Multi focal tumours

minuet

Hi everyone...I've been off these boards for awhile, but wondering if any of you have multifocal tumours. If so did they stage you by the largest one or use combined size. Mu oncologist added them all together. He said this method reflects "tumour load" better and may upstage so that the most aggressive treatment is given. I feel good about the aggressive treatment part but feel that adding them together is somehow not the same as one big tumour of equal size.

Thanks for your comments

Anonymous

I am fairly certain my bs staged me based on the largest tumor - which was just shy of 4cm. The smallest one was 1cm. I'm thinking this because had she combined all 3 of them, I would have been staged higher than 2B. But...either way, my treatment would have been the same.

Seabee

 I had a multifocal tumor, the largest part of which was 2.2 cm, and that's the measurement that was used in staging--which as far as I know is standard practice. I don't know what the rest would have added, but in any case the first onco I saw proposed AC+T chemo, which is pretty aggressive. I objected to A, for several reasons, among them its tendency in neoadjuvant trials to be largely ineffective against lobular, but all three oncos I consulted in this city (which has two large medical centers) sang the same song.

When I finally got the results of my Oncotype DX test, however, the score indicated low risk, and no benifit from chemo. Assuming this is correct, all three oncos were pushing aggressive treatment which was highly unlikely to be of any benefit whatsoever--to me, at least.

Because of the risks involved in aggressive chemo, the idea that more aggressive treatment is necessarily better, and that one needs to find additional reasons for doing it, seems to me irresponsible.

gandl

I had multifocal tumor in six places.  My onc used the largest to stage.  They were similar in size and none over 1 centimeter.  I wonder if they had grown longer if they would have formed one large mass which would have been seen as one large tumor instead of 6 small ones.  I asked why they do not add the sizes together to do the staging and was told that the standard practice is to use the largest one, and that strategy works. I didn't do chemo or hormone treatment, but I did have my ovaries removed.  

kalyla

My Onc added them together end to end, so the total was 7.3 cm. He mentioned tumor load to me too. I feel that many, many tumors are best treated most aggressively, therefore, it's better to be upstaged from stage 2 to stage 3, etc..

Seabee

One problem with ILC is that it interweaves with normal tissue, so its dimensions are not so clear cut. If you added up all the tissue that ILC branched into, you would probably get very misleading results. This growth pattern also makes it hard to get the tumor out with clear margins, though it is possible.

It seems to me that there would be more reason for considering tumor load if there were several distinct tumor sites in the same breast.

kam54

I was staged by my orginal tumor which was 2.5cm.  However, after having MRI's prior to my double mast surgery, they found cancer in my other breast, my treatment was determined by all of them together, including the multi focal areas.  I did question this and was really not given a satisfactory answer, but did complete all the chemo and radiation.  I thought it better to do it all.  I did go for a second opinion about the radiation and he said my case was a little more complicated due to finding the cancer on the other side and my margins not being as clear as they would have liked.