Ok, now what?

hyphencollins

Hi everyone-  I've mostly been lurking lately but I just received my final pathology report from my BS and wanted to check in.  I'm hoping to get any thoughts from anyone about what (maybe) to expect when I meet with the MO and RO as well as the PS (wasn't anticipating radiation so I don't know what this means re my TE fills and exchange plan).

* Stage IIA - Multifocal with two foci (1.0 cm and 0.9 cm) of IDC ,ER+, PR+, Her2 not overexpressed (+1), Grade 1 (Nottingham Histological Score -- 3/9)

* DCIS  - Extensive Intraductal Component (didn't give size), Solid, Comedo, and Clinging Types, Necrosis present, Grade 3.

* 1/11 Lymph nodes positive - size of metastatic deposit 0.4cm

* Lymphovascular invasion present (this was noted under the lymph node section? I'm not sure if this means in the lymph node or in the tumor itself); no extracapsular extension

Also, despite the mastectomy, the margins aren't clear (against the skin area) - I think this is the IDC margin, not the DCIS.

The BS said I should expect radiation and she also expected the MO would recommend chemo, given my age (40, pre-menopausal).  She also referred me to PT for lymphedema prevention.  

I'd love to hear from anyone with similar-ish stats, what was your experience with adjuvent treatment, radiation, or implants?  From my reading here, I'm wondering if the MO will really recommend chemo given that it is Grade 1.  What questions should I be asking? 

Thanks in advance!

SpecialK

You might want to request an Oncotype Dx be done since you are ER+, Her2-, it may help inform choices about chemo.  The size of your node and the LVI may be concerning to your MO, as well as your age, and it sounds like you need rads due to the close margin at the skin.  What does your PS say about rads?  Some like to accelerate the fills - done during chemo - so that you are completely done, and quite possibly overfilled, when you start rads so your skin is not asked to stretch afterwards.  Often you have to wait a little longer for exchange also to let the skin recover.

Meow13

You know since you are both ER and PR positive hormone treatment may work well for you I think tamoxifen (pre-menopausal). I do wonder about a 3 on the nottingham scale, get the OncoDx and see what you get for a score chemo might not be effective for you.

I was multifocal 2 tumors each one centimeter one was ILC(5/9) on nottingham and IDC (6/9).

Grade 2. My oncoDX was 34 recommended chemo but I didn't do it

RaiderGirl

I am grade 1 also, StageII  3.2cm  IDC

I was told that chemo is a usually done if lymph nodes are involved.

However, the OncoTypeDX was the deciding factor. A low score on this test meant that chemo lowered the risk of recurrance by only3%. So MO ( 2 of them) said no chemo.

Good luck sweetie.

hyphencollins

Thanks everyone for your thoughts!  I appreciate it.  I met with the MO and she is sending it out for an oncotype dx test.  She recommends chemo with intermediate or high score only.  She is also going to have the regular lab test er, pr her2 on the lymph node tumor although she expects it to be similar to the primaries.  So...we will see.  The meeting with the RO is the 11th.  Thanks again

coraleliz

I had 2 positive nodes & the chemo decision was left up to me. I was given statistics. That was before I had the oncotype test. My MO didn't think it necessary. Knowing it was out there & available bothered me. I wanted the extra information. I was leaning away from chemo anyway but when my score came back low, there was no way I was going to do chemo. My case went before the "tumor board" & there was no consensus. That was 3 1/2 yrs ago.From reading the boards here, it does seem that more women with positive nodes are recieving recommendations to skip chemo under circumstances similar to mine(probably yours).