JJ, how lovely of you to be so concerned.
When I was first diagnosed it was after a procedure called a core biopsy, where they take a small sample to see if it is cancerous. This is probably how they tested your MIL, it seems to be pretty standard. From the sample they examine the cells to see how different they are from normal cells. Grade 1 is slightly different, Grade 2 is moderately different and Grade 3 is very different. For tumours that are grade 1 and 2, and are small, they generally don’t prescribe chemotherapy because it is felt that it’s overtreating. What is often suggested for these tumours is wide local excision (lumpectomy) followed by a course of radiotherapy. The general concensus is that this treatment is just as effective at preventing any recurrence as a full mastectomy, so it’s not second-rate treatment by any means.
When they remove the tumour they generally also take out a lymph node or two from under the arm, to check to see if the cells have thought about spreading. You might have read about “positive nodes”, this is what is meant there. Even if nodes are positive that doesn’t mean that the cancer has spread outside the breast, just that it’s been trying to.
When the lump and node(s) have been removed they are examined under the microscope to confirm the grade, and only then can they finalise the treatment plan. It does sometimes happen that the grade goes up, but it doesn’t ever go down. This is because tumours aren’t uniform, and a sample may not contain cells from the most virulent part of the lump. They will also look at what type of breast cancer it is. There are lots of different types. The most common is invasive ductal carcinoma (IDC) which accounts for around 75% of BCs.
They will also look at whether it is receptive to the hormones oestrogen and progesterone (in which case they may suggest 5 years of hormone therapy, daily tablets) and they also look at whether it’s receptive to a specific growth hormone called HER2 (in which case they may suggest Herceptin, which is generally more effective when combined with chemotherapy). This is all general stuff though, and your future mother-in-law will get a treatment plan that is tailored for her specific circumstances.
A small correction to bubbletrouble’s comment, chemo isn’t only given if it’s spread, it is most often given for primary tumours that are grade 3, or large. It is also usually given if it’s been detected in the lymph nodes that they tested. If it’s grade 3 then often they will suggest chemotherapy in addition to radiotherapy, but again that very much depends on what your MIL’s surgeon and oncologist suggest. There are many different types of chemotherapy, and if it is needed the oncologist will suggest something that has been specifically tailored for your MIL.
You might want to suggest your MIL joins the forums too, she will find tons of support from people in the same boat as her. I know the forums have kept me sane over the last few months.
Have a lovely evening with your in-laws, it’s so nice that you care enough to come on here and I hope I’ve given you some helpful information. The Publications part of this site is also an extremely useful resource.
Someone else made the very good point that your fiance will also benefit from your support, nobody likes to be worried about their mummy, however grown up they are. Give him hugs too.
Good luck,
CM
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