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All TopicsForum: DCIS (Ductal Carcinoma In Situ) → Topic: DCIS w/microinvasion

Topic: DCIS w/microinvasion

Forum: DCIS (Ductal Carcinoma In Situ) — Just diagnosed, in treatment, or finished treatment for DCIS.

Posted on: Jan 7, 2009 06:34AM

Hockeymom1 wrote:

I was diagnosed with DCIS grade 3 >5cm by a Breast MRI guided biopsy.  I am BRCA1+ and decided to undergo a bilateral mastectomy.  Pathology from my mastectomy shows;

Microinvasive 0.5mm  ER-/PR-

Tumor grade: 8/9 poorly differentiated

Stage: T1mic,pNO, MX

 My question is this;  I know chemo is not usually warranted for such a small microinvasion.  However, with my BRCA1 status and ER/PR negative status, does that change anything?

 I've lost so many women in my family to both breast and ovarian cancer.  I want to do all I can.

 Thanks for any information,

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Posts 1 - 16 (16 total)

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Jan 7, 2009 06:58AM hopefor30 wrote:

What do your doctors say?   I'd get more than one opinion on this if I was you.....I do know someone who also had DCIS with microinvasion, and had the same characteristics as you.   I think she ended up with some version of "light" chemo and Herceptin -

Good luck with your research and decision.  It isn't easy, I know.

M.

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Jan 7, 2009 07:03AM Hockeymom1 wrote:

First oncologist laughed when my husband mentioned chemo and asked if he didn't like my hair!  VERY arrogant!  Although, his reccomendation does go with all the literature I've read. However, I've also read that BRCA1 cancers tend to be a little different and need to be looked at differently also.  I do have a second opinion up at Duke in a couple of weeks.

 Trust me, I don't want chemo but i do want to make sure I've done all I can to NEVER have to deal with cancer again!

K.

DCIS 5cm+ w/0.5mm microinvasion Grade 3 ER-/PR- 0/2 nodes

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Jan 7, 2009 08:46AM, edited Jan 7, 2009 08:49AM by Vinessa

I just want to share my experience with you as I think we have a similar diagnosis.  During Thanksgiving I received the news that my left breast had high grade ductal carcinoma.  The tumor was almost 4 cm. but there were other areas within the breast as well. I had several needle biopsies performed and a breast MRI (checking both breasts).  They found small suspicious areas in the right breast as well and wanted to do a further MR guided biopsy.  I decided because of my large family history of breast cancer, to have the right breast removed as well.  At 49, I had no difficulty making this decision because I have 2 teenage children.  I can live without my breasts...Last Friday I had my bilateral mastectomy.  I was home by Saturday afternoon.  I knew I would recover in my own bed faster...  I didn't use the pain medicene as the anesthesia stayed with me after surgery for awhile.  I still have two drains on me and they are slowly emptying less.  My hardest challenge was yesterday trying to wash my hair without getting the drains wet.  If someone out there knows a technique for a "do it yourselfer", please advise.  So far, I must admitt, things are going smoothly.  Stay positive as much as possible (even though it's hard) never give up & pray for strength.  The initial scare seems to be the worst.  Women have always proven to be great sources of strength during hardships.  Last night my doctor phoned to tell me that the pathology report on the sentinel nodes was all clear.  This means chemo is not necessary as the cancer stayed in the breast tissue.  Prayers are answered!

Dx 11/15/2008, IDC, 3cm, Grade 3, 0/2 nodes
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Jan 7, 2009 12:13PM Beesie wrote:

K,

Generally it's considered that the line in the sand for chemo is an invasive tumor that is 1cm in size.  If a tumor has very favorable characteristics, then chemo might still not be recommended even for tumors that are a bit larger.  On the other hand, if a tumor has very unfavorable characteristics, then chemo might be considered for a tumor that is smaller than 1cm.  Unfavorable characteristics include tumors that are highly HER2+ (in which case Herceptin might also be prescribed) and tumors that are ER-/PR- (in this case particularly because the patient would not benefit from Tamoxifen or AIs as an alternative to chemo).  I have never heard of BRCA status coming into play on this decision and I was not aware that BRCA cancers might be different than any other breast cancer - I hadn't heard that.

Since you have a tumor that is considered to have unfavorable characteristics, the question is:  For someone who has an invasive tumor that is smaller than 1cm but has unfavorable characteristics, at what size of tumor should chemo be considered?  According to the NCCN treatment guidelines (which are used by most doctors in the U.S. and elsewhere), the answer is 0.5cm, if the tumor is ER-, PR-, HER2- and the patient is node negative.  You can follow through the treatment guidelines decision-tree in this file, on pages 11, 12 and 16:  http://www.nccn.org/professionals/physician_gls/PDF/breast.pdf

Given this, I could see that if you had a 0.3cm or 0.4cm tumor with very unfavorable characteristics, a doctor might be conservative and recommend chemo.  But with a 0.5mm microinvasion, you fall well below the chemo line.  For anyone who is node negative, the reason for prescribing chemo is the general assumption that the larger the tumor, the greater the number of cancer cells and the greater the chance that one or two of those sneaky cancer cells might have escaped the breast unnoticed.  So to put it in perspective, with your type of pathology, the base line for considering chemo is a tumor that is 10 times the size of yours (and therefore contains about 10 times as many invasive cancer cells).   

By the way, I notice that you mention that your DCIS is grade 3.  With only a 0.5mm invasive tumor, were they able to test it for grade?  My microinvasion was 1mm and while my DCIS was grade 3, my microinvasion was grade 1.  This was very comforting to me.  I'm not saying that it would be the same for you, but if your microinvasion hasn't been tested separately from your DCIS, it could be that your microinvasion is not as aggressive as your DCIS.

Hope that helps!  I'll be very interested to hear what the docs at Duke say.

Dx 9/15/05, DCIS-MI, 6cm+ Gr3 DCIS w/IDC microinvasion, Stage I, 0/3 nodes, ER+/PR- “No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke

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Jan 7, 2009 12:46PM Hockeymom1 wrote:

Thanks for the information Bessie.  

I will keep you posted in what I find out up at Duke.  This docor is BRCA savvy and a specialist in triple negative and microinvasion cancer.

For now, I'm working on recovering from my mastectomy and feel pretty confident I've done what I need to do to make sure breast cancer is a thing of the past for me.

DCIS 5cm+ w/0.5mm microinvasion Grade 3 ER-/PR- 0/2 nodes

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Feb 3, 2009 03:36PM Vavoom10 wrote:

Hello Hockeymom1,

The things I have come across in regard to being BRCA positive is that it would be best to have your ovaries removed to prevent ovarian cancer according to what I have read.  It seems that this gene can cause ovarian cancer as well.  Ovarian cancer is very hard to detect and is usually only caught too late, the statistics say.   This is what I have been reading on various medical websites.  I purchased a very informative book called Breast Cancer, Real Quesstions, Real Answers by Dr. David Chan, MD from the UCLA Jonsson Comprehensive Cancer Center.  It has answerd a lot of questions I had, not all, because each of us is unique, but 97% of my questions.

Dx 10/18/2008, IDC, 3cm, Stage II, Grade 3, 2/26 nodes, ER+/PR-
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Feb 17, 2009 11:55AM dee1961 wrote:

Just checking to see if there are any ladies in the Columbus Ohio area.
I'm waiting to have surgery March 9th, so would like to find someone close by to maybe be support for each other.

Love is never wrong

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Mar 3, 2009 10:31AM dee1961 wrote:

Anyone else diagnosed with DCIS w/IDC microinvasion beside Beesie and myself?
I would like to hear how you are doing and what treatments the doctors had you go thru.
Thanks,
Dee

Love is never wrong

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Mar 3, 2009 10:42AM Hockeymom1 wrote:

Hi Dee,

 I had a VERY small amount of microinvasion 0.5mm, triple negative.  I had a bilateral mastectomy and no further treatment.  I am in the process of having a second opinion on my pathology just for peace of mind.  My physician up at Duke suggested it and I figured why not.  I'm sure it will be the same. 

 Are you expecting any further treatment?

 My oncologist even ok'd me for a small amount of Estrogen as I had my ovaries removed in the fall last year.  (I had no idea I'd be dx'd with cancer 2 months later).

I am BRCA1+ and feel pretty good that I've covered all my bases and hopefully won't have to deal with cancer again.

I see you are having your surgery soon.  Good luck.  I am going for my exchange surgery 3/16.

Keli

DCIS 5cm+ w/0.5mm microinvasion Grade 3 ER-/PR- 0/2 nodes

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Mar 3, 2009 10:44AM Dejaboo wrote:

Theres a few ladies out there with a Microinvasion & DCIS.

I am close.  But Technically I am not considered a Microinvasion since my IDC was 1.2mm. Microinvasion is less then 1mm.  I have had some Drs refer to me as a Microinvasion.

My DCIS was close in size to yours at 1.5cm

I had a BLM.   My ER is only 18%.  I have am Increased Risk of stroke So I choose not to take Tamox.

I see you are having Surgery on the 9th. What Kind of surgery will you be having?  Thats a Good Day.  It was My JazzyGirls (my Other Dog) Bday!

Good Luck Monday!

Pam

Dx 3/7/2008,DCIS, IDC-1.2mm, Stage tIA, Grade 1, 0/1 nodes, ER+/PR-,HER2+,Lump/SNB-4/1/08, Bilat 5/22/08, EX 9/22/08, PFO & ASA heart Closure 12/29/08, 7/09-RAVH, 11/09-NOLA-SGAP-to fix Symmastia! Stage2 4/2010, Stage2B 11/2010, Truncal & Arm LE

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Mar 3, 2009 11:44AM dee1961 wrote:

Hi Hockeymom and Dejaboo,
I was told with a bilateral mastectomy I would not need any futher treatment as long as the SNB comes back clean. I am also having immediate recon. I may have to have one ovary removed
(had hysterectomy at 27) they left one ovary to keep me from going into menopause at that time.
Maybe some Tamox, but if I have to take Tamox and have bad SE's I may not finish with that, I will have to see how it goes.
Good luck with your exchange Hockeymom. Happy B-day to your "baby" Dejaboo.
I'm going for the cure on Monday! :)
Best wishes,
Dee

Love is never wrong

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Mar 5, 2009 09:55AM, edited Mar 5, 2009 12:01PM by Liz08

Ladies-

I just wanted to join in and say "Hi" !

At the age of 38, I was diagnosed with DCIS with a focus of a microinvasion of less than 1mm (stage T1mic).   As you can see we are not all that common since our cancers were caught extremely early.  I ended up with a lumpectomy, re-excision to clear a margin that was close to the skin so my surgeon removed extra skin, rads and taking supplements that my naturalpath advised for me take.

Bessie, you always come to the rescue with excellent research and information.  

Wishing everyone the very best.

Liz

Dx: 1/16/08, Stage T1mic, DCIS, < 1mm microinvasion, ER-/PR-, Her2+, 0/1 nodes

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Apr 22, 2009 03:13PM Kaidog wrote:

I know this thread has been quiet for a while - but I'm another one of those DCIS with microinvasion ladies.  I'm doing a bilateral mastectomy next week because my microinvasion tested as HER2+++ - and I don't want to be constantly massaging my breasts looking for more cancer! 

 I think we're all incredibly lucky to have caught our cancers at this point - I feel like there's an angel on my shoulder.   

Hugs,

Laura  

Trying to love my chemo curls

Dx 4/10/2009, IDC, <1cm, Stage I, Grade 2, 0/4 nodes, ER-/PR-, HER2+
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Apr 22, 2009 04:44PM, edited Apr 22, 2009 04:47PM by Liz08

Laura-

I have said that there must be an angel watching over me and my family many times.  I have gone thru soooo many challenges in my life since childhood and I swear that there has to be an angel watching over me and my family.  I am by far not some holly roller but if I didn't believe in Angels or in God I know I would have never gotten thru this.     Sending (((hugs))) your way.

Liz

Dx: 1/16/08, Stage T1mic, DCIS, < 1mm microinvasion, ER-/PR-, Her2+, 0/1 nodes

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Oct 14, 2009 08:32PM amyob wrote:

I just joined the board today.  I was also diagnosed with DCIS, 4.5 cm, grade 3.  They found a 1 mm micro invasion on my pathology report after my bilateral mastectomies last week.  I am ER+, PR+, and Her2 pos, 3+.  I am going to the oncologist this week and was wondering what treatments you all had.  I know I need to get the 2D6 test to see if Tamoxifen will work, especially since I'm Her2 pos.  I've been reading about Herceptin, which might work since I'm perimenopausal, node-negative, stage 1, ER+, and IDC.  What routes did you take??

Amy 

Dx: 9/19/09, Stage T1mic, DCIS, < 1mm microinvasion, ER+/PR+, Her2+, 0/2 nodes

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Feb 15, 2010 07:05PM, edited Feb 15, 2010 07:07PM by Liz08

Hi-

for those who had microinvasive DCIS that was her2+++, as of this afternoon we have our forum index (thanks to the moderators!).  Please feel free to post there. We can finally connect! The forum index is called Micro-invasive DCIS that is Her2+++.  Thanks!  Liz

Dx: 1/16/08, Stage T1mic, DCIS, < 1mm microinvasion, ER-/PR-, Her2+, 0/1 nodes