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12-23-2011, 02:25 PM
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#1
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Member
Join Date: Dec 2011
Posts: 7
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vascular invasion
Im thru bmx, 4 AC & 6 of 12 taxol/herceptin, but just noticed on path reports "lymphovascular invasion present." Drs never mentioned this to me. Tumor was
1.4 cm, er+ pr+ her2+, node negative (0/4), grade 3, stage I & that was all explained to me but LVI was not.
Does anyone know how significant LVI is to prognosis? Does it mean mets or recurrence is more likely even after all the treatment? Or is LVI just a factor like her2+ is that would warrant chemo where without LVI the patient might not have needed chemo? Would appreciate hearing from anyone who may have discussed LVI & what it means for prognosis & treatment.
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12-26-2011, 10:46 AM
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#2
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Senior Member
Join Date: Sep 2005
Location: Alaska
Posts: 2,018
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Re: vascular invasion
alli98,
The online decision-making tools like Adjuvant Online don't ask about LVI when estimating, but might have some discussion about their impression about it. If it isn't a clear and definite measurable factor for them, it likely isn't certain.
Comparisons are complicated. You and I have similar characteristics other than that I did not have LVI, and you probably didn't have CAFx6 like I did, and you probably did have trastuzumab.
You might discuss it with your onc to see what your personal path samples showed. How prevalent was it on the samples used in looking at your pathology?
AlaskaAngel
__________________
Dx 2002 age 51
bc for granny, aunt, cousin, sister, mother.
ER+/PR+/HER2+++, grade 3
IDC 1.9 cm, some DCIS, Stage 1, Grade 3
Lumpectomy, CAFx6 (no blood boosters), IMRT rads, 1 3/4 yr tamoxifen
Rads necrosis
BRCA 1 & 2 negative
Trials: Early detection OVCA; 2004 low-dose testosterone for bc survivors
Diet: Primarily vegetarian organic; metformin (no diabetes), vitamin D3
Exercise: 7 days a week, 1 hr/day
No trastuzumab, no taxane, no AI
NED
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12-26-2011, 08:15 PM
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#3
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Senior Member
Join Date: Jun 2009
Location: Los Angeles, CA
Posts: 309
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Re: vascular invasion
I would talk to your Onc about this-
Good Luck!
__________________
DX: 11/08 Age: 53
Surgery: 1/09
Bilat Mastectomy, no reconstruction
ILC-4 tumors-1.7 cm,1.5 cm (2).8 cm
DCIS-11 cm
All tumors Grade 3
All tumors ER-0%/PR-0%
All tumors HER2+
IHC-all tumors Overexpression/borderline
FISH 2 tumors Her2-Negative
FISH 2 tumors Her2+ Equivocal
Stage I, 0/1 nodes
LVI-Indeterminate(treated as positive)
SPR Score 8/9
Ki-67 20%
BRCA genetic test 1/2=negative
Chemo: 6 rounds TAC Feb-June 2009 w/Neulasta
Herceptin: 6/12/09-6/4/10 52weeks
HNPCC genetic test: negative
Port Placement-9/23/09 Port Removal 6/25/10
Echo's every 3 months-All normal
2/09 Staging PET/CT showed 0.2 micronodule upper R lobe-lung-Onc does not think this is mets--
6/5/09 AND 10/09 CT scan 0.2 micronodule unchanged
1/10-PET/CT-uptake in nasopharynx-
1/10-MRI All normal
6/10-Bone Scan-clear
12/10-PET/CT-All Clear-NED
12/11-PET-All Clear-NED
12/12-PET-All Clear-NED
12/13-CT w/contrast Head, Torso-All Clear
12/14-CT w/contrast Head-All Clear
2/15-Core needle biopsy-R scar line
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12-27-2011, 08:17 PM
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#4
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Member
Join Date: Dec 2011
Posts: 7
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Re: vascular invasion
AlaskaAngel, what is CAFx6?
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12-27-2011, 08:40 PM
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#5
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Member
Join Date: Dec 2011
Posts: 7
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Re: vascular invasion
Oh I see what CAF is - I had never heard of that cocktail before. Anyway, I will ask onc & bs what vascular invasion means for me. I just think its weird they never mentioned it. Most things I ask them about after reading horror stories, they say are nothing to worry about so hopefully they same thing about LVI.
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12-28-2011, 12:11 AM
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#6
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Senior Member
Join Date: Sep 2005
Location: Alaska
Posts: 2,018
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Re: vascular invasion
Yes, CAF (sometimes also called FAC) and FEC both use similar drugs (Adriamycin for one, and epirubicin for the other). In the US, prior to using the taxanes those who were HR+ generally got CAF or FEC, and those who were HR- got CMF. CAF and FEC are still used in Canada, Australia, and Europe for some patients instead of a taxane, for those who don't get as much benefit from using a taxane. (Like me, for example.)
I think your guess about the thinking behind your treatment is correct and that the systemic chemo is what they would use regardless for the LVI. Your onc or the pathologist should be able to tell you how consistent and prevalent it was or not from your tissue samples.
A.A.
__________________
Dx 2002 age 51
bc for granny, aunt, cousin, sister, mother.
ER+/PR+/HER2+++, grade 3
IDC 1.9 cm, some DCIS, Stage 1, Grade 3
Lumpectomy, CAFx6 (no blood boosters), IMRT rads, 1 3/4 yr tamoxifen
Rads necrosis
BRCA 1 & 2 negative
Trials: Early detection OVCA; 2004 low-dose testosterone for bc survivors
Diet: Primarily vegetarian organic; metformin (no diabetes), vitamin D3
Exercise: 7 days a week, 1 hr/day
No trastuzumab, no taxane, no AI
NED
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12-28-2011, 09:02 AM
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#7
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Senior Member
Join Date: Jun 2011
Location: Somerset, NJ
Posts: 487
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Re: vascular invasion
Here are a few articles about lymphovascular invasion (LVI), none of which were particularly heartening:
http://onlinelibrary.wiley.com/doi/1...26711/abstract
Specifically for the node-postive folks:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3200515/
This is older, but I found it when I was looking for information about radiation (which I was originally told I would not need, but do need after all, partly because I had LVI). The section you want to read is under "Prognostic Factors":
http://theoncologist.alphamedpress.o...t/9/6/606.full
And another from 2007 with lots of tables and statistics:
http://www.belsurg.org/uploaded_pdfs...07_284_287.pdf
__________________
2/6/09 Core needle biopsy: negative; Mammos through 2010: no change
3/30/11 Pea-sized lump in left breast at site of prior biopsy; mammo negative, sonogram not so much
4/14/11 Core needle biopsy: negative for cancer
5/18/11 Excisional biopsy 1.2 cm tumor, LVI, positive margin; ER+60%,PR+20%,HER2/CEP17 5
6/15/11 BMX: Left DCIS & LH; Right ADH; SNB: 2/3 nodes: 1.4 cm and 1 mm; ALND L1&2: 0/10; Stage IIa, Grade 3
7/14/11 CT/Bone scans NED; MUGA 66%
7/19/11 Biweekly dd AC w/Neulasta; done 8/30/11
9/13/11 Transfusion (Hemoglobin 8.6); MUGA 64%
9/20/11 Start Taxol + Herceptin; Taxol done 12/6/2011; continue Herceptin until 9/4/2012
12/27/11 Radiation - 6 weeks; 2/27/2012 - DONE! Yayyyy!
2/29/12 Start Tamoxifen 20 mg/day; continue until 2/28/17
5/16/12 Start five-years Metformin trial
6/19/12 MUGA 61%
8/21/12 Brain MRI NED (head still hurts, brain still fogged)
9/4/12 Herceptin done!
9/6/12 Port out!
7/11/13 Aricept 5mg for cognitive impairment; increased to 10mg as of 8/23/13; back to 5mg 12/2013
5/2014 Add Namenda 7mg
9/2014 Stop Aricept and Namenda; Neuropsychological evaluation
10/24/14 Start cognitive rehabilitation therapy
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12-28-2011, 12:10 PM
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#8
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Member
Join Date: Dec 2011
Posts: 7
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Re: vascular invasion
Thanks for articles rhondalea. Our treatment plans seems pretty similar except for the rads you are getting. I should b done with taxol in feb. Good luck.
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12-29-2011, 12:45 AM
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#9
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Senior Member
Join Date: Apr 2011
Posts: 403
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Re: vascular invasion
Hi, Alli. I think many here who had positive lymph nodes freaked about the path report. There are quite a few of us here in our 30s are diagnosed at stage 3. Vascular invasion, yes i had 10 out 23 and that was after 4 chemos. My cancer cell broke away from my lymph nodes as well, i think it is called external capsular invasion. When my surgeon told me i had 10 positive nodes i said,um not too bad only 10. He didn't not say anything. Later i found out what it meant and i couldn't pull myself out from "google". It has been 10 months since i started 1st chemo and there were so many bad dreams after surgery when things eventually felt so real as my scars proved what happened- i had cancer. There are still gloomy moody days but it is getting better. I guess what i am trying to say that you will be fine. I eventually came to understand that living today is the most important. I used to worry sick about my prognosis but it really sucks to live in fear and worry. Easy said, it is tough. I hope you will feel better soon. There is a life after cancer, it is upto us whether we want to live it happy as much as we can.
__________________
1/11 age 36 DX
ER/PR-, Her2 +
TCH*6, Herceptin
BMX with immediate recontruction 5/2011 Lattismus Flap- Dx stage 3c 10/23 nodes
9/11 Radiation
3/12 Local recurrence to skin stage IV
Whole body scan CLEAR
4/12 Tykerb & Xeolda Skin mets slowly regressing
8/12 PET & Brain CT Clear
5/13 Skin mets progressing
6/13 PET scan chestwall recurrence in contralateral anxillary,internal mammary and ipsilateral subpectoral nodes
6/13 kadcyla
10/13 whole body scan -clear NED. previously resolved skin rash gone but 3 new lesions. Biopsy confirmed for skin recurrence
11/13 to 02/14 tykerb & herceptin
02/14 add abraxane/gemzar, 2 weeks on 1 week off at reduced dose
05/14 whole body PET clear/ brain CT clear but skin mets are getting worse, ready for new chemo
05/14 navelbine perjeta herceptin
07/14 skin mets progressing red rash worse
08/14 wide local excision with diep flap to close wound. Final path shows 2 positive margins showing inflammatory carcinoma Going back to surgery in 2 weeks
09/01/14 resection- clear margins
3 weeks after 2nd surgery, a new nodular rash found near drain incision with 2 small red spots behind the chest wall biopsy on 10/1. Positive for breast cancer
Radiation 11/2014 with xeloda then weekly cisplatin
11/14 brain MRI clean
12/14 finished 33 radiations burnt and very painful. Bedridden for 1 week
12/14 t current Herceptin and perjeta only
02/15 rash on upper back right side skin mets radiation planned
02/15 staring electron radiation *35
Stopped at 30 due to severe skin burn, resumed 10 days later
05/15 red patches appeared in between previously radiated area, skin mets. Ct and brain Mri clear. Simulation planned, radiation to start after trip to Alaska.
05/24 new spot identified in scar line on previously radiated reconstructed breast- electron on both side chest wall area and scar line
07/15 multiple skin and lung recurrence begin halaven
11/15 cough much better but very tired on halaven and starting to see some new red skin blotches-suspicious
11/15 heading to China for immune therapy
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12-29-2011, 05:45 AM
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#10
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Senior Member
Join Date: Jun 2011
Location: Somerset, NJ
Posts: 487
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Re: vascular invasion
Thanks, alli. For the Taxol, you might want to look into acetyl-l-carnitine. There are several studies which indicate it minimizes or even prevents neuropathy. It worked exceptionally well for me, and I have no neuropathy at all.
Note to yanyan: lymphovascular invasion is not the same as positive lymph nodes. See here for a concise explanation:
http://www.dslrf.org/breastcancer/co...d=132&cid=1104
__________________
2/6/09 Core needle biopsy: negative; Mammos through 2010: no change
3/30/11 Pea-sized lump in left breast at site of prior biopsy; mammo negative, sonogram not so much
4/14/11 Core needle biopsy: negative for cancer
5/18/11 Excisional biopsy 1.2 cm tumor, LVI, positive margin; ER+60%,PR+20%,HER2/CEP17 5
6/15/11 BMX: Left DCIS & LH; Right ADH; SNB: 2/3 nodes: 1.4 cm and 1 mm; ALND L1&2: 0/10; Stage IIa, Grade 3
7/14/11 CT/Bone scans NED; MUGA 66%
7/19/11 Biweekly dd AC w/Neulasta; done 8/30/11
9/13/11 Transfusion (Hemoglobin 8.6); MUGA 64%
9/20/11 Start Taxol + Herceptin; Taxol done 12/6/2011; continue Herceptin until 9/4/2012
12/27/11 Radiation - 6 weeks; 2/27/2012 - DONE! Yayyyy!
2/29/12 Start Tamoxifen 20 mg/day; continue until 2/28/17
5/16/12 Start five-years Metformin trial
6/19/12 MUGA 61%
8/21/12 Brain MRI NED (head still hurts, brain still fogged)
9/4/12 Herceptin done!
9/6/12 Port out!
7/11/13 Aricept 5mg for cognitive impairment; increased to 10mg as of 8/23/13; back to 5mg 12/2013
5/2014 Add Namenda 7mg
9/2014 Stop Aricept and Namenda; Neuropsychological evaluation
10/24/14 Start cognitive rehabilitation therapy
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12-29-2011, 09:22 AM
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#11
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Senior Member
Join Date: Jun 2009
Location: Los Angeles, CA
Posts: 309
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Re: vascular invasion
YanYan-Great advice!!
I appreciate all the info and articles, interesting.
My situation is bizarre-
My LVI was indeterminate-inconclusive-in my case the lab test was negative-however when they 'viewed' it the 'old fashion way' it was positive.
My Onc considers and treats this as a Positive.
I was Stage 1, but treated as Stage 3, which I am thankful for everyday.
Here is to the famous quote and book by the same name by Ram Dass...... "Be Here Now"
That is what I practice everyday---
Love to ALL
__________________
DX: 11/08 Age: 53
Surgery: 1/09
Bilat Mastectomy, no reconstruction
ILC-4 tumors-1.7 cm,1.5 cm (2).8 cm
DCIS-11 cm
All tumors Grade 3
All tumors ER-0%/PR-0%
All tumors HER2+
IHC-all tumors Overexpression/borderline
FISH 2 tumors Her2-Negative
FISH 2 tumors Her2+ Equivocal
Stage I, 0/1 nodes
LVI-Indeterminate(treated as positive)
SPR Score 8/9
Ki-67 20%
BRCA genetic test 1/2=negative
Chemo: 6 rounds TAC Feb-June 2009 w/Neulasta
Herceptin: 6/12/09-6/4/10 52weeks
HNPCC genetic test: negative
Port Placement-9/23/09 Port Removal 6/25/10
Echo's every 3 months-All normal
2/09 Staging PET/CT showed 0.2 micronodule upper R lobe-lung-Onc does not think this is mets--
6/5/09 AND 10/09 CT scan 0.2 micronodule unchanged
1/10-PET/CT-uptake in nasopharynx-
1/10-MRI All normal
6/10-Bone Scan-clear
12/10-PET/CT-All Clear-NED
12/11-PET-All Clear-NED
12/12-PET-All Clear-NED
12/13-CT w/contrast Head, Torso-All Clear
12/14-CT w/contrast Head-All Clear
2/15-Core needle biopsy-R scar line
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01-04-2012, 11:52 AM
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#12
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Senior Member
Join Date: Mar 2006
Posts: 1,843
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Re: vascular invasion
This may be of general interest. It is a fascinating review.
Tumor Angiogenesis as a Target for Dietary Cancer Prevention
http://downloads.hindawi.com/journal...012/879623.pdf
Clearly all the usual caveats apply as to seeking advice before supplementing
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