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Nov 7, 2016 01:32PM
Nov 7, 2016 03:30PM
Being younger, you are facing many challenges that I did not. I did find myself obsessively reading and searching for information. I was looking for clues to answer questions like exactly what caused this or to predict my outcome, neither of which is truly knowable. Early on in the process, I noticed that reading posts or papers in the evening increased the chances that I would lie in bed worrying late into the night (ditto if I woke up in the middle of the night, which happened a lot because of surgical issues). So for some time, until I was less prone to worry, I made a rule to stop reading any breast cancer-related material after ~8:00 PM, and this really helped me.
In addition, posts from the forums for those concerned about possible recurrence, those just diagnosed with a recurrence or metastasis, or the Stage IV forum triggered anxiety and fear, so I blocked those forums for a period of time, until I was stronger. I still only read these selectively.
If you think that it might help, then to block a forum, go to the menu at upper left, and select "All Topics". Navigate to a Forum, open it, and then block the forum by clicking on the "Block Forum" link as shown here:
At the next view, confirm that you wish to block the forum by clicking on the red "Block Forum" button. (I think this will also remove these threads from your "Favorites".)
Re your question, while less likely, the possibility that even very small invasive tumors can sometimes spread is one thing that I did not understand at first. However, the TNM staging system accounts for this, because while not common, it is sometimes seen. Any T1-size invasive tumor that is also pN1mi is considered Stage IB, including the smallest T1mi tumors (per Row 4 in the chart and note at right):
T1mi Tumor ≤ 1 mm in greatest dimension
T1a Tumor > 1 mm but ≤ 5 mm in greatest dimension
T1b Tumor > 5 mm but ≤ 10 mm in greatest dimension
T1c Tumor > 10 mm but ≤ 20 mm in greatest dimension
Probably, not all cells that are able to leave the primary tumor site safely reach the nodes and establish themselves there. So, perhaps there may be some element of chance when it occurs early. And/or perhaps, there was a local immune reaction in the breast, that was able to hold the size of the primary tumor in check. The why in any particular case is unknown.
Per page 2, right column of this summary, pN1mi is the designation for micrometastases that are greater than 0.2 mm and/or more than 200 cells, but none greater than 2.0 mm:
Treatment algorithms in guidelines also separate N1mi disease from N1 disease. This is because as grainne noted, N1mi disease has a more favorable prognostic profile than N1 disease. Indeed, with increased understanding of the prognostic significance of smaller nodal deposits, the AJCC staging manual was specifically revised to down-stage those with pT1 N1mi M0 disease to Stage IB, while N1 disease is designated as Stage II or higher:
"Whereas in the sixth edition, T1 N1mi M0 and T1 N1 M0 disease were both categorized as stage IIA, in the seventh [current] edition, T1N1miM0 disease was categorized as stage IB."
One of the hardest things for patients (as opposed to their family and friends) is to get to a point where you can believe more often than not, that you could be one of those in the larger group identified by statistics who will have a favorable outcome. Meanwhile, be kind and patient to yourself and protect yourself when you need it.
Stage IA IDC, 9/2013 BMX. Right: IDC (1.5 mm, grade 2) with DCIS (5+ cm), 0/4 nodes, pN0. Left: DCIS (5+ cm), 0/1 node, pN0(i+).