IDC in dermis — what stage does that mean?

dres123

Hi everyone—I'm posting on behalf of my wife. She recently had a recurrence of IDC in two places. The first tumor was not actually a recurrence but thought to be a residual from tissue not taken during her single mx. That first tumor had a mix of DCIS and IDC so our onc explained that it still is contained within the Brest tissue. The second tumor was entirely IDC and was found in the dermis and subcutaneous tissue at about “10 o'clock"

I'm having trouble understanding how the IDC in the dermis would be staged. Our onc said that it typically isn't restaged but wanted to know that's the case. She was stage 1A prior to the recurrence and based on the size and pathology of the other tumor, she's probably be 2A now. Basically my question is, is it considered metastatic if it has spread to the dermis but still in her breast

Also, she's slated for TC chemo due to there not being clear margins and the KI-67 being relatively high (25%). She's HR+, HER2- — oncotype on repeat test is 14 compared to 11 before.

Thanks in advance for any thoughts/advice!

moderators

Hi Dres,

We're so sorry to hear of your wife's recent diagnosis. You may find this page helpful from the main Breastcancer.org site on Recurrent Breast Cancer -- it sounds like she's dealing with a local recurrence.

Please keep us posted on what the doctors say and how she's doing!

--The Mods

beesie.is.out-of-office

Dres, I am sorry that your wife is dealing with a recurrence.

To my understanding, breast cancer cells in the skin would define this to be a T4b tumor. If there is no nodal involvement or evidence of mets, a T4, N0, M0 diagnosis is Stage IIIB.

American Joint Committee on Cancer's Staging System for Breast Cancer, Eighth Edition: What the Radiologist Needs to Know https://pubs.rsna.org/doi/10.1148/rg.2018180056

dres123

thanks for all the feedback. Really appreciate it

The research I did indicated that if the tumor is confined to the dermis only, then the T4 classification does not apply. At least that’s what the website below indicates in the T4 description

https://emedicine.medscape.com/article/2007112-overview#a1

beesie.is.out-of-office

Your question has changed. You'd asked "is it considered metastatic if it has spread to the dermis but still in her breast" and based on my understanding and the information I provided, it appears that the answer is "no".

Now you are adding that you've done research that suggests that T4 does not apply if the tumor is confined to the dermis. How does this tie to your original question? Does that mean you think that it is mets if it's in the dermis only? Or does that mean that you think it's Stage IIA based on the size of the recurrence?

That said, my interpretation of the Medscape staging explanation is different than yours. Where it says "not including invasion of dermis alone", I interpret that to mean that there is no other cancer in the breast other than the cancer found in the skin. If there is a tumor within the breast tissue, as is the case with your wife's diagnosis, I believe that the cancer on the skin would be classified as an "ipsilaterial satellite nodule of the skin". But, that's just my interpretation, as another breast cancer patient with no medical knowledge.

Ultimately the MO is right. Officially breast cancer is not restaged. So if your wife was Stage IA based on her initial diagnosis, now she is Stage IA with a recurrence.

From the Medscape article:

T4 Tumor of any size with direct extension to the chest wall and/or to the skin (ulceration or skin nodules), not including invasion of dermis alone
T4a Extension to chest wall, not including only pectoralis muscle adherence/invasion
T4b Ulceration and/or ipsilateral satellite nodules and/or edema (including peau d'orange) of the skin, which do not meet the criteria for inflammatory carcinoma

dres123

I appreciate the response and the interpretation. Upon further research I think T4 is not included if the tumor is confined to the dermis. I found a second article indicating that.

Also in the surgical report it says T2, not T4

I am not trying to argue it, I just want to leave that thought here for posterity. Thanks again!

beesie.is.out-of-office

The chart you posted refers to the "Primary Tumor".

Not sure why you asked the question if you already are certain of the answer and have information from the surgical report.

dres123

I am not certain of the answer. I wanted confirmation from anyone who has dealt with something similarly, if anyone had it. But I also wanted to clarify my research in case anyone stumbled across this post in the future.

mswife

Involvement of the the dermis on pathology alone is not classified as T4. T4 typically meansevidence of ulceration, swelling (obvious skin changes).

I'm also supporting a partner through this (my husband) - he was diagnosed in March. Happy to chat if you have any other questions!

sunshinegal

I'm late to chime in here, but according to my Dana Farber MO, my chest wall recurrence (in the skin layers) is a metastatic event, however he says it's a gray area that isn't well described by "stage 4." I learned on this board that recurrences aren't typically (re-)staged so I don't have an easy shorthand to describe my situation.

It's scary to have the word "metastatic" apply to my situation, but I've come to terms with it.

All the best to you and your wife!

dancingdiva

hi, mine came back in skin and in lymph nodes and is considered metastatic. maybe it also has to do with the size of the original cancer. not sure. my original was huge

happyhiker1

Just wondering if you have any info about dermis involvement, as I have been recently hit with a BC recurrence with pathology showing dermis and subdermis involvement. Am scheduled for mastectomy this next week, apparently the treatment when recurrence. It is difficult to get much info from my apparently very busy surgeon, but she said a total mastectomy necessary in such cases. Do you know if having dermis involvement is somehow more worrisome than other recurrences in same breast??

Rubytoos

Hello Happyhiker1--There is quite a bit of debate on how to characterize and treat BC that extends to the skin. I had a local recurrence in the scar tissue from a previous lumpectomy. I thought it was simply scar tissue and even the radiologist was convinced it was a cyst and did not biopsy it. However my surgeon was insistent and an excisional biopsy did show it was a recurrence that extended into the reticular layer or lower dermis. She was emphatic that I have a mastectomy at that point. And so I did. And the pathology from that was clear which was great. So while it is worrisome it is not something to worry about per se. There isn't a ton of information on this phenomenon. I read a paper by a researcher in Switzerland and I actually wrote to him about my case. I found that very helpful. If you want to send a PM if in fact this is still possible with the new board software, feel free and I will share what I learned.

happyhiker1

Thanks for your answer! I sent a PM to you, would really like any further info you may have!

Thanks!

Rubytoos

HappyHiker--I didn't realize that with the rebuilt forum all my settings were reset and I was unable to receive messages. I changed that and did send you a PM. I gather you had your mastectomy and hope you are doing well. I went through similar last summer and as an aside, PT made a huge difference with range of motion and overall recovery.