Cecal adenocarcinoma with lymphovascular invasion.
by Emmy
(Oxford, Pa., )
Hello--this is a wonderful site--thanks!
I am a 68 year old woman who was diagnosed with the above in 2004, after blood work showed a hemoglobin of 6. I had complained to my doctors for 2 years of shortness of breath and fatigue. They blamed it on my heart bypass done in 2002.
I had a right hemi-colectomy done, with 18 inches of my colon removed, followed by 7 months of chemo with 5FU and Leucovorin.
I had 3 what my doctor called pre-cancerous polyps removed in February of this year, all other tests have been okay.
My real question concerns my pathology report back in 2004, which was never explained to me.I had only 9 lymph nodes removed, all were negative. Lymphovascular invasion WAS identified, the cancer was ulcerated, with necrotic areas. It was 3-4 cm. in size, moderately differentiated. I had the chemo because of the lymphovascular invasion. I guess I was a stage 11b?
I want to know what difference the LVI makes in survival .
Thank you SO much!
Emmy.
Dear Emmy,
Thank you so much for your question about lymphovascular invasion. It is too bad that we cannot give you a specific answer, because good research studies have not been done yet about any differences in survival. Lymphovascular invasion (LVI) means that cancer cells were found inside the tumor's blood vessels and inside the lymph channels. * Generally, it is not good for survival when the cancer cells invade the blood vessels and the lymph channels.
There was one study back in 1994 that looked at cancer cells inside the blood vessels (vascular invasion) of about 350 people with colon cancer. In that study, about half the people without cancer in the blood vessels were alive at five years, and less than a quarter of the people with cancer inside the blood vessels were alive after five years. However, there are differences in other studies about how to measure lymphovascular invasion, and the definition is different for different doctors that look at tumors under the microscope (pathologists). Most doctors agree that survival is worse when the cancer cells invade the blood vessels or lymph channels.
*Lymph channels connect the lymph nodes, and are like vessels between them.
The correct answer (as always) is to go back and talk to your cancer doctor. Be persistent, and ask your doctor to explain things in plain English that you can understand. Sometimes the doctor's nurse can help you understand things if the doctor is too busy.
Thank you for your question.
If you want to read the medical literature or have something to show your doctor for further discussion, here is some of the pertinent information we reviewed.
"The Staging of Colorectal Cancer," Compton & Greene, _CA Cancer J Clin_ 2004; 54:295-308
http://caonline.amcancersoc.org/cgi/content/full/54/6/295 (full text)
Lymphatic and Venous Involvement by Tumor of Any Stage: The L and V Classification Systems of the AJCC/UICC
Venous invasion by tumor has been demonstrated repeatedly to be a stage-independent adverse prognostic factor by multivariate 44,45,62–69 and univariate analyses. 70–73 However, some studies identifying venous invasion as an adverse factor on univariate analysis have failed to confirm its independent impact on prognosis on multivariate breakdown. 73,74 Similar disparate results have also been reported for lymphatic invasion. 64,65,69,72,74–78 In other reports, vascular invasion as a general feature was prognostically significant, but no distinction between lymphatic and venous vessels was made. In a few studies, the location as well as the type of the involved vessels (eg, extramural veins) were both considered strong determinates of prognostic impact. 49,67 Therefore, data from existing studies are difficult to amalgamate. Nevertheless, the importance of venous and lymphatic invasion by tumor is strongly suggested and largely confirmed by the literature.
In part, disparities among existing studies on vessel invasion may be related to inherent problems in definitive diagnosis of vessel invasion, which typically requires the identification of tumor cells (single or groups) within an endothelial-lined channel. However, histologic artifacts that mimic vessel invasion and pathologic changes that obscure it (eg, vascular destruction by tumor) are both common, and interobserver variation may be substantial. Special techniques such as immunohistochemical stains to identify endothelium or special stains to identify the elastic tissue remains of venous walls may or may not increase the ease or accuracy of evaluation. Because these techniques are also labor intensive, time consuming, and expensive, they are not performed routinely. Detection of vessel invasion in any given case is also affected by specimen sampling. It has been shown that the reproducibility of extramural venous invasion detection increases proportionally with the number of tissue blocks taken, from 59% with two blocks to 96% with five blocks. 49 At present, no widely accepted standards or guidelines for the pathologic evaluation of vessel invasion exist, and pathology sampling practices vary widely on both individual and institutional levels. Sampling practices are further impacted by cost containment issues, which in general have encouraged reduced sampling of resection specimens. The College of American Pathologists has suggested that at least three blocks (optimally five blocks) of tumor at its point of deepest extent be submitted for microscopic examination. 3,42
The 1994 study's PubMed abstract is here (PMID=8200644):
http://www.ncbi.nlm.nih.gov/pubmed/8200644?dopt=Abstract
The five-year survival rates off a bar graph (Fig.2, p. 500), with N=274 without vascular invasion have 50% 5-yr survival, and N=74 with vascular invasion have approx 20% 5-yr survival.
