Will 30% of Early Stage (1-IIIA) go on to metastasize??
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If you have invasive ductal cancer, It has spread to the other tissue.. I was stage one.. I believe that advanced stage means METs.
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IDC, doesn't mean it spread anywhere. It means it's the type to spread if it's not caught in time. So long as there is not LVI or node involvement no spread has occurred with IDC. Advanced DOES NOT always mean mets. You can be a 3B/C (no mets) and have Advanced stage.
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herb....just want to make sure everyone knows that invasive ductal carcinoma means it has spread beyond the ducts and has the potential to spread to other areas. NOT that it has already has!
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I am considered early stage and I had extensive lvi and two positive nodes . Stage 2b .
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To Herb's post, here are some more accurate information definitions:
- DCIS (ductal carcinoma in-situ, Stage 0) --> breast cancer (or sometimes considered pre-cancer) that is fully contained within the ducts of the breast
- IDC (invasive ductal carcinoma, Stages I to IV) --> breast cancer in which cancer cells have broken through the ducts and moved into the breast tissue (and possibly beyond, but not necessarily so)
- Early stage invasive breast cancer (Stages I to IIIA) --> breast cancer that has not spread beyond the breast or level I & II lymph nodes.
- Locally advanced breast cancer (Stages IIIB, IIIC) --> breast cancer that has spread beyond the breast to the chest wall and/or the skin of the breast or breast cancer with nodal involvement beyond the level I & II lymph nodes, but there is no spread to other organs.
- Breast cancer metastasis / distantly advanced breast cancer (Stage IV, or any stage that advances to become metastatic) --> breast cancer that has spread to the bones and/or other organs
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Thanks Beesie. So, as herb said, with IDC the cancer has at least moved to other tissue.
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Traveltext, given that it's "breast" cancer, I wouldn't consider breast tissue to be "other tissue". Breast tissue is the primary site where breast cancer develops (and this is one of the reasons why DCIS is sometimes classified as a pre-cancer, since the malignant cells have not yet even entered the breast tissue).
Perhaps what I posted is exactly what herb meant, however my interpretation would be that "other tissue" refers to tissue beyond just the breast tissue. Given the number of responses that herb's post has generated, I think others share my interpretation. And that's why clarity on this point is important.
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I agree with Beesie, IDC doesn't mean 'spread' and to say "well it's spread to your breast...." That kind of does a disservice to staging and what IDC is. If it wasn't spread to the breast, it wouldn't be cancer. IDC / ILC is simply breast cancer. No spread inferred.
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Re: "So long as there is not LVI or node involvement no spread has occurred with IDC."
Having negative axillary nodes or not having lymphovascular invasion (LVI) are both favorable findings. Unfortunately, the absence of lymph node involvement and the absence of LVI do not establish that "no spread has occurred" prior to removal of the tumor. While, consistent with a lower risk of distant recurrence, these favorable findings do not eliminate the possibility. For example, a person with a hormone-receptor positive, HER2-negative, 1.8 cm IDC, negative nodes, and no LVI is very likely to receive the Oncotype test for invasive disease for the specific purpose of assessing distant recurrence risk. In some cases, the distant recurrence risk will be seen as sufficiently high to support a recommendation for chemotherapy in addition to endocrine therapy.
BarredOwl
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Well, with men, who have very little breast tissue, it is common for the malignant cells to move to surrounding tissue. At least that's what my breast surgeon told me and she spent a lot of time removing the tumor and all the tissue surrounding it.
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Barred, fine, but you are sidetracking my point. Herb said IDC MEANS there is spread and that was what I was addressing. The term Spread is very significant and she's using it inappropriately.
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"(W)ith men, who have very little breast tissue, it is common for the malignant cells to move to surrounding tissue"
Traveltext, that's why you are Stage IIIB, which as per my post is considered to be a 'locally advanced breast cancer'. It's still IDC, but it's just a subset of all the possibilities that make up IDC. You can't define all of IDC based on your specific diagnosis.
As I noted, IDC / Invasive Ductal Carcinoma refers to all stages of invasive breast cancer, Stage I through to Stage IV. Hence my definition in my earlier post that IDC is breast cancer that has "moved into the breast tissue (and possibly beyond, but not necessarily so)". Yes, sometimes with IDC there is spread beyond the breast tissue to surrounding tissue, and sometimes there is spread to other organs. But other times - and in fact in the majority of cases - breast cancer cells are found only in the breast tissue, which suggests that there has been no spread beyond the primary cancer site in the breast (although to Barred Owl's point, this is something of which we can never be certain).
I agree with Lisey that the word "spread" is significant. In the cancer world, it tends to be interpreted as "spread beyond the primary cancer site" and that most definitely does not describe most cases of IDC.
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I think herb meant spread outside of the ducts. DCIS is so common a finding people are used to thinking of the cancer being in the ducts. IDC means it's not in the ducts (anymore).
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Actually, Barbe, I don't agree. DCIS is very common but most people don't have a clue what DCIS is (and isn't), or that it's contained in the ducts. I say that after having spent 11+ years on this board, with much of that time in the DCIS forum.
And while that might be what herb meant, her statement was confusing and could easily be misinterpreted, which is why it's important to provide clarity.
For something so simple, this has turned into quite the complicated discussion.
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Hi Lisey:
I understand the main focus of today's posts. As far as "side-tracking", please note that you were the one who first brought up lack of nodal involvement and LVI, not me.
In a 49-page thread with a focus on the potential for those with early stage invasive disease to suffer distant (metastatic) recurrence, I think my comment today is sufficiently "on topic": Those with negative nodes and no LVI are not immune. I have taken the time to explain this many times elsewhere, because I think it is an important point and because it is a common area of misunderstanding-- a misunderstanding that may lead some patients to decline recommended systemic treatment(s) potentially to their detriment. At a minimum, one cannot make an informed decision if one does not understand the nature of the risk. I am quite likely to continue to make the same point whenever it comes up, whether central to the current dialog or not.
BarredOwl
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you are straining at gnats on this one Barred. I MEANT Stage 1/ 2 IDC. Obviously, if there were distant mets, we wouldn't be talking about EARLY STAGE. The whole point I was bringing up is to say that not all IDC has 'spread' as Herb suggested. Spread is the wrong term - because it has a distinct meaning in the cancer field. It means to a place that was not in the origin tissue. If the breast is the origin tissue and it is ONLY in the breast, then it hasn't spread.
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It's so appropriate we're having this debate over the word spread in a thread that had endless discussion over just the title.
I think it's unfair to call herb out over the use of the word. How is it any different than using moved or invaded? I don't think herb is wrong, it's just that some would like to see it better defined.
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For some spread means just out of the duct to anywhere, still in the breast or not. DCIS hasn't spread. The others stages have spread because it's out of that duct now. Or it can mean you are now stage IV. It's a general word that needs detailed backing in order to define it better.
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A gnat is probably in the eye of the beholder. I tend to comment about what I personally feel is worth noting.
I did not miss or overlook the "camel" or central issue as you see it. I had nothing further to add in that regard, after Beesie's comprehensive clarifying remarks.
I understand the distinctions between the "invasion" of the tissue outside the duct by cancerous ductal epithelial cells (a hallmark of "invasive disease") versus the locoregional "spread" of such cells (e.g., to axillary lymph nodes) versus the distant "spread" of cancerous cells to distant sites (beyond the breast and axillary nodes).
"Obviously, if there were distant mets, we wouldn't be talking about EARLY STAGE."
There is an additional distinction to be made between "detectable, clinically overt distant metastatic disease" on the one hand versus "undetected micrometastatic distant spread".
I will simply clarify again for newer members with early stage disease (which includes Stages IA, IB, IIA, IIB, and IIIA), that even with Stage IA, node-negative (N0) disease with no LVI, it is still possible that in the years before surgery, a few rogue cancer cells have already MOVED to distant sites, either via the lymphatic system or via the blood stream. A few rogue cells or clusters of cells at a distant site(s) are a form of "micrometastatic" distant spread, which is undetectable by conventional tumor staging procedures or scans. This phenomenon may exist, even when lymph nodes are negative and there is no LVI, because these methods are not 100% accurate in determining whether any tumor cells have moved to distant sites, and do not eliminate the possibility.
The potential for such undetected micrometastatic distant spread provides the rationale for systemic treatments (e.g., chemotherapy; endocrine therapy (for hormone-receptor positive disease); and/or HER2-targeted therapy (for HER2-positive disease)):
Pantel, J Natl Cancer Inst (1999) 91(13): 1113-1124 - [parenthetical notes added by me]
"Because the goal of [systemic, post-surgical] adjuvant therapy is the eradication of occult [undetectable] micrometastatic tumor cells before metastatic disease becomes clinically evident, the early detection of micrometastases could identify the patients who are most (and least) likely to benefit from adjuvant therapy. . . "
Unfortunately, no such detection methods exist today. Therefore, a risk assessment is performed:
Pantel, J Natl Cancer Inst (1999) 91(13): 1113-1124
". . . For patients with no evidence of systemic metastases when the primary tumor is resected [removed by surgery], traditional staging parameters of the tumor (e.g., tumor size and lymph node status) are determined; with this information and a statistical assessment of the risk of [distant] disease recurrence, the decision is made as to whether to give systemic adjuvant therapy to prevent metastatic relapse. . ."
The results of multiparameter tests, such as OncotypeDX for invasive disease (used for hormone receptor-positive, HER2 negative disease), can also be used to help assess the risk, further informing understanding of the risk and decisions about chemotherapy.
BarredOwl
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I had isolated tumour cells or ITC's which could have been responsible for my mets. Yet another can of worms...
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The reasons why cancer can spread even before a tumor has developed have been discovered in recent research. More HERE.
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Thanks Traveltext, I find these articles equal parts enlightening and depressing. It's good to have more knowledge though.
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It certainly is salutary, but as BarredOwl implies, one aim of the various systemic treatments is to round up stray cells.
I've always believed light treatment for so-called early stages is a big mistake and the moment when the full bc regimen should be applied is the moment when you get a hint of this pernicious disease.
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Very interesting, Traveltext.
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Reading that makes me feel so hopeless! How does this finding correlate with survival statistics? Are we all destined for metastasis? Seems like so many breast cancer patients go on to live normal life spans
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Kathy, reading through this thread you'll follow the debate over the percentage of people who go on to metastacize and you'll understand that the risk is more or less than 30% depending on your stage and grade. This article just shows why treatment is never 100% effective. Certainly consensus is that your stage and grade is a good zone to be in!
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I've always said that lower stages get more mets than stage 3 due to being under-treated!
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Barbe and Traveltext, do you think then that everyone no matter what should get chemo, rads and hormone blockers? I believe the study pointed out that these treatments would not get rid of these early stage traveling cells.
Sometimes this websites make me more upset! My doctors have been so positive about my prognosis but coming here things often feel so blesk and i second guess my treatment. For example should i have insisted on chemo despite a low oncotype
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Kathy, I'm sure your doctors gave you best-practice treatment. This thread is not for the faint-hearted, but we all have to learn to handle life post-treatment and while all knowledge is not necessarily power, awareness of the intricacies of this disease can keep us grounded in reality.
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Kathy, it's been theorized lately that not all breast cancers have the ability to metastasize. If you had a low oncotype, you may have been overtreated even without chemo. Oncotype isn't perfect, but it's based on some really good science and it's not just a shot in the dark..
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