Taxotere and my Pathology Report

Hi Jo:

Yes, there are studies that looked at the impact of multi-focality on distant recurrence risk, (as well as on local recurrence risk). The study populations I have seen were not huge. Some studies were not entirely consistent with each other. I do not know whether more recent studies have clarified the situation or not. Because I have no idea what the current situation is, I suggested that Tracy ask her Medical Oncologist about that:

(b) Ask what is known about how multifocal disease may impact distant recurrence risk profile, and how this factor was weighed in your case (with six tumors).

The word "may" was used because I don't know what the situation is.

The question focused on distant recurrence risk, because that is the main consideration in systemic therapy decisions (e.g., chemotherapy).

BarredOwl

Tracy, this is in very general terms.

DCIS is "ductal carcinoma in situ." IDC is "invasive ductal carcinoma."

The critical difference is the "in situ" vs. "invasive" words.

DCIS isn't "invasive" cancer. "In situ" means that by the characteristics of the abnormal cells themselves, they are not able to "escape" the structure where they started. Think of a sink drainpipe that somehow has a population of abnormally multiplying grapes - they can multiply and multiply, maybe get down into more pipes, possibly even spread through all the pipes in your house, but grapes won't erode through the pipes because they just don't have that ability. They're not normal grapes if they're multiplying in the pipes, but they're only affecting the pipes. DCIS can spread all through the ducts of the breast, but that will be the extent of where it can go. "Invasive" cancer is fundamentally different because it has gained the ability to go through the architectural limits of the structure where it started. If you had grapes in the sink drainpipe that could behave like "invasive" cancer, they would find ways to slide or push through the walls of the pipe and into anything nearby - they'd be in the flooring, the electrical, they'd make their way into the enamel of the sink. For a cancer, this means it can spread straight from the organ where it started into an organ next to it, like breast cancer into the pectoralis muscle, or it can spread into blood vessels or lymphatics, from where it can be carried around the body.

The only cancer that can cause distant metastases is "invasive." Chemotherapy is to prevent distant recurrence. Surgery and radiation are for the spot where the cancer began.

If you only had one focus that was invasive cancer, that's the only one they would be worried about having spread to other parts of the body and needing chemo. "Chemo" isn't ever given for DCIS, so it's not as important to know the characteristics of every focus of DCIS as it would be if you have 6 separate invasive tumors.

I hope that helps. Please understand, this is in no way a comment on whether or not you should do chemo based on what you now know about your path results, just an explanation of DCIS vs. IDC.