Positive LVI and Benefit vs Toxicity of Adjunct Treatment
Hi, I am new to this forum. I was Dx with DCIS 8 cm in March 2023 but elected to "wait and watch". I felt a painful tumor in February 2025 and after testing and resultant unilateral mastectomy in May 2025, Dx with Extensive Invasion of LVI in two or more blocks. My stats are Grade 3, ER+/PR-/HER2+ and Ki-67 = 60. The Pathology showed DCIS 20mm, LCIS, and IDC 20mm. Margins clear and 2 sentinel nodes clear. I can't get passed the Extensive Invasion of LVI and I have read many research studies that confirmed poor OS and DFS. I meet with the oncologist tomorrow and based on the studies that I have read, it does not appear that adjunct treatment will provide any benefit of OS and only toxicity. I just retired and finally able to travel the world; however, I am concerned that I may run out of time before the metastatic. I would very much appreciate how anyone with similar pathology has handled.
Thanks!
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Hi @orangeblossum, welcome to our community. We're sorry for the reasons that have brought you here. You mention that you have a rather high Ki67 proliferation index (anything above "20" is considered fast-growing), and that your cancer is grade 3. If your sentinel nodes were clear, yet you were diagnosed with extensive LVI, your oncologist may still deem you a good candidate for systemic therapy and / or radiation, based on the aggressive growth of your cancer. Please address your concerns with your oncologist, and cite any research articles that worry you.
You may also find some of the comments in the following discussion thread to be helfpul (even though it is an older thread, the questions raised and discussed are similar to yours):
We're all here for you!
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Hi @orangeblossum, I’m sorry your diagnosis brings you here. While LVI is not a good thing it generally does not have much influence on treatment as far as medical oncology goes. I had a lumpectomy followed by radiation which was more aggressive because of my LVI. Unfortunately I had some rare serious side effects from radiation so I’m not sure the extra treatment was worth it. Since you had a mastectomy radiation may not be a factor.
According to my surgeon LVI is just evidence that the cancer has learned how to spread. There is no way of knowing how far it has gone. It is only the first step in a process which involves traveling through the blood or lymph system, finding a niche to stay dormant for a while, being reactivated to recirculate and finding another spot to invade and grow. It is difficult for rogue cells to survive all of that so metastasis is not likely even though it can happen whether or not LVI is present.
When your MO proposes each treatment you can always ask how not doing it will affect your risk of recurrence and what SEs might be expected. You don’t have to commit to anything on the spot, can do further research and get a second opinion if you want. Your individual situation is not the same as a generalized research study so you shouldn’t make decisions based on what you have read. I hope your oncology appointment goes well.
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I chosed aggressive treatment, being young at the time, wanted to be around for our kids.I am glad I had a radical masectomy and chemo for a year, twice a month.
Saw our kids finished school, university, marry, 30 years survivor.
I am retired from a cancer center, my choice made me live years.
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