Size vs # of nodes

ck55

Another question.

Has anyone ever been told which carries more weight as far as survival: Size of tumor or # of positive nodes?

Like I said in my other post about what constitutes early stage, I am just looking for some kind of good news.

Thanks again, Cyndi

diana50

initially, when first diagnosed; my surgeon thought stage I.  small tumor...1.8 cm.  the 10 fully encased lymph nodes...10/12 is what tossed me into higher stage....clincial trial for chemo...the whole nine yards. so now, there are articles out about aggressiveness of small tumors...but lots of lymph nodes. 

i just think you get diagnosed...do the treatment....and hope/pray for the best.  actually, thinking all breast cancer patients are doing the same thing; treatment...exercise....and pray.  bottom line. 

orlandpark65

CK   you were dx in 2006. That's great news for me.   I had both big tumor a lots of nodes.  I did  ac/ 4 taxol, lot's of radiation and now onto tamoxifen.  

Diana and Sherri too!     

christine47

so interesting that some of the smallest tumors have positive nodes and large tumors, no involved nodes.  Probably more predictive is the grade (1-3).  This tells more about the aggresiveness of the cancer.  I aggree, hope and pray for the best.

SharonMH

Hi ,  I dont know what carries more weight as far as surivial goes tumor size or number of positive nodes  I had a 5 cm tumor. and 14 out of 15 nodes positive.  I am two years out and  I am NED and doing well,  SharonH

ck55

It is interesting that some of the smaller tumors end up with more nodes.

My tumor was a grade 2, with a mitotic rate of 1. I think of it as a big fat lazy tumor that I probably had for years. I had mammograms every year starting in my mid 30's (my Mom had BC so I was on it). It was never seen. The only thing that finally showed up was a small area of microcalcifications which was DCIS, and the biopsy found the ILC. 

It was never felt. Even with the films in had my breast surgeon could not feel it. It did show up on an MRI. Sneaky bastard!

So I am hoping that not only was it lazy but very unambitious as well and didn't feel the need to go out exploring new places to homestead!

I guess we never know until we do, and then we deal with it.

Cyndi

orlandpark65

Me too CK55.   Annual mamo's with dense breast, it was hidden behind.  I think anyone that has dense breast should get a diagnostic mamo. 

orlandpark65

Me too CK55.   Annual mamo's with dense breast, it was hidden behind.  I think anyone that has dense breast should get a diagnostic mamo. 

pupfoster1

Me also CK55.  Had the large dense breasts and was never picked up on my yearly mamos.  I think the grade would tell how aggressive the cancer WAS, but once you go through tx you have to believe that it worked and kicked whatever might be left's ass!

Sharon

Luah

I've heard that it's the proportion of nodes affected that is most relevant, not the absolute number ... that's why 4 or more kicks you up a stage. Tumours can be large and slow-growing and not aggressive, or not. Grade counts too. It's a bit of a crap shoot imo.

PinkShirtNow

Yeah, I have dense breasts too.  I just never really knew what that meant.  I have had annual mammograms and I ended up with a 3.9 cm tumor that I found myself.  I have had cysts before so I waited about 6 weeks to have it checked at my annual mammogram.  I pointed it out to the technician who marked it but I certainly hope that they wouldn't have missed it this year like they probably did last year.  Had I realized that my dense breasts made it tough to see tumors, I would have been a lot more proactive about more precise tests.  Hindsight is 20/20, I guess.

Beeb75

These researchers at Harvard suggest that cancer follows a mathematical model (which I think is so wild.) They actually figured out how size of tumor and number of lymph nodes play into the recurrence risk mathematically. (This is all explained over at the site Cancermath, in the technical reports, which is where I found it.)

Basically, the tumor size correlates to recurrence risk with each additional millimeter adding one percentage point to the recurrence risk. So a 5 mm tumor would have a 5 percent recurrence risk. A 6 cm (that is, 60 mm) tumor would have a 60 percent recurrence risk.

Each positive lymph node adds, I think, 6 percent to the recurrence risk.

Keep in mind that whatever the total recurrence risk is -- given the tumor size and the positive nodes -- it can be cut by 2/3rds with adequate treatment. So even someone with a large tumor and many nodes can have their recurrence risk brought down dramatically to pretty good odds, with treatment.

And, there are definitely cell characteristics that play into recurrence risk, like receptors, and grade, and type (with ILC less likely to recur, I believe.) 

Also, from the data I've seen, the modern treatments save the lives of around 75 percent of Stage 3 BC patients.

(Please forgive me for posting out of Stage. And I hope this doesn't scare anyone. But since the question was asked, and I happened to know the answer, I thought I'd post it.) 

Denise2730

I'm so confused about all this also. My tumor was 1.7 cm and only one node out of four was cancerous. Does that automatically make me a chemo candidate? I have no idea the grade but I am picking up a copy of my pathology report today.

Denise

Ellie1959

Please explain again Bee75- would 5 cm be 50% or 5% - I am math challenged (and blonde) - Thanks, Ellie

Beeb75

Chluvr, usually, people with a positive node (like me and you) are recommended for chemo. I did chemo.

Ellie, a 5 cm tumor would mean a 50 percent recurrence risk WITHOUT treatment. Plus two nodes at 6 percent additional per node, would mean a 62 percent recurrence risk WITHOUT treatment.

With treatment, you can typically cut the recurrence risk by 2/3, so you'd be left with about a 20 percent recurrence risk after all the treatment.  

Ellie1959

Thanks Bee75- I did double mx, chemo and rads and 4 years of AI - I'm going to say I have an 80% chance of NOT having a recurrence - and jump off the other bridge if I get to it!

ck55

Well Bee75 - that scares the crap out of me!! So with a 9 CM tumor and 2+ nodes my recurrence rate would be 102%?!  

So if I under stand you correctly, with all the treatment and AI's is would bring it down 75% or about 25% chance of recurrence?

Don't like it.

 Cyndi 

Beeb75

Hi Cyndi,

A 25 percent chance of recurrence means a far better chance of NOT recurring. Look at it that way.

Plus, I think ILC is a little different, with a lower chance of recurring. AND you had the best receptor combo. AND you're already 5 years out from diagnosis.

I think you're in pretty good shape! 

ck55

Beeb75

Thanks for the words of encouragement.

Didn't mean to go into "shoot the messenger" mode.

 Cyndi

sweetbean

the other thing to consider is your life after treatment.  I had a 5cm tumor and 2 lymph nodes, so after treatment, I am around 20% recurrence risk.  However, i exercise every day, take lots of supplements, eat very healthily, reduce stress, you get the picture.  All of those things can reduce your risk as well, so it is good to add them in, esp if you are still stuck at 20% after treatment.

Pure

umm I have never heard of this as a way of calculating reoccurence..Where did you find this?

Beeb75

Pure,

It is in the technical reports section of lifemath.com/cancermath.com. 

http://www.lifemath.net/cancer/about/techreports/technical_report_1.pdf.

This is probably not the be all/end all explanation of breast cancer recurrence risk...but it's an interesting one developed by researchers at Harvard and validated, I believe, using real SEER data sets. 

Sweetbean, yes very true. Also the things like aspirin, alcohol, etc. There's more we can do to reduce our recurrence risk. Also, there are always new treatments coming out. I don't know if drugs like Herceptin are really factored into the mathematical model, for example. 

starbeauty

Beeb

I've missed issues with aspirin... What is that about?

Beeb75

Hi Starbeauty,

I'm not sure if there's been a randomized, controlled (aka gold-standard) study on aspirin, but I think there was a retrospective one that showed among a large population of women who'd had BC, those who took aspirin regularly had fewer recurrences. My onc is not completely convinced, but she OK'd me taking a baby aspirin 3X a week.

Aspirin can cause GI bleeding in some people, so you need to be careful and check with your doc if it's OK for you to take it, but I think the theory has something to do with the COX gene which gets activated in some breast cancers and which aspirin foils.....or something like that. 

Beeb75

Here's some info on the aspirin study I was talking about:

http://www.breastcancer.org/risk/new_research/20100216c.jsp

Also seems like a Q&A on this site does not recommend aspirin to prevent recurrence, but seems like something that it can't hurt much to try. Anyway, I am, as I mentioned, with my onc's OK for a thrice weekly baby aspirin. 

mks16

I asked my oncologist about baby aspirin and he wasn't convinced either. However, he says it will protect from colon cancer and said to go ahead and take it. I didn't know about colon cancer until he mentioned it, but I did read about studies showing fewer recurrences in women who took baby aspirin for at least a year.

mks16

Here is the link to one of the numerous articles on benefits of aspirin:

http://www.dailymail.co.uk/health/article-1392566/Aspirin--taking-day-save-YOUR-life.html 

mks16

Sorry beeb, didn't see your post before, we must've posted at the same time.

many

With 40 + nodes ,it makes 240 + 60 for tumor which makes total= 300 which even divided by 3 gives 100% does that mean my wife has 100% chance of recurrence I am really broken up with this calculation

Beeb75

Many,

I think it meant to be a rule of thumb rather than a certainty. After all, it doesn't really even make sense for someone to have more than 100 percent chance of anything.

I only posted it because someone asked about the relative importance of tumor size vs. nodes. It offers some information about that.

But all of this information is incorporated into the model at Cancermath.com, so that is a much more reliable source if you want to figure out specific recurrence/mortality rates. 

If you plug your wife's data into Cancermath, you will see that with treatment, she has a 70+ percent chance of beating her cancer. That's pretty darn good!

Wishing you and your wife all the best. 

faithfulheart

We can't play God on this statistic thing, there's such a panic going on. Like diana 50 said, get your treatment, exercise, eat right, and pray........It is what it is. I hate DR. Google, I never go there, we are not statistics!!!!  My onc. told me that yesterday,  I said I hate being a III C, He responded, you are not a stat!  The longer we stay in the game, the more they learn. New meds. new teatments, lets all just stay in the game, and live!!!! !Over thinking this is a waste of time, don't you think. It makes for a great discussion, but I would get in the fetal position and stay there if I did that tumor, node calculation!!  Yikes, Surviving this beast is the only option I will except, and if I here otherwise, then I will fight like hell, I got some kids to raise sistah's!!!!

Blessings to all,

S

steph