Can anyone help or offer information?

Asterix1234

Hello my name is Debra, if anyone can offer clarification on this, I would be very grateful.  Cancer, it would seem is as individual as the very people it inflicts... the Internet has not been overy helpful.  I am 6 days post op with mastectomy and sentinel node biopsy.  My questions are...How can someone die of breast cancer?? Is this just a reference to breast cancer as a primary and spreading to other parts of the body? Sorry if I sound dumb at the obvious, but I am confused by the statement...died of breast cancer.

And what is architectural and nuclear grade? (mine showed 2/3 on PR from biopsy) What is it and what does it represent. Is it 2 out of 3? and what?

Thank you again ladies, you bring some light to this dark, dreerie tunnel.  All the best.  Debra

FACECRAFTER

Hi Debra, and welcome to the club no one wants to join.  The good news is you've come to the right place.  You;ll get good answers to your questions here.  You are right, cancer is very individual.  As you go thru these boards, people will have all kinds of different diagnoses.  The good news is, most of them are very treatable and although a long road, you'll be able to get on with your life.  To answer your question:  

People die of breast cancer spreading to other parts of the body.  That is, the breast cancer metastisized.  For example you can have breast cancer of the brain, or the bones, as opposed to brain or bone cancer.  It is a matter of which is the primary cancer. So it is said the person died of breast cancer, although it was not in the breast alone.

Now for the other two answers:

nuclear grade: 

"An evaluation of the size and shape of the nucleus in tumor cells and the percentage of tumor cells that are in the process of dividing or growing. Cancers with low nuclear grade grow and spread less quickly than cancers with high nuclear grade".

Architectural grade is an effort to be more precise that the standard tumor grading procedure of 1 to 5, using cell differentiation.  Apparently there are differences of interpretations by different pathologists.  This is used to be more precise in grading tumors.  You'll probably still get grade 5 and grade 1, but the in-between ones are subject to smaller differences.  In the end, I don't think it amounts to much.  I think the 2/3 is stage 2 and grade 3?  with a 3-3.9cm tumor size, and only 1 of 5 nodes, your STAGE IS 2A  and your grade (level of aggressiveness) seems to be a 3 (high)  A grade 3 tumor is easier to treat than the lower grades (not intuitive)  -- faster multiplying cells are easier to kill off usually. 

     What is your ER/PR/HER2  pos or neg?  That will determine your long term treatment.

Hope this helped.  You can see that I was Stage 2  Grade 3 and it's over and done with, I'm healthy.   JUDY

Asterix1234

Judy, thank you so much for the information.  As I am only 6 days post op, I have been told that further information will only be available when the Path. comes back on the 25th of this month.  I was also wondering what the criteria for chemo is?  Strange as this may sound with full knowledge of how invasive and nasty it can be, I want chemo, I want the insurance that IF anything was missed then it may be taken care of with chemo.  Does it sound like I will need it?  What was your treatment?  Thank you again - information is power to me....something I have not felt a whole lot of as of late.  I am so, so grateful for this site!  All the best to you.    Debra

FACECRAFTER

I am not sure what the criteria for chemo is.  I know I had it before the Mx to shrink the tumors-I had one in the lymph node as well.  After the Mx??  I'm not sure.  Generally radiation is done to assure that no cancer is left.   You chose to have a Unilateral Mx??  I had a BiLateral Mx - didn't want to worry about anything coming back, and since I already had a total hysterectomy...chances are good.  Again with a Uni Mx- don't know.  Your ER/PR/HER2 status is key.  And we don't know it yet.

Your oncologist will decide- together with you- what Tx is best..If it is chemo, make sure you get the anti-nausea meds- Decadron and Kytril - Kytril is very expensive but it works!!  I had no SE's (side effects) from the chemo.   If you decide on rads - then you will need to keep your skin supple with creams throughout the process to avoid as much skin breakdown as possible.  We'll wait for the final path report.   Keep me informed..I'm with ya.   JUDY

Beesie

Debra, welcome, although I'm sorry that you've had to join us.

Judy has provided a lot of good information; there are just a few things I'll add.

About the grade, often a tumor contains some cells that are one grade and some cells that are another grade.  So I would guess that the "2/3" on your pathology report means that your cancer is a combination of grade 2 and grade 3 cells.

As for chemo, generally chemo is considered for anyone with nodal involvement, which you have.  Although you're in Canada, the treatment guidelines are virtually identical to those of the U.S..  Here is a file that explains the U.S. treatment guidelines:

http://www.nccn.org/professionals/physician_gls/PDF/breast.pdf 

If this link doesn't work, go here http://www.nccn.org/index.asp , then click on NCCN Clinical Practice Guidelines in Oncology in the column on the left side about 1/2 way down the page, and then once you are on the new page, click on Breast Cancer in the middle column.  That will get you to the same document that I've linked above.

Based on both your tumor size and the fact that you have nodal involvement, chemo is sure to be offered.  Radiation likely will be recommended as well, even though you had mastectomy, because of the nodal involvement.  You can follow the decision tree for your diagnosis on pages 10 and 11.  The rest of your treatment is dependent on your hormone status, i.e. whether you are ER+ or ER- and HER2+ or HER2-.  If you are ER+ you will likely be put onto Tamoxifen. If you are HER2+, you will likely be prescribed Herceptin.  Neither of these drugs will be recommended if you are ER- and HER2-.

As for staging, with a 3cm tumor and one positive node, you are actually Stage IIB.  You can find information about staging on pages 57 - 59 of the file that I linked.

I hope this helps!

Luah

Hi Debra. I haven't heard of architectural grade, maybe google?  Generally, I understand Grade to be distinct from Staging.  If you scroll down here, http://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_How_is_breast_cancer_diagnosed_5.asp

you will see an explanation of grading; it would seem your tumour on biopsy appeared as 2/3 - a measure of its aggressiveness.  The final path report may segment this further, on a scale of 9, 3 indicators measured from 1-3, called the histologic grade, yours would seem to fall 4-6.  I didn't get a grade on biopsy, which bothers me as I like to have as much information as possible.   

You won't know staging until the final path report (I know the 25th can't come soon enough!), because that depends on a range of factors, not just the appearance and behaviour of the cells under a microscope.  Further explanation here: http://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_How_is_breast_cancer_staged_5.asp?rnav=cri

Scroll down to TMN staging system. Hope this helps.

Added later... 

Beesie: Thanks for that link... even better!

Asterix1234

Thank you everyone for your posts, I now understand.  Can anyone make the time go faster so that tomorrow could possibly be.....September 25th.  LOL ...I can try.

Thank you again and all the best!

Debra

FACECRAFTER

The one thing I'll tell you is that everything takes longer than you want from here on, until you are through.  You are on the scenic route, the direct route has been detoured.   No one is control, even your doctors, so you might as well stop trying to control the process.  Just go with the flow, you'll find it a whole lot easier.  (This took me a while to accomplish, as I am a real control freak.) 

 And keep a notebook or binder with all of your papers in it, path reports, doctor appointments, everything.  Take a deep breath, and step on the slow train.  JUDY