Skeletal Muscle and Perineural Invasion

Posted by 2024chs @2024chs, May 26 7:11am

I am hoping for some guidance with a post lumpectomy pathology report. I am 47 and recently diagnosed with DCIS in the left breast and IDC (two masses) in the right breast. The report indicated that there is no evidence of lymph node involvement, which I know is good news. However, included was the following language:
-: PRESENCE OF PERINEURAL INVASION.
-: PRESENCE OF SKELETAL MUSCLE, WITH INVASION BY TUMOR.
I am guessing this may indicate the cancer has spread? I have my follow up appointments lined up. I just want to be prepared with what to ask.

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Rubyslippers | @triciaot | May 26 10:57am

It’s great that it’s not in your lymph nodes! I’d guess the approach would be to stop any movement towards the lymphatic system. I’m no expert on perineural invasion and did not have that type of cancer. There are some things you’d probably want to know especially if you will be looking up info about your type of cancer and treatment. I’ve attached a chart that lists items that the pathology report usually identifies. These are some of the details the oncologist will use to decide on treatment. It includes things like whether it is Luminal A or B, estrogen positive, progesterone positive, level of Ki67, etc.

I always thought in terms of “if this then that” during discussions about treatment. For example, if new surgery and all can be removed, then what follow up? if new surgery and it’s more extensive then what might be involved? Or, if a systemic treatment is suggested with no surgery then what would the next 5 years look like?

More info I’d ask: based on the location of the muscle and perineural invasion what might be the expected progression of invasion - are there nearby organs that tend to be involved if there is metastasis- and what would symptoms look like if that happened (pain in a certain area, bleeding, gastrointestinal issues)? This is all hypothetical and may never ever happen. But I usually want to know what to look for just in case. I feel safer knowing I have as much info about symptoms. It’s not that I want to constantly worry - but I find it easier to get on with life if I have that “checklist” to compare when inevitable changes happen in my body.

You might also want to get a second opinion, or change to a comprehensive cancer center if you’re not there already. Many of the big centers will provide a second opinion by looking at the pathology. It’s usually paid for by insurance, but not terribly expensive if it’s not. They are very used to sharing digital data and even shipping the actual slides back and forth. My cancer center, 3 1/2 hrs away, can access MyChart with my local PCP in another medical system, and share with my gynecologist who is with a third medical system.

2024chs | @2024chs | May 26 12:16pm

In reply to @triciaot "It’s great that it’s not in your lymph nodes! I’d guess the approach would be to..." + (show)

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Thank you so much! This is really helpful information. I have started to look at getting a second opinion as well.

Rubyslippers | @triciaot | May 27 9:04am

In reply to @2024chs "Thank you so much! This is really helpful information. I have started to look at getting..." + (show)

Here’s a really good article about the first steps after diagnosis. Some suggestions were for this oncologist mother, and you’re not that old. But she has good suggestions anyway.
https://www.washingtonpost.com/wellness/2024/05/27/cancer-diagnosis-what-to-do/#