LVI and chemo

Ask our Nurses your questions
1

Hello
I have IDC grade 2, 18mm, ER and PR positive, Her2 negative, micromets in sentinel lymph node and lymphovascular invasion. I’ve had surgery and am now waiting for oncotype score. I’m 55 and assume that I’m post-menopausal. Just had a blood test to check. I’m to have radiotherapy amd hormone therapy.

My query is about LVI. Reading the discussions on the forum, it seems that LVI is sometimes taken into account by oncologists in making the decision about chemo if the oncotype score is intermediate, and sometimes not. Why is this?

I have been told I won’t see an oncologist unless I need chemo. If my oncotype score is low, is the LVI ignored? I asked the nurse but she dismissed the question saying if you have a positive lymph node there is always LVI so it’s irrelevant. From reading research papers, it appears that this is not the case- there can be positive lymph nodes but no LVI. Please can you explain how LVI is taken into account and treated? Is it routine not to see an oncologist at all?

Many thanks

2

As I understand it with LVI its possible cells could travel to other parts of the body, but also, if you have a positive lymph node, then it could spread via that route which makes it likely you will be offered chemo -unless you have other medical reasons why that would be a high risk for you.
It sounds like they have told you the plan so far, which is always radiotherapy when had a lumpectomy. It would be reasonble to expect that you will have chemo as you have a positive lymph node, which teats the whole body so it will cover the LVI aspect too.

3

Hi @citizene the nurses will get back to you with a more authoritative reply shortly but regarding the oncologist appointment, I think it is becoming increasingly common not to see one if the prescribed course of treatment does not include chemo, which is the outcome for the vast majority of women with BC. The NICE recommendation for early stage er+ BC without the likelihood of spread is surgery, radiotherapy and endocrine treatment. If the patient is happy to go along with that, there isn’t much to gain from an oncologist appointment. In my own case, coming up to three years ago, I was er+ pr+ HER2- Stage 1 Grade 1. I did see an oncologist following surgery but all that happened is she told me I would have 5 sessions of rads and she slid the prescription for Letrozole over the desk. It lasted no more than 5 minutes and could easily have been communicated by the BC nurse. Possibly depending on which health authority you are in, this does seem to be becoming the norm now so that oncologists can focus on more complex cases including those needing chemo, those with actual or potential spread and those in which patients decline elements of treatment thought to be necessary. I’m sure that if you were insistent on having a conversation with an oncologist prior to starting your treatment, one could be arranged, even if only on the phone, via your nurse.

4

Thank you both, really helpful. I’m finding waiting for the oncotype result hard. So much waiting!

5

I’ve just heard my Oncotype score is 7 so no chemo. Does that mean I should just forget about the presence of LVI, it doesn’t matter?
Many thanks

6

Hi citizene

Thanks for posting.

It’s understandable that you have further questions whilst you wait for the Oncotype score. Waiting for results can be a very anxious time.

As @entropy says, lympho-vascular invasion means the breast cancer cells have spread into the lymph and blood vessels within the breast, and can be seen in these vessels under the microscope. The MDT will review all of the information they have on your cancer to assess the risk of the cancer coming back in the future, the Oncotype score will play an important part in this decision. They will also weigh up the risk of any potential harm of treatment such chemotherapy. They will often use NHS predict to support the decision making.

Because your cancer is ER/ PR positive, hormone therapy forms an important part of reducing the risk of the cancer coming back, and sometimes there is little or no benefit to having chemotherapy.

If the Oncotype comes back indeterminate, then your team will assess the other factors including the size of the tumour, hormone positivity, grade of the cancer and the lymph node involvement, to decide whether they feel chemotherapy will be of benefit. As @Tigress says, if the team feel chemotherapy is not required, you will not usually be offered an appointment with an oncologist. But if would like to speak with an oncologist, you can request an appointment, so that you can understand the rationale for any decisions made.

Talking to someone who has had a similar experience can often be helpful. Our Someone Like Me service can match you with a trained volunteer who’s had a similar experience to you. You can be in touch with your volunteer by phone or email and they can share their personal experiences to answer your questions, offer support or simply listen to how you are feeling.

You can ring the Someone Like Me team on 0800 138 6551 or email them at someone.likeme@breastcancernow.org, so they can then match you to your volunteer.

Do call our helpline if you would like to talk this through or have any further questions. The helpline team have time to listen, talk things through and signpost you to additional support and information if necessary. Your call will be confidential, and the number is free from UK landlines and all mobile networks.

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Best wishes

Katie

Breast Care Nurse

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