Lymphovascular Invasion Present and Perplexing Pathology Report
Hi All,
I am new here, and have spent the last seven hours crying. I received the pathology results today, and as you may have guessed, it's not good. Not good, confusing, scary, and I have discovered Google is not my friend tonight.
My pathology diagnoses results were:
-Foci of ductal carcinoma in situ, intermediate nuclear grade with cribriform pattern, necrosis and calcifications
-Focal invasive carcinoma is present
And for extra anxiety and despair in the comments, "the foci measure unto 1millimeter in maximum dimension, compatible with micro invasion precluding grading of invasive carcinoma" and "there are areas of lymphovascular invasion present in the specimen, which raises a concern for possibly larger foci of invasive carcinoma which are unsampled."
I haven't breathed since. I am 50 with 6 year-old twin girls, and I have been crying in between hugs, dinner, and trying to act normal so my girls don't see me lose it. I can't stand it, I want to crawl out of my skin. This is like a nightmare I can't wake up from. I am confused, scared, and I vacillate between guilt and anger that I have not kept up with my mammograms the past years, fear I won't see my children grow up, and regret I have not sucked the life out of every waking moment since my children were born.
I have spent the last three hours since I put my children to bed trying to understand what I am up against. My doctor wants me to have an MRI and see the surgeon immediately (which I will do without haste as soon as possible this week if I can get in). She has assured me we will do everything possible in between surgery, treatment including radiation and chemo depending on the surgeon's plan and results from the MRI. Yet I cannot get past "llymphovascular invasion present" and there is nothing that I can Google that is not grim and dire. I am spinning like a top. I want to grab my children and run away from reality but run where, to what, and for how long?
Beyond what my doctor has explained to me about LVI, has anyone else out there faced this? Any words of wisdom, any sage advice? Any insight, I'm hungry for some comfort to make it the next hour, day, week. I just don't know how to keep it together without absolutely falling apart. One minute I am determined, the next a blubbering mess.
I have read the "Understanding your Pathology Report" so generously provided on this site, and it is very helpful. Yet, here I am, shaking and scared out of my mind. I have to find a way to shift my mindset from "this can't be happening" to "it's happening, what's the plan."
All my love to all you lovelies out there who are smarter, stronger, and are fighting the fight.
L
Comments
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Ipace, we're so sorry for the circumstances that have brought you here, but we're glad you've found us. We're sure other members will come along soon with some words of encouragement. Know that you are not alone in this scary and confusing time!
We're glad you found the "Understanding your Pathology Report" article helpful. The following section may also contain some useful information for you: Members Who've Just Been Diagnosedas well as the DCIS (Ductal Carcinoma In Situ) forum.
We hope this helps! Please come back to let us know how you're doing. We're thinking of you!
The Mods
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Hi lpace,
Sory you are here. I understand your shock and desperation, because I had the same reaction when diagnosed at 48, I also had twins, who were 10 year old at the time. I think you are reading too much into your pathology report, and you will see this very differently once you to an oncologist and understand your diagnosis, the plan for your treatment and your prognosis. When diagnosed, I knew nothing about cancer, and in my mind all cancer was bad, and meant imminent death. That's not true. Sounds like you have DCIS (which is not cancer), and some tiny parts of it are invading the surrounding tissue, which makes them a tiny bit of cancer. Very early diagnosis. Of course, nobody wants any cancer diagnosis, early or not, but what you have is a tiny tumor, probably very treatable.
My cancer at diagnosis was 3.5cm, with two palpable lymph nodes that tested positive for cancer, and there was lymphovascular invasion everywhere, and extracapsular extension in the nodes, meaning the cancer look like it was extending beyond those nodes. That was more than 5y ago, and so far my cancer hasn't come back after the initial treatment. But at the beginning, I plunged into total desperation and lost like 10 pounds in the first two weeks, woke up every night at 3am planning my funeral. I was wrong. If you anxiety is not letting you function, please ask for help, you can take anti anxiety medication for a while until you are back on your feet. Once you understand your diagnosis, start treatment and have a plan in place, you will start feeling much much better, and the anxiety will lift off. You can do this. Please try not to get ahead of yourself.
LaughingGull
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lpace082, by law, the pathology report should be posted but if we are not doctors who know how to read it, sounds like a disaster for us. We all have been there. I was advised by the doctor who did the biopsy to stay away from google. If you google even a sneeze, you'll end up reading that you have a monster disease
.ductal carcinoma in situ means Stage 0. That means that many women may have it and they don't know becasue it is not considered invasive. The invasive part you have can be so tinny that a lumpectomy can take care of it. Please don't borrow the worries for now. I am glad your doctors are pushing you to do more tests to figure out their treatments. Please keep us posted.
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lpace, I'm sorry you are here. LaughingGull has given you good advice. I had lymphovascular invasion which did not show up on my biopsy and was first mentioned in my surgical pathology report. My surgeon was not concerned about it and it did not change my treatment plan.
Surgery is probably going to be the first step so instead of googling dire survival statistics you might want to read about that so you can have an informed discussion with your surgeon. Would you prefer a lumpectomy if feasible or a mastectomy? Would you want reconstruction and, if so, an implant or a flap reconstruction? This site has a great deal of useful information and the members here will share their experiences and support you. Educating yourself will help you feel that you are doing something positive, help ensure an outcome you are happy with, and relieve some of the anxiety. The recommendation for an MRI and a surgical consult is a good plan, so take comfort in the fact that you have a knowledgeable doctor, too. All the best going forward!
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First of all your reaction is completely normal. We all kill ourselves off at diagnosis for lack of a better description. We are all wrong though and once you get a handle on this you'll understand why. Because you don't have a handle on it yet and are still in shock so give yourself grace as you move through this. Anyway I am assuming this is your pathology result from your biopsy, yes? If so it doesn't read as particularly unusual for those of us further down the road. It sounds like it's mostly DCIS which is noninvasive and a few small spots of IDC. But like super small. In other words, very very early. Sure LVI is present and you don't want it but it's very common and in some cases statistically doesn't seem to affect prognosis. After all it's not even a factor in our staging system which means they haven't completely quantified how much it matters yet. At any rate, accompanied with small IDC's it doesn't appear to be anything so unusual or concerning that puts you outside of the norm. Either way, this appears to have been caught super early and although no one wants a breast cancer diagnosis the fact is that it is very common for women. So common that the amount of money and research put towards it has made it at all stages a very treatable and livable diagnosis. Just hang on until you meet with your oncologist and know that these feelings you have, this impending sense of doom, does pass once you have a treatment in place. You will find happiness again, you will enjoy your children and family life, and you will move on and can possibly be even better than you were before. Different sure. But sometimes different can be made into a great thing.
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lpace, this "I have been crying in between hugs, dinner, and trying to act normal so my girls don't see me lose it. I can't stand it, I want to crawl out of my skin. This is like a nightmare I can't wake up from. I am confused, scared, and I vacillate between guilt and anger that I have not kept up with my mammograms the past years, fear I won't see my children grow up, and regret I have not sucked the life out of every waking moment since my children were born." could have been written by me but you expressed it so much better. You verbalized exactly how I felt at the time of my diagnosis. I still feel like it. I managed not to cry in front of my girls, 6 and almost 9, and that's all I managed. I also contacted my estate lawyer! We've been meaning to update our wills and trusts for the kids for 1.5 years and procrastinated but hey, now I have an appointment for mid-January. Nothing adjusts your priorities like a cancer diagnosis.
By the way, don't feel like not keeping with your mammograms has anything to do with it. I kept with mine religiously after my girls were born, as my mom passed away from BC; I even did the BRCA testing, and it was negative. My 2021 Sep mammogram was fine; the one at the very beginning of Dec wasn't, so... Best of luck to you, and you are at the VERY early stage. That's great.
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I wanted to thank each of you for your support on my post. Your words of wisdom, kindness, and love have helped me more than I can describe. It has been a long, hard week but I've taken all the steps to keep going. I have my plastic/resconstructive surgery appointment on Monday (I've told the doctor regardless I want to have a double mastectomy). I have been advised the DCIS is too big for a lumpectomy (5cm) and I honestly don't want to risk anything in future with the invasive carcinoma, which she thinks might be the size of a bb, but she's not sure yet, not until the MRI and surgery. I'm 50, I've enjoyed my boobs since I was 14, but I'm ready to say goodbye to them, and have no hard feelings to do so. I have scheduled my MRI for Tuesday afternoon, and I just received my receptor update, I'm ER+, PR+, HER2-, with the Ki-67/High 25%. In my consultation, I wasn't prepared for the Ki-67 number, so that has sent me into a mild tail-spin, but I pulled myself out of it. My surgeon did a great job of providing me with guidance on what treatment will happen based on the results of the MRI, surgery, biopsy, and if my LN are +/-.
What I am doing is coming to terms with all the dependencies, the "if that, then this" scenarios, the whole way everything just hangs in the balance until you get to the next step. But I am dealing with the uncertainty better, and appreciating the goodness around me, my children, my brother, my friends.
What I had originally gone in for was I found a lump in my left breast. This lump has since been eliminated as an oil cyst. What they were more concerned about was the calcifications in my right breast on the mammogram, and then ordered the biopsy. What is scary to me is that my surgeon said they did not see the bb-sized invasive carcinoma on the mammogram or ultrasound. She said they happened to get a piece of it in the biopsy when they were biopsying the calcifications which they have said now is DCIS. It's hard for me to wrap my mind around how much l longer I would have waited to go in for a mammogram had I not found that lump in my left breast. I guess everything does happen for a reason.I feel like I have spent my 40's (and now my 50's) in online support groups. First, through IVF, then heartbreaking infertility, miscarriages, raising twins, then divorce, then well, now this. I have relied on the kindness of strangers and strong women like yourselves who are experiencing or who have experienced the same difficulties, challenges, and heart aches that I was going through and continue to face. Women I'll never get the chance to meet or hug, so brilliantly versed with calming, soul-soothing, and wise words to guide me through dark woods. I wish I could do more, pay you all back in some way other than words. But all I can offer is my thanks for helping me through this terrifying week. It was a shock, an absolute unexpected slam into the barrier on the highway. It all still feels a little unreal, but I appreciate what you have all said that life will always now be different. And different can be good.
XOXO.
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We're right there, an army of women that you can now join as we comfort and love on each other, At any rate, don't be concerned about your KI-67 score. I didn't even get one because my top rated cancer center says they are unreliable and can differ from lab to lab. And even if you do have a 25 that's high but in the grand scheme of how high they can go, not high if that makes sense. They'll go from your oncotype score after surgery instead and that has a plethora of science behind it in determining the right treatment. You're still super early in your diagnosis but I'm so glad to hear that that you seem to be pulling yourself out of the initial panic that always results. You will probably go up and down with it for awhile to be frank so check back in as you need to. But the panic will end and you just learn to live with your diagnosis as part of your new normal. I mean this is breast cancer, horrible, something we all wish didn't exist, but you throw a rock and you're going to hit a woman with it. It's a big, big sucky club with lots of wonderful people and there's comfort in the sheer size of it.
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My advice is to also schedule fun days with those kids! Or even just for yourself. When I wasn't doing appointments, tests, scans, surgeries, and all the medical dreary stuff, I was enjoying day trips and local outings and even a few long weekend getaways in between. I thought of it as pre-planning memories. And it worked! Even one year out, I remembered the fun more than the appointments, and at almost five years, I have to refer to my calendar or medical chart to remember specific days for things like surgery. But I remember those fun outings with no problem.
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