does chemo work just as good on low grade cancers

Hi all,

I’m just wondering as i have read quite a few messages stating that chemo works better on more aggressive cancers - does this mean it doesn’t work as well on low grade cancers - i’m just a bit confused.

i have finished treatment now and am reflecting on all that has gone on in the past year. My cancer was low grade, however still managed to get into 5/9 lymph nodes so i am now questioning how successful is/was the treatment.

thanks
Suky

Hi!

I think that if the cancer has gone into your lymph nodes then you do need chemo, despite it being a low grade. They would be concerned about possible spread from the lymph nodes and the chemo is what deals with that around your body. Low grade cancer that has NOT spread to lymph nodes is another story, but then i think it depends on age - if you’re under 50 they seem to give it to you regardless. But every oncologist just seems to do his/her own thing as there don’t seem to be any hard and fast rules. I didn’t have chemo because I’m 64 and it hadn’t spread to lymph nodes and I was offered the choice, but for 2.3% difference I declined.

Hi I accepted chemo at 62 because of being triple neg it offered 7.5% more and rads added 2.5% to that raising stats for 10 year survival from 75% to 85%

I am 48. Had 1 large and one tiny tumour all Grade 1. I was told from outset I would be 90% probable for chemo following mx due to size of lump and my age (considered young). I had 4/17 lymphs involved and was highly hormone responsive too which was good.

I started chemo yesterday. Don’t know my percentage range; too much information to take on board, and as figures are loosely staged on stats and not directly related to me, I would prefer to carry on with the mindset that I am doing all I can for myself and not compare myself to others (personal preference).

I do know however that had I just had rads/hormone it would have reduced chances of recurrence (on top of their stats) by another 13%. Adding chemo to this reduced it to 32%. Big difference!

Hope this helps put your mind at rest

Hi,

Its funny how the statistics vary and the Onc’s decisions. My tumour was 18mm grade 1 with some DCIS and 1/9 lymph nodes with micro metastases and highly receptive to oestrogen and progresterone and the Onc said that had I been over 40 (I am 39) he wouldn’t have offered me chemo and that if I didn’t want to take it he wouldn’t twist my arm (I am going to see him again on Monday for a start date).

When asked re statistics he said that with no further treatment I had a 25% chance of recurrance, tamoxifen for the hormone bit would half that to 12.5% and chemo would give me another 3 -5% so I opted for the chemo as like Pheebster I wanted to throw everything I could at the cancer.

I was also told that I wouldn’t need rads as I had had a mx and therefore nothing to radiate but I think some other women have rads even after a mx but am guessing that is due to the number of lymph nodes affected.

Strange, and to be honest a bit disconcerting when you think treatment can vary so much.

Thankyou ladies for your responses.

I am 34 and was dx dec 07 and 5/9 nodes involved and er+. I too had everything thrown at me, 3 epi, 3 tax and 3cmf and 17 rads - finished last week but its just that this question is niggling me. Its when i read emails and they say chemo works better on more aggressive cancers i question my cancer and has chemo done its job?

does anyone know of any stats on low grade cancers and success rates with chemo? When i speak to the onc she gave me a 60/70% success rate with all the treatment but i supposes i’m looking for reassurance.

Thanks
suky

Hi Suky,

I think I get what you are posting about now. Do you mean that we are more likely to have a recurrance of our low grade cancer because chemo isn’t as affective on it than perhaps we would be had we a more aggressive cancer which had a better chance of being got by the cancer?

I hadn’t heard any of this re chemo and I have just swallowed deeply. Where did you read this?

I am very new to this as haven’t even started my chemo yet but could it be that you are feeling this because you’ve reached the end of your treatment and are now kinda just “waiting” (again) to see whether you survive healthy into old age or to see whether its going to come back?

I would guess that’s kinda natural as when you’re being treated its a whirlwind and a positive thing and when you get to the end of active treatment it must seem kinda “is that all?”, “what else are they going to do”, “do I just have to sit here and wonder now?”

I am sure other ladies will post to reassure you that its normal if this is how you are feeling.

BTW can I ask, your stats (even though they are only stats) seem (when I compare them to mine and probably never a good idea) quite low - 30 to 40% chance of recurrance even AFTER all the treatments and with a low grade cancer, is that right?

Hi Ostrich,

Yes y ou’ve got it… Its just what i’ve read on other threads so now i wonder. I don’t particularly want to point the finger at oneone as we all have done out bit of research and heard different stats etc., but i felt the need to question it. i haven’t been told this by the onc but will ask at my next appointment.

although i finished last week i do feel a bit uneasy about the what now but i have to learn to move on and that can be difficult.

i think the stats vary as i had more lymph nodes involved but stats are very complex and can be interpreted in many ways.

hope i haven’t frightened you but i need to ask the question.

Sukes

Ostrich I’s also having rads - 5 weeks.

Grade 1 cancer is the ‘one’ to have whichever way you look at it. I work for a Doctor and am obviously surrounded by medical people all day, and they all gave a huge sigh of relief when my results came back as all grade one. As my onc said when I commented how relieved I was to find out my whole cancer was Grade 1…“if we had been dealing with a rad 3 this would have been a whole different story…” That did it for me

Obviously there are lots of other things to be taken into the equation when working out these damn awful life condemming stats but I would listen to your oncologist and not read stuff written by other people who are not medically qualified.

Look at the positives and work on those

x

Thanks Pheebster, will do. Just looked at my Nottingham Prognosis score and Adjuvant Online score (I know, I know) and they confirm the stats my Onc gave me. Okay, there are no guarantees that it wont come back but my odds seem pretty good so once treatment is finished am going to just get on with life and try not to worry about what might happen. As you say, grade 1 is the best to have (I fiddled with the info I input into Adjuvant Online and thank my stars I didn’t have a >5 cm tumour of grade 3 with triple negative and >9 lymph nodes involved!!!) (That said I am only too aware that there will be some ladies on this site who have had to face that and my heart goes out to them).

Sukes I hope someone posts some answers to help you, much love, x

Precisely Ostrich - keep thinking that way. My tumour was 5cm so thank freak it was Gr. 1!!!

Anyway - the tumour has gone - think of it that way. Cancer is out. All we have to deal with now are the Gr. 1 demon cells which will be 1/3 as resilliant as the Gr.3 bstds!!!

Hi,
I am just wondering whether this idea about chemo working better on more aggressive tumours, is actually true or just misunderstood by a change of wording. I will just quote a bit from the Susan Love BC book as she is a known expert in this field
'When you are considering whether to have chemotherapy, it is important to understand what its benefits are… Chemotherapy reduces the risk of recurrence by about a third, that means that the higher the chance of recurrence, the more beneficial the chemotherapy is likely to be for you. If you have a 60% chance of recurrence, a one third risk reduction means chemo will reduce that chance by 20%, but if you have a 9% chance of recurrence the one third reduction is only 3%.this is an important concept to understand when trying to weigh risks and benefits.

I hope this is helpful, as I see it , chemo gives us all a one third better chance, it is just that people start at different positions according to their dx.
Take care
Lily x

Hi

I too had Grade 1 BC and read that chemo worked best on fast dividing cells so if the cells are Grade 1 and acting more like normal cells and dividing less fast then the chemo isn’t so good at targeting them. Sorry can’t remember where I read it. But I didn’t have chemo because I am over 50 and no nodes involved and on Arimidex after rads. Onc said I didn’t need chemo and I was only too glad as I didn’t like the sound of the side effects.

Jo xx

Deal all,

thnakyou for the comments. Jo so its defo not me going mad as you too have read it somewhere. I pray this damn disease never comes back as i want to live but with whats happened in the last year its hard to see where now.

Pheebster, lily and ostrich - i know grade 1 is better than grade 3 but i suppose the questions will always be there, why me, how when especially being young and healthy and doing all the things u do to prevent Bc out of life style., ie, don’t drink, smoke, never over weight breast feed 2 kids b4 30 don’t eat red meat etc., so why?

thanks alot.
sukes

Hi Sukes,

I think the thing I am learning with this BC is there are no rules and therefore no explanations or guarantees.

Why me? Is a question you will probably get the answer to. I at 39 do smoke, have more than a weakness for a glass or 3 of white wine, never overweight, breast fed 3 kids before 30 and do eat red meat, don’t do much exercise, probably have a higher risk factor than you but then I believe someone who “fails” to follow all the rules to prevent BC or any kind of cancer is as likely not to get it as someone who follows all the rules.

My Dad is 62, smokes like a train, heavy drinker and party goer (36 plus years in the army and the last 10 living it up on a yacht around the world), takes no exercise and has lead a less than quiet life has no real health problems. My mum, (who was divorced from him 30 years ago) gave up smoking 20+ years ago, vegetarian, walked dogs lots every day, does enjoy a glass or 3 etc had a stroke 8 years ago at the age of 52 (very young for a stroke apparently). Go figure that one out?!

My OH annoyingly told me after watching GMTV yesterday that drinking alcohol can lead to BC and they had proved it. What good is that news to me now? I already have BC and thats like telling me its my fault. So I could have not enjoyed the wine over the years but can he say I wouldn’t have got it anyway? He read some other article a few years back that said BC was linked to pork scratchings (my other weakness) and has harped on at me ever since. Part of me thinks he’s a killjoy who just likes to make me feel bad for enjoying the things I do and to be honest the GMTV comments made me really angry.

You’ll never know so please don’t beat yourself up trying to work out why and if and when it will come back. All you can do is carry on LIVING, be breast aware and aware of the warnings of secondary, and carry on LIVING. As has been said before on this site, you may get hit by a bus tomorrow so don’t worry too much about the what ifs and why mes.

You didn’t deserve BC or cause it and you can’t prevent it coming back. Stop and smell the roses, xxx

Hi Sukes

I think I know what your are getting at. Chemo works by attacking rapidly dividing cells, including hair cells, skin, blood cells. Cancer cells usually are more rapidly dividing than normal breast tissue etc because they are deformed cells. The reason people are often given a regimen of two or three chemos is that each type works on a different part of the cell division process (mitosis). An aggressive cancer usually has more rapidly dividing cells because it is growing quickly so chemo will work. However, chemo will work on a lower grade tumour because even though the cell division is slower than an aggressive cancer, it still will divide more rapidly than a normal cell, hence the chemo will destoy it when it divides.

Hi Cathym

Thanks for the explanation. Its a question thats been on my mind for some time now but all i can do is h ope and pray the bugger doesn’t comeback.

Thanks
Suky

My onc and surgeon never use the term “aggressive” in relation to cancer grading as they think “aggression” is an inaccurate, subjective and inflammatory term.
I am inclined to agree with them.
Grade 3 cells are simply more differentiated (from normal cells) than Grade 1 are. They have the POTENTIAL to divide and therefore spread quicker than Grade 1 cells. But it doesn’t mean they definitely will. Because they have the potential to divide quicker than grade 3 cells it increases the likelihood of them being caught by the chemotherapy cycle.

The more I learn about breast cancer, the more I understand how few rules there are.
A substantial %age of women with no lymph involvement will still go on to develop distant metastases. A woman with a large, high grade tumour may be node negative while a woman with a small, low grade tumour may have several lymph nodes involved. It is baffling.
Staging is considerably more important as a prognostic indicator than grading. My onc says he would rather deal with Stage 1 Grade 3 cancers than Stage 3 Grade 1 cancers.
My ER+ status suggests my cancer is slower growing. My Grade 3 status suggests my cancer is faster growing.
It’s all swings and roundabouts.

It is a frustrating awful disease with exceptions to every rule.
I wish everyone well with their tx and as Suky says - just hope the bugger keeps away.