confused about path report

[lizmcdowell]

Thank you for this site, it is very helpful.  Path report states high grade mixed ductal type and lobular differentiation measuring up to > than 5cm but identified within span of greater than 9 cm.  Later in the report it also stated itraductal carcinoma with features of high grade ductal carcinoma in situ with evidence of prominent lymphatic vascular permeation.  My questions are, are there 3 different cancers?, How can it be both invasive and in situ?, is the tumor considered 5cm or 9 cm?, their were 2 lymph nodes involved, is this what lymphatic vascular permeation means?  ER/PR pos. HER2 Pos. I had 8 chemo 4AC and 4 Tax, 30 radiation treatments to the breast and 30 the super clav lymph nodes, now on tamoxifen for 5 years, what are the chances of recurrence with all these things considered? Thanks again for this site.

[CCF-RN,MSN-JS]

Dear lizmcdowell, In a pathology specimen there could be features indicating both in situ as well as invasive cancer.  If there is any invasive component this is what treatment recommendations are based on.  Although taken out of context, it sounds like they are talking about a 9cm specimen, but the cancerous component was greatest at 5cm.  Lymphatic vasculature permeation is not referring to the lymph nodes.   Like small blood vessels or capillaries that run through the breast, the lymphatic system also has a series of small vessels that run through the breast.  Lymphatic vasculature permeation means that cancer cells were found invading these vessels, which can be a indicator of increased likelihood that cancer could spread, as evidenced by the positive lymph nodes.  

All of the information on staging and the features of the tumor, are taken into account to make treatment recommendations.  You have received appropriate adjuvant treatment in the hopes of decreasing the chance of recurrence of the breast cancer.  People who are HER2 neu positive are thought to have a more aggressive cancer. Having said that, folks who are HER2 positive are also good candidates for Herceptin. In many cases, breast cancer can be controlled for a long time.  It is possible that, at some point, you will experience a recurrence.  Women can live a long time with breast cancer. If it does reoccur, many women live "well" with the disease.

[lizmcdowell]

I forgot to mention that I am 42 and had a lumpectomy.  The final margins are free of tumor: however pattern of infiltration and involvement of lymphatic vessels residual of tumor can not be completely excluded.

[surgeon]

It's not unusual to have areas of carcinoma in situ in a breast that has invasive cancer. The prognosis depends more on characteristics of the invasive component. Likewise the fact that it shows ductal and lobular components is not rare, and doesn't really have prognostic significance.  I'm not sure I fully understand the nature of the report, as to whether it's 5 cm or 9 cm; I think you implied only the invasive area was 5 cm, so it would be a 5 cm tumor. Lympho-vascular invasion is what's seen when looking at the tumor itself; seeing it means increased risk of finding it in lymph nodes (which was the case) or spread elsewhere. Absent any evidence of tumor beyond the breast and local nodes, cure remains possible. Quoting exact odds is not very meaningful, in that such numbers apply to studies of thousands of people; but there's no way to make a prediction about an individual. Unfortunately, like all women in your situation, you will have a period of uncertainty until more time passes. Meanwhile, there's reason to be optimistic, while being vigilant.