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Topic: Node positive multi-focal microinvasive IDC

Forum: DCIS plus HER2-positive Microinvasion —

Meet others with this diagnosis.

Posted on: Jan 28, 2019 03:25PM

Ms_Anthrope wrote:

I am just joining this group because even the oncologists at my cancer center disagree on my treatment, so I am wondering if anyone had a similar DX.

In Sept I had a left mastectomy. Final pathology:

  • 6.5 cm DCIS grade 3 tumor with multi-focal microinvasion
  • highly positive for ER, PR and HER2
  • HER2/CEP7 ratio of 7.16
  • Lympho-vascular invasion
  • Micro-metastasis in sentinel node (the only one taken) (HER2 reading from lymph node)
My case went to the to the tumor board because it was so rare. One oncologist at my cancer center said I needed PCTH + the year herceptin, and another said I could literally do NOTHING. I took the middle route, having just completed 12 weeks of taxol + herceptin, and in a week, I start herceptin every 3 weeks for a year.

I realize I am in a super small subset. Anyone else have a similar diagnosis, and if so, what was your treatment plan?

Thanks much.

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Jan 28, 2019 07:51PM TB90 wrote:

This is unique as many of us are. How can you have invasion of any type with DCIS? Lymphoma-vascular invasion sounds like IDC. Sorry, I have never heard of this. I completely understand you confusion and even irritation with conflicting treatment recommendations. I experienced this too but for different reasons. My recommendation is research and ask. You are in the right place. The expertise on these boards is amazing.

Dx 11/28/2013, DCIS, Grade 2 Surgery 12/17/2013 Mastectomy: Left Radiation Therapy 2/19/2014 Breast
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Jan 28, 2019 08:49PM Moderators wrote:

Hi Ms_Anthrope, welcome to BCO! We're so sorry you find yourself here, but we hope that you find the guidance and support you need as you continue your treatment. We can't imagine how frustrating it is to not have a clear path or answers, but hopefully one of our many thoughtful members can offer some insight from their own experiences,

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Jan 29, 2019 08:41AM - edited Jan 29, 2019 09:01AM by Ms_Anthrope

It's weird, I know.

Sometimes its referred to as DCIS and sometimes IDC -it's right in between them. It was a giant DCIS tumor with several small areas of invasion (microinvasion) that broke through the cell membrane. Based on my pre-surgery biopsy, my doctors thought I might need no adjuvant treatment, and were surprised it got to my sentinal node.


Maybe I'm in the wrong forum and the moderators can redirect me?

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Jan 29, 2019 09:02AM LeesaD wrote:

I hope someone with a similar diagnosis chimes in. I always thought any sort of invasion diagnosis trumps DCIS diagnosis. I had IDC but my pathology after my diagnosis showed extensive DCIS throughout but it wasn’t even mentioned really other than on the pathology as I was treated for the IDC. Since you have invasion I would think therefore you should have been/ should be treated for the invasion. Many on here have both IDC and DCIS but the diagnosis is always the IDC as that’s the worst of the two. And you also had micromets and LVI so it’s showing it’s trndency to move. I’m sorry if I’m not much help and just thinking out loud here but I guess I’m questioning why they would question treatment options when there is invasion and you should be treated as such.
Oncotype Score 3, 2/4 Sentinal Nodes micromestasis so pushed for ALND for 'peace of Mind' and surprise found 2/14 positive axillary nodes Dx 2/3/2017, IDC, Right, 3cm, Stage IIB, Grade 2, 4/18 nodes, ER+/PR+, HER2- Surgery 3/27/2017 Lymph node removal: Right, Sentinel; Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery 4/17/2017 Lymph node removal: Underarm/Axillary Chemotherapy 5/9/2017 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Radiation Therapy 8/2/2017 Hormonal Therapy 9/7/2017 Arimidex (anastrozole), Zoladex (goserelin) Surgery 11/17/2017 Prophylactic ovary removal Surgery 1/30/2018 Reconstruction (left): Fat grafting, Silicone implant; Reconstruction (right): Fat grafting, Silicone implant
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Jan 29, 2019 10:51AM Beesie wrote:

Ms_Anthrope, you are in the correct forum.

Your tumor appears to be DCIS-Mi, DCIS with a microinvasion. Microinvasions are IDC, just very tiny - by definition, a microinvasion is no larger than 1mm in size. Some people (like me) have just one microinvasion mixed in with their DCIS; other people have several. It appears that you have several.

DCIS-Mi is not the same as DCIS. DCIS is Stage 0; DCIS-Mi is Stage IA. It is the smallest possible invasive cancer.

Because it is invasive cancer, although rare, it can lead to nodal involvement and lympho-vascular invasion. With micromets to the nodes, the staging changes to Stage IB.

Normally the treatment of of DCIS-Mi is the same as the treatment for DCIS, but this can change if the microinvasion is HER2+ or if there is nodal involvement, as in your case. In those situations, DCIS-Mi tends to be treated as any other small invasive cancer.

“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke
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Jan 29, 2019 11:22AM LeesaD wrote:

Bessie thank you for helping her and educating me as well. This is definitely the place to come to for info. The women here are so educated and communicate info more effectively than doctors do sometimes.
Oncotype Score 3, 2/4 Sentinal Nodes micromestasis so pushed for ALND for 'peace of Mind' and surprise found 2/14 positive axillary nodes Dx 2/3/2017, IDC, Right, 3cm, Stage IIB, Grade 2, 4/18 nodes, ER+/PR+, HER2- Surgery 3/27/2017 Lymph node removal: Right, Sentinel; Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Surgery 4/17/2017 Lymph node removal: Underarm/Axillary Chemotherapy 5/9/2017 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Radiation Therapy 8/2/2017 Hormonal Therapy 9/7/2017 Arimidex (anastrozole), Zoladex (goserelin) Surgery 11/17/2017 Prophylactic ovary removal Surgery 1/30/2018 Reconstruction (left): Fat grafting, Silicone implant; Reconstruction (right): Fat grafting, Silicone implant
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Jan 29, 2019 11:41AM Ms_Anthrope wrote:

Thanks, Bessie. Yes, I was classified as stage 1B because of the lymph node.

I saw another oncologist today outside of my cancer center, and he said he would also have recommended the PCTH regimen because of all my other factors. He was extremely surprised to hear that one of my docs at the cancer center suggested no adjuvant therapy but agreed my cancer was extremely rare.

Next week I start the remaining 9 months of my Herceptin treament, and somewhere in there I'll get my reconstruction surgery. Who knew BC could be such a long haul - my journey started last May with my mammogram...

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