grade 3 ??????

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21

Hi Horace,
Its all so confusing isnt it but this is also copied from cancer research uk re stages 1 and 2.
Stage 1 breast cancer

* The tumour is no more than 2 centimetres (cm) across (T1)
* The lymph nodes in the armpit are not affected
* The cancer has not spread

Stage 2 breast cancer
This is divided into two groups

Stage 2A means

* The tumour is less than 2 cm, the lymph nodes under the arm contain cancer but are not stuck to each other and the cancer has not spread or
* The tumour is less than 5 cm, there are no cancer cells in the lymph nodes in the armpit and the cancer has not spread or
* Although no tumour is seen in the breast, the lymph nodes under the arm contain cancer cells but are not stuck together, and there is no sign of spread to other parts of the body

Stage 2B means

* The tumour is less than 5 cm and the lymph nodes under the arm contain cancer cells but are not stuck to each other, and the cancer has not spread or
* The tumour is bigger than 5 cm across, there are no cancer cells in the lymph nodes in the armpit and the cancer has not spread
Dont know if this helps any.
All the best
Lindiloo

22

Just a couple of things - Tamoxifen can kill off stray cancer cells. It can trigger apoptosis which is the process of a cell committing suicide.
Also there is a lot of debate about how effective chemotherapy is in an adjuvant setting for women who are ER+. Some specialists think it is of no use at all in node-neg early stage women. I have far more benefit from hormone therapy than chemotherapy.

My medical team never use the word “aggressive” in regard to grading because it is alarmist and inaccurate. Grade 3 simply means that the cancer cells are very different from normal cells and quicker growing than Grade 1 cells. That is all. Other pathological attributes such as HER2 expression and ER status are far more significant in regard to “aggression”.

Grading is also HIGHLY subjective and 5 different pathologists will possibly come up with 5 differing results (as has been proven in several studies). It is not uncommon for US women to have their tumour samples seen by more than one path lab so they can be 100% sure of their pathology report.

23

Hi Ostrich, as MsMolly said, Tamoxifen DOES mop up stray cells as my bcn told me.

Because I am highly hormone positive it is the zoladex and tamoxifen that give me the 89% chance of it not coming back. My onc said the chemo and herceptin would only increase this to 92% and therefore was my decision whether to have it or not.

24

Thanks for the info re tamoxifen, didn’t know it could cause the buggers to commit suicide, hooray! I was wrong but glad to be.

I agree that chemo isn’t as beneficial as hormone therapy for strongly er and pr+ women. The tamoxifen is my best weapon taking my chances of recurrance from 20% to 10% and the chemo only adding 3% to take it to 7% but as I had some little cancer cells in one lymph node I decided to take the chemo to give myself every chance.

As I said Lolly I know nothing really about herceptin and assumed if you were her2+ then herceptin was as vital a weapon as the hormone therapy.

25

Just a comment on “Stage 4 gets everything they can throw at it”:

I was diagnosed with spread to bones, three weeks after primary dx. This was summer 2006. So far I’ve had hormone therapy only (no rads, no chemo, no surgery! strongly ER+, also PR+) and my smallish breast tumour and bone mets are currently stable. If my treatment fails - I don’t say “when” - I would probably take whatever my oncs recommend, but the “throwing” happens as part of a sequence, with the stronger options held in reserve.

26

keep coming back to this - must be because I am an accountant and am interested in numbers…personally I have found this adds 4 % or adds 5% as not that helpful. There are a couple of things here-

If someone told you you had a 1 in 25 (4%) chance of being knocked down and killed if you crossed a road, you would be pretty shocked and avoid crossing the road!

  • and you have no idea whether taking chemotherapy when you have a primary is giving you a 100 % chance of a cure, or maybe 100% chance of delaying secondaries for years, or is no use at all 0% difference. They can only tell you what happens to a pool of women with roughly the same characteristics, you don’t know where you fall.

Catherine

27

You are right Catherine - it is really all or nothing. It either works or it doesn’t.
I prefer to focus on proven knowledge. One thing they know for sure is that chemotherapy does not work as well for ER+ cancers as it does for ER-cancers. They also know that the more strongly ER+ you are, the more effective the hormone therapy will be.
As I mentioned on another thread the %age gain from chemo in risk reduction for node neg ER+ women is really a stab in the dark because it is impossible and ethically dubious to recruit a study group of ER+ women who are prepared to have chemo but no hormone therapy.
They know that chemotherapy carries some appalling, and in some case life limiting side effects - risk of leukaemia, heart problems, etc.
Nobody should have chemotherapy unless they absolutely need it. I personally feel it is dished out too easily at the moment and women who will derive no benefit from it are being put through hell for no reason (i.e. it won’t prevent a recurrence) - and they are putting their future health in jeopardy.
The extremely expensive OncotypeDX test which is so popular in the US isn’t all it is cracked up to be and we are a long way from individualised treatment.

Mrs Blue - interesting point. With my primary diagnosis I asked the onc if it is better to keep “something in reserve” in case of recurrence. He said no, the current consensus is to chuck everything at it now so you don’t get a recurrence in the first place.

28

MsMolly

I was told that in my case it was better to keep the herceptin in reserve. Its funny how these oncs have such different opinions!

29

Hi all,

I agree with all of this. I think that as a rule people in general are almost “brainwashed” into thinking that chemo is THE only treatment for cancer.
I was diagnosed the day after my 36th birthday in Nov last year with a 16mm grade 3 IDC. They told me that because of my age it would be hormone positive and also that because it was a grade 3 it was more likely to have spread and they wanted to do a full axial clearance.
I was unsure about this and due to a lot of other things that happened which I won’t bore you all with here, I ended up changing hospitals.
I ended up having a lumpectomy and a senitel node biopsy rather than full clearance and it was a good job that I did stick to my guns, as it turned out that there was no spread into lymph or vascular system, and I was not hormone positive, but triple negative!!

The next things, cos of my age and the grade 3 they recommended chemo and radio.
I am very against the use of chemo unless it is absolutely necessary, so I refused the chemo. I was told after the “yes, but you will die if you don’t have it…” conversation that realistically it would only improve my chances of it not coming back by around 5%.
However because I am triple negative I could have no hormone treatment, so I have just had radiotherapy - got 2 weeks to go (I wasn’t entirely convinced on this, but thought I should compromise!!)

Don’t get me wrong, I am not for one minute saying that chemo doesn’t work. It does is a lot of situations, but on the same vein I do think that the hospitals dole it out as they overtreat rather than undertreat.
You can see why they do this, but it is easy for them to make that decision when all the choice they have to rely on is statistics. Nothing is personal here - it can’t be.

I chose not to have chemo, as I felt that the cons outweighed the pros in my case. Having worked for the pharmaceutical industry for over 10 years I know of the bits the doctors don’t tell you!!

If my cancer had have spread, then I would have had to go through with the chemo, but thankfully as it hadn’t I decided not to. However I was made to feel dreadful about making this decision. It verged on bullying to be quite frank, but I stuck to my guns.
I hope I have made the right decision, but at the end of the day, it’s all a bit of a lottery, you could have all of the treatment and still end up getting this nightmare back.

I still have moments when I think “should I have had it…?” but I know that my decision was right for me. It is just a shame that people in the medical profession have a lot of difficulty accepting that even if your opinion differs to theirs, they should still respect your opinion! Telling someone they are going to die if they don’t do as they say isn’t helpful!

Realistically, the only data they have is statistics and it’s all a bit of guesswork really. You just have to do what’s right for you.
Also, it seems that treatment options seem to vary slightly depending as to which hospital you’re at.

30

Interesting thread. Many thoughts.

Just one for now: statistically, all other things being equal (node involvement, size of tumour etc) chemotherapy may be more effective on er- pr- breast cancer than it is on er+ pr+ breast cancer but again…statistics don’t apply to indiviudual cases…some er- pr- cancers don’t repsond well to chemotherapy (Mine hasn’t so that’s one!) Some hormone resistant er+ pr+ cancers get good response from chemo.

Jane

31

Just want to add that when my onc told me that chemo and herceptin would only make a 3% difference, he also added the fact that 1% of people die from the chemo itself!!!

32

Your story is fascinating Julie - and I applaud you for standing up for what you want. It is often overlooked that the greatest weapon against recurrence with early stage cancers is actually surgery. Get the damned thing out before it metastasizes.
I think that for many people (myself included before dx) cancer goes hand in glove with chemotherapy.
I am surprised by how much faith people have in it - that extends to the medical profession too. I attempted to have a conversation with a chemo nurse during my first treatment. I asked her if she knew why chemo didn’t work sometimes. She looked at me as if I was insane and said “Chemotherapy ALWAYS works.” So according to her we should all rejoice because apparently there is a cure for cancer.

33

What an interesting diversity of professional opinions we have been given!I was told that chemotherapy worked best on hormone negative cancers so it was usually the treatment of choice for TN and er/pr neg women.I was also told that TN bc was more common in younger women and in those from ethnic minority groups in UK.I was declared unusual as I was TN at 62 and plain white.I had chemo and rads after surgery because there is ‘nothing to follow’ for tn bc so need to do maximum at primary dx.Often,as for jane,this isnt enough to banish the beast entirely.It does sound as though some f us are being gravely misinformed though.

34

Fascinating thread. I’m having chemo for a node negative, grade 2, strongly ER+ and HER2- cancer which has been removed. So to all intents and purposes I (hopefully!) don’t have cancer right now and have no idea what effect the chemo is having because in theory it’s not actually acting on anything.

I’ll probably never know. If it doesn’t recur, will that be because I had chemo, will it be because I’ll go on to have hormone therapy or would it be the case that it was never going to recur once I’d had surgery to remove it? If it does recur - is something I’m unwittingly doing now causing that to be the case?

I was told chemo improved my chances of 10 year survival by around 10% so that’s why I’m going with it. However, I do wonder if it’s the right thing sometimes because it’s really not pleasant.

35

Here’s something I don’t understand…

Typical adjuvant chemotherapy for early stage bc is 6 cycles of FEC or 3 FEC + 3 Taxotere. Anyway it is normally 6 cycles.
I had 4 cycles and was told by both oncologist and then surgeon that the 4 cycles equals 4/5ths efficacy of a full treatment cycle.
Now … even with my rubbish 0 Level Maths I just don’t see how that works out. Unless 5 is actually the full requirement for a treatment cycle and they are giving one extra for luck.
Anyone know?

36

No but I had 4xFEC and 4xTax for my node neg,no vasc inv,grade 2 ,2cm trip neg!!

37

There is no definite answer to your query msmolly. Protocols for chemotherapy treatments change all the time. Sometimes its a case of the manufaturers’ changing their recommendations, sometimes its a new trial…different oncs will have their own different favourite trials. Oncology isn’t a precise science…its an art as well.

I was diagnosed in Oct 2003…at that time very few women had taxotere as adjuvant or neo chemotherapy. (myself and Christine MH were among a tiny tiny group having taxotere on these forums) I had 6 cycles of AC before surgery and then 4 cycles of taxotere after surgery( I had private insurance though onc said he would have made a special case for me if on NHS as I had poor prognosis) Now 3 plus 3 or 4 plus 4 seems standard for node positive breast cancers and in some places for trip negtive irrespective of node involvement. Personally I don’t think 3 or 4 probably makes any difference…either the chemo will work, will work for a while, or it won’t.

Jane

38

I think all this goes to show what I’ve always said which is that all oncologists are a complete law unto themselves. They all have their own likes and dislikes re treatment and there is no one to tell them if that’s the best for the patient or not. I think you could go to 3 different oncs on diagnosis and get 3 entirely different courses of treatment offered to you. My onc said the reason why people get given different chemos on primary dx is “a north/south divide” - the ones in the north don’t like the drugs that the ones in the south use!! What a brilliant reason for deciding what sort of chemo to give. Perhaps we would be just as good at diagnosing ourselves and sorting out our own treatment!

39

percentages and me just don’t mix (CSE Maths) but I wonder whether the 4/5th thing is similar to the belief/proof (who knows… but as mentioned by my medical team) that the biggest benefit of Tamoxifen comes in the first two years, and after that it falls sharply (in statistical terms). Does that make any sense?

Under NICE guidelines, I had to be offered chemotherapy - my tumour was over 3cm although it hadn’t spread to the nodes. On paper, both Tamoxifen and chemotherapy each gave me a 7 per cent improvement against recurrence but my rather eminent oncologist (ah, the joys of living in the shadow of a major teaching hospital) made it clear that she considered Tamoxifen much more important and we swapped the chemotherapy for Zoladex. I’m 18 months in and mostly happy with the choice I made. Someone who helped me a lot when I was first diagnosed said that the best oncologists use a fair bit of intuition when deciding on treatment.

I get the feeling that the US took longer to come round to the benefits of hormone therapy, but might be wrong about this. Adjuvant online doesn’t yet include Zoladex in its calculations.

40

I hate to sound like a meek little “doctor always knows best” but I think we need to take account of how complex it all is, everyone of us is different and there are so many different factors to take into account - not just our cancers but also other risk factors for side effects, like DVTs or heart problems. Then oncologists, by the time they have got to consultant level, will have had a lot of experience to draw on, but each will have had slightly different experiences and will often have found that some things seem to work better. That’s because there are probably a range of “right” approaches, not just one (as there are in many complex issues in life.)

But they will also draw on new research, new drugs are being developed all the time, new trials show such-and-such a protocol works a little better in such-and-such a set of circumstance. This stuff is based on proper evidence-based research with double-blind testing, to show whether it works. Self-diagnosis and all the unscientific woo that floats around is based on anecdote, and you have no way of knowing whether what works for one person would work for you. Someone might tell you that chewing apricot pips kept their cancer at bay, but they may have had a non-invasive, in-situ tumour, which could well sit around for years doing nothing (if you want to take that chance.)

We are going through a period when “faith” in science is being challenged, partly because it never could live up to the expectations we once had of it, and partly because scientists are human and sometimes make mistakes - or even cheat. Into that gap leap all sorts, from the well-meaning but mistaken to the downright charlatans. Cancer is too serious for that. You ain’t gonna catch me chewing no apricot pips!