

    Just to throw out some numbers for tamoxifen and DVT and/or PE

    This study found no increased risk of DVT for Asian women. https://www.ncbi.nlm.nih.gov/pubmed/25240736

    This study of Danish women found The 5-year risk of DVT/PE was 1.2% for women receiving tamoxifen and 0.50% for women not receiving tamoxifen. Women treated with tamoxifen were at a higher risk for DVT/PE during the first 2 years after exposure. https://www.ncbi.nlm.nih.gov/pubmed/19569248

    This study involved women with an invasive breast cancer, treated with radiation +/- chemotherapy +/- tamoxifen (so they aren't exactly DCIS/LCIS patients): Published in 1995:This article evaluates the frequency of thromboembolic accidents (TEA) in 441 postmenopausal patients treated by an association of conservative radiosurgery, tamoxifen +/- chemotherapy, for a breast carcinoma T0, T1T2 < 4 cm. Nineteen patients (4.3%), all in remission, presented a TEA, between 1 and 44 months after the beginning of the tamoxifen treatment. We observed seven pulmonary embolisms (PE), 11 deep venous thromboses (DVT) and an acute arterial ischemia. Two patients aged 74 and 80 years died, the others had a favourable evolution under anticoagulant treatment. Among these 19 patients, six presented known risks factors (phlebitis, cardiovascular disorders) and ten had a "favouring circumstance" aggravating the risk of TEA (surgical operation, severe infection, fracture). https://www.ncbi.nlm.nih.gov/pubmed/7742616

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  • ChiSandy
    ChiSandy Member Posts: 12,133
    edited July 2017

    Even though you had DCIS in one breast, your risk of developing breast cancer (of any type) in your other breast is quite low:

    http://www.clinicaloncology.com/Breast-Cancer/Arti...

    Therefore, the benefits of tamoxifen (or AI therapy in general) are, for you, outweighed by the risks.

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