vascular invasion

ptesinge · January 2007

hi ladies-
can anyone tell me more about what it means if i have "microscopic invasion"? all lymph nodes were neagative, but the docs said i had the invasion in the quotes above. they said "not to worry. it was only microscopic" but what does that mean? did the cancer pass into the blood stream or did it not? i just want to be clear (as possible) on my how it affects my prognosis or chances of mets in the future...
(all tests showed no cancer anywhere else)it's a darn complicated disease, no?!

thanks,
sarah

Naniam · January 2007

Sara,

I take from the heading of your post your pathology report showed microscopic vascular invasion. My path showed that I had focal tumor invasion of vascular spaces and my lymph nodes were also negative. I had IDC and DCIS, Stage II, Grade II.

It is good when we have the invasion but no positive lymph nodes. I honestly don't know if it raises our chances of mets more than anyother one with invasive breast cancer. Sometimes that concern creeps in but then I try to focus that my lymph nodes were OK. My oncologist didn't seem to be concerned about that being in my path report - lymph nodes being negative was what he focused on.

Hope this helps and is clear as I'm in need of sleep!!!
Feel free to ask me if you need any follow up.

Best to you,
Brenda

ptesinge · January 2007

thanks brenda. my onco's didn't seem too concerned either, but they did say usually it's conerning. i guess i'm unclear on how it's possible to 'sortof' be in the blood vessels, or even int he blood vessels but not spread anywhere else. onine resources are pretty vague.

and i did wonder also how VI compared with having negative nodes, since negative nodes are said to be the most important prognostic indicator...

thanks again brenda. anyone knowing anything more, all info is appreciated.

sarah

jasmine · January 2007

Here is a link to information on this site regarding lymphatic and vascular invasion: http://www.breastcancer.org/cancer_lymph_blood_vessels.html

ptesinge · January 2007

yeah, see that doesn't tell you very much. that's about the most info i get from most sites. thanks very much though!

i guess i'll just have to ask the doc again when i finally see him, how one can have a little or a lot makes and how it compares in prognostic importance to node involvement! will share here once/if i get the answer.

jasmine · January 2007

If you want the honest truth, it means that some of the cancer cells made it into the blood stream. Its not the best situation but hopefully chemotherapy will take care of any cancer cells that have migrated to other parts of the body.

mreilley99 · January 2007

i have ILC stage 3 grade 2..neg nodes..but i do have lymphovascular invasion! my tumors were large enough that i needed a bi lat mast..no other choice...i am currently on chemo...did 4 rounds of ac now onto 4 rounds of taxol. let me know what you end up doing.

Naniam · January 2007

Both my oncologist and my radiation oncologist said having vascular invasion meant that cells "could" have gotten through not that they "did" get through. With my lymph nodes being negative it was a good sign all was well.

Marianne sounds like your tumors were 5cm at least to be Stage III and nodes negative. ILC, if I understand correctly has a high incidence of occuring in the other breast.

Bottom line, we are aware it happened and have had surgery, chemo and rads. Some days I do think about it but one of those things I try to push away. If that bridge pops in front of me, I'll cross it when I get there.
After this little adventure so far, I just want to enjoy my family and life in general.

Brenda

jasmine · January 2007

Well, as you see there are a variety of opinions on what vascular invasion means. That's probably why you have found such vague interpretations in your research. To me, common sense tells me that vascular invasion means invasion. Its not a big leap for me. But that's just my 'personal opinion.' Opinions are like noses...everyone has one. Best wishes on your journey and hang on to hope and joy.

ptesinge · January 2007

well i've got no problem with hrsh truths and i appreciate all of the info/opinions! and i'm glad if i'm not the only one who finds the info a little vague.

brenda you are right. i need not to think about it and enjoy life as much as possible. i just find it helps me to "put things away" in my mind if i really understand strightforwardly the risks.

(incidentally, there is a medical reason for why a good attitude is an important prognostic indicator, did you knw that? it's because when you are stressed/scared, your immune system operates in flight or flight decision mode. meaning it makes deisions for the short-term. read: possibly ignoring the stray cancer cell in favor of "more pressing" matters.

that's what my brainiac sister said she discovered in her research. but i admit that i don't have a direct source for that info. perhaps it is only a theory. either way, interesting, no?)

anyhow, all of your input still helps.
thanks ladies!

jasmine · January 2007

Pte, I'm like you. I would prefer to know the truth so I can know what I'm up against and make better/best decisions to hit this head on. There is always hope and many of us are surviving in spite of lymphatic/vascular invasion.

mreilley99 · January 2007

i agree with the positive attitude method! i am flying through does dense chemo...not of course without bad days from side effects..but i refuse to let this take me down! as far as vasucalar invasion goes...i wish there were more facts about odds for recur in our future but as long as i know that i have had as much chemo and rads to prevent recur i will have to put my faith , positive energy into all of that! and of course take one day at a time..there are no guarantees for anything in this life!

ptesinge · January 2007

awww. i do loev my 'sistas' here! it helps keep the positivity up. marianne, good luck with the rest of your chemo! it'll be over before you know it. and then feeling good will never have felt so good, if you know what i mean :-)

higs-
s

Molly57 · January 2007

I don't know when you may have another chance to talk to your onco or surgeon, but why don't you put your question to them just as you put it to us. It won't kill 'em to explain it one more time and you deserve an explanation that you can understand, even if it's a harsh truth.
Molly

ptesinge · January 2007

i'll do that. i have a better idea how to phrase it now as well.

i'll give it a shot!

Isabella4 · January 2007

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jasmine · January 2007

It would seem to me that that blood would need to return to the heart and lungs at some point to be re-oxygenated and also to the kidneys to have toxins removed. Seems pretty unbelievable to me that blood in the breast stays there forever and ever. Really!

Dar1 · January 2007

My biopsy path report showed lympho/vascular invasion, but the surgical path report said there was none. I asked my onc about that. He said that most invasive cancers have some lympho/vascular invasion. He also said that some theroize that the biopsy can push the cancer cells into the vessels, whereas the surgery did not because it removed the whoe tumor (I had a mastectomy) I'm still confused about the differences in the two reports, but I'm having chemo because I'd rather err on the side of caution. I don't know if one can be sure at any rate - it's like cars on the highway - sometimes there's lots, sometimes none. Lets hope that none of them reached a destination and set up camp!

mreilley99 · January 2007

i am curious as to all of our diagnosis's..with the lymphovass invasion...and how large were your tumors and what was done...i was orgin dx with a 1.7cm lobular tumor which after bi lat mast ended up being more than 5cm of the lobular and also ductal with lympho vascular invasion..however my nodes (3) were neg. i am also getting conflicting information on this subject and i find it very confusing ...i agree..if it wasnt serious then why am i getting 8 rounds of chemo...ac and taxol! seems to me that the docs are leaving no stone unturned. i am a stage 3a. with liver lesions ..so far they are B9.! thank heavens! i also find it hard to beleive that the "blood would stay in the breast" ..my goodness ..do these people think we are stupid!!!!!!

Naniam · January 2007

Before I found this site, I ask this question at the John Hopkins breast cancer site. I believe they put it as "it is a concern there was vascular invasion but good the lymph nodes were negative." My lymph nodes were negative. My tumor 2.5 cm IDC and it had lobular expansion and vascular invasion. As here, perhaps a cancer cell got through but the chemo should have taken care of that. Everyone focused on the negative lymph nodes. For many years prior to my diagnosis of breast cancer, I worked in the medical field. I decided a very long time ago with all the blood vessels and glands in and near the breast, it would be very easily and probably likely a cell would get through. Having this on my path report is something that I am aware of. In the early days of my diagnosis I even tried to find stats on women who have had recurrence with negative nodes but vascular invasion to no avail. I had vascular invasion, I took my chemo and rads and so far I have chosen not to do AI's. I have not gotten anyone to tell me "openly and honestly" that it has increased my chance for recurrence by any percentage.
I tuck it away for information and try to be alert but at the same time trying to not let breast cancer rule my life anymore than it has for the first year. I have found it hard to adjust and move on from the effects of the chemo and rads on my body and my energy - for ME,if I dwelled on this I think I would go totally nuts.

From reading all of your post, you have encountered the same thing. It is there; no one gives any stats on recurrence rate in women with this. THe main thing is we know it and tuck it away and if we hurt or something doesn't feel right - push to get test and get checked out.
My oncologist doesn't do tumor markers. My liver function did rise significantly on one post chemo treatment - think it was my gallbladder causing this - I also have hemangiomas of my liver but so far all is well. I pray we all stay well - we have had treatment and/or taking AI's.

We've done all we can and paid a heck of a price for getting this diagnosis.

If any of you find any kind of stats on recurrence with vascular invasion and negative nodes, please share. I did look and look a year ago.

Brenda

mreilley99 · March 2007

i just read this on a discussion - lymphovascular invasion= that the tumor cells have gotten into the fluid carrying channels within the breast tissue. tumors with this kind of invasion are at an increased risk for spread beyond the main cancer within the breast tissue spreading to the nodes and other areas of the body. this is from a 2000 topic discusion righthere on bc.org...another person stated that with this lymphovascualr invasion that it is equivalent to having to having 2 nodes positive! ouch...not what i wanted to hear...i have just finshed my 8 rounds of chemo and now am moving onto rads after i get clearance from my oncologist...blood count issues!

ptesinge · March 2007

Thanks marianne. I never had it put that way. Even if it's not necessarily what we wnat to hear, it helps to have the info.

I can share that I wa originally pretty upset that my doctors took 12 nodes, when it turns out they were all negative. They did say, however, that my VI meant that the cancer could come back in the lymph nodes. I used that to make me feel a little better about the fact that they removed so many!

Appreciate you sharing that-
sarah

mreilley99 · March 2007

yeeah,,,i am glad i learned that..even though it gives me more to be concerned about i would rather know all than not at all! i have a cat scan this coming thursday..i finshed 8 rounds of chemo last week and waiting for my blood counts to come up beofre i begin rad for 7 weeks...sarah can you tell me what your course of treatment has been so far and how far "out" are you and what does your doc do to "watch " you for more cancer? how often do you go and what kind of tests do they do for you? thanks so much for your help! i also learned the other day that i had more than 11cm of lobular and ductal in my rightbreast at time of removal..the good news is that the surgeon was able to get clean margins on my mast..i had a bilat bc i didnt want to worrying about it spreading to the other side.

ptesinge · March 2007

Hi marianne,
first, BIG CONGRATS on being finished with chemo. it's the best feeling ever, to be dine with that!!! (rads was a breeze compared to chemo!)

well, since i am in europe, my treatment tends to be differnt in some ways. but i had a Left mastectomy (will have bilat this summer with recon) and, as i said, 12 nodes out. I then had 6 rounds of a chemo cocktail called FEC (standard here). my last cycle was over Dec 8. I just finsihed 25 rounds of rads 2 weeks ago.

I know i have to see the doctor every 3 months to begin with. I have read that I will get PET scans, first every 3 months, then 6 months, then 1ce a year, etc. But i have had no tests like that since prior to chemo. So I am a little uncertain on that. I will have my next appoitment in April (which reminds me I need to make it) and i guess I will see then! i am anxious to find out myself.

feel free to drop me a PM if you want to talk more or have any more questions!!

sarah

Lorie_Anne · March 2007

Hi Sarah,

I never post much here..but felt compelled to answer your question about lymphovascular invasion.

On my original DX; the path report showed NO invasion; however after the bi-lateral masectomies it showed in that final pathology report.

My oncologist who always gives it to me straight (which I want); said in her opinion lymphovascular invasion on the "final" surgical report qualifies for " 3 or 4 positive nodes"; even if the SNB shows no positive nodes. Of course I did some follow-up on this and I am full agreement.

While it may be true the chemotherapy may kill the lingering cells; the risk of reoccurence in my case is huge.

I do not necessarily believe in stats regarding this disease; but it does make you wonder.

Good Luck to you,

Lorie

sjoc · March 2007

Hi - my path report also incicated lymphatic/vascular invasion even though my SNB report was negative. My onc explained to me that there were some cells in the lymphatic space but that the nodes tested negative. My report said the cells in the lymphatic space did not test absolutely positive so they were going to keep my status as node negative. I was stage II, grade III and finished chemo the end of september.

mkl48 · March 2007

Question,
What if one has LI and already positive nodes. Do you add 2-4 more nodes to the total or does it just apply to node neg who have LI? Staging is done on actual nodes I believe. Most invasive BC has some form of LI so the statistics won't change that much I would think. Does all the recuurance in node neg women occur in those that had LI?

mreilley99 · March 2007

i havent a clue yet on recurance..hopefully i wont have any recuramcce..however ..it is the COMBINATION of pos or neg nodes..the size of the tumor and the aggressiveness of it that determines your staging...bloom richardson scale...NOT just on pos or neg nodes...not all tumors have LI..it was noted on my final path report which ones did and which tumors did not...so i disagree...not all tumors have some form of LI!it was the amount of tumor size and LI that called for attention given to the length and amount of chemo..there were no other options on my case. teh good news for me is that i am not brcaa positive nor am i her2/pos...at least not this time !

Lorie_Anne · March 2007

Actually, my node status was negative; however due to my previous radiation therapy for Hodgkin's my surgeon did not want to increase risk of Lymphomdema in that area for the removal of nodes.

So, in other words my node negative status (5 taken out) still did not diminish what my oncologist felt by the LI; Grade 3 tumor status (8/9)BRC; and the fact I had cancer in BOTH breasts.

Just my 2 cents

Lorie

squiggles · March 2007

The doctor who said that having LVI is equivalent to two or three positive lymph nodes sould have their license revoaked.

LVI has been extensively examined as a prognostic feature and it has never been shown to be anywhere as good an indicator as lymph node status. In other words, it's clear that having positive nodes gives a woman a higher chance of recurrance. But after collecting stats on thousands of women, LVI has never been an accurate indication of much increase of probability of recurrance.

Having positive nodes means that a tumor has the ability and desire to spread. Of course it doesn't mean that chemo and hormone therapy won't stop it dead, but that it has the ability to fool the immune system.

LVI just means that it's shedding cells into the blood stream. It's still very possible that even though the tumor is spreading cells, the body's immune system everywhere besides the beast is saying: "hey, a breast cell. You don't belong here. Bang, you're dead!". In liu of evidence of any spread outside the breast, there's a very good possibility that those cancer cells are being killed as soon as they enter the lymph and blood system.

So, LVI isn't a great thing to have, but many women with LVI never have a recurrance, and many women without LVI do. It's just not a reliable indicator of anything.

One more thing: there is some new interesting data suggesting that the only cells that are able to metastisize might be stem cells. If that's true, than LVI becomes even less of an indicator, because the cells that are shedding into the blood and lymp system might not contain any stem cells.

mreilley99 · March 2007

all interesting nowhiners...but i guess i must ask if you are a doctor or a nurse ? we are all just sharing information that ha been given to us by our health care professionals, since they are the "professional" we would like to think that they know what they are indeed talking about. i havent found anything "extensive" enough to confirm nor deny LVI as far as mets are concerned or for that matter recurrences...but i do find it extremely interesting that several woman have dr's who have told them about lvi...my doc tried to discount it also and for my hospital it is the amount of tumors added up that give weight to the descion concerning how much and how long systemic therapy would go...it seems to me based on that ..my dr's were not going to leave any stone unturned so to speak even with LVI being a part of my dx. what is your original dx if you wouldnt mind sharing nowhiners? and what is/was your course of tx...thanks for replying.

vascular invasion

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