Lymph, vascular invasion with positive nodes?

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Question from Ashley: Lymph and vascular invasion were lumped together in my path report. Is this an important feature if my lymph nodes were positive? How come some people don't have this, yet have positive lymph nodes?
Answers - Ann Ainsworth Lymphatic or vascular invasion means that the tumor cells have acquired the ability to invade the walls of these channels and may spread to the lymph nodes or beyond. We may see involvement of the lymph or vascular channels in the tissue sections we examine under the microscope, and then again, we may not—but the tumor can still be present in lymph nodes. While we examine many sections of the tumor, there may be areas not looked at under the microscope in which invasion of these channels has occurred.
Marisa Weiss, M.D. Clinically, both of those pieces of information can be useful. If there is significant lymphatic/vascular invasion within the breast, that is associated with a higher risk of recurrence in the breasts, as well as a higher risk of having lymph node involvement. Knowing this, we work closely with a surgeon to identify the most effective way to treat the breasts so that we can reduce your risk of recurrence there.

For example, it might mean a re-excision to get around both the main cancer as well as cells in the channels. For a woman who has extensive involvement of these channels, she may require mastectomy followed by radiation, as well as systemic treatment, for example, chemotherapy.

Lymph node information also has a significant impact on your treatment plan. If your sentinel lymph node or nodes are involved, your surgeon may talk to you about the possible role of additional lymph node surgery. This depends on your individual situation. If lymph nodes are involved, your radiation oncologist may add a treatment field that includes the lymph nodes.

Systemic therapy is usually given for anyone with lymph node involvement (as well as women without lymph node involvement but with other features that would indicate an increase risk of cancer cells spread beyond the breast). Systemic means treatment of the whole system or the whole body. This can include treatments like chemotherapy, hormonal therapy (tamoxifen), or aromatase inhibitor or immune therapy like Herceptin.

The Ask-the-Expert Online Conference called Your Operative and Pathology Reports featured Beth Baughman Dupree, M.D., F.A.C.S. and Ann Ainsworth, M.D. answering your questions about details of pathology and operative reports and the importance of discussing them with your doctors.

Editor's Note: This conference took place in November 2004.

The materials presented in these conferences do not necessarily reflect the views of A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.

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