What Are Primary Indicators Of Aggressiveness

Avh112

what have you all been told by your doctors as the key indicators of aggressiveness? Is it the K1-67, is it the mitortic score on the grading? Is it size of original tumor? Feels like staging might be a bit misleading and the most important things to look at is the aggressiveness of the cancer. Thoughts from others on what are the key items on the pathology report

Meow13

From what I seen aggressiveness doesn't necessarily drive outcome. I realize there are many studies that say otherwise but I know many people stage 3 many nodes and high grade tumors that have responded and not see the cancer return. Some doctors believe in ki-67, mine doesn't others go off cancer grade, mitotic scores and others that place all the cards on oncodx scores. I think statistics aren't reflective of newer treatments. I mean anyone stage 4 only has a 20% chance of being alive after 5 years, that is out of date.

Key is getting diagnosed as early as possible and newer drugs.

Ingerp

I've never thought so much about "aggressiveness", but how many treatment tools are available. I was told early on that HER2+ tumors are more aggressive but also have better outcomes, specifically because of Herceptin. I've also heard re: prostate cancer that the more aggressive tumors often respond better to treatment. I worry about the triple negative women. Of course tumor size is reflected in the staging.

Avh112

I recognized that anything can happened at any stage and any set of numbers but don’t the stats show that lower stage (less aggressive) tumors are less likely to have reoccurrence? I guess ultimately with all the different things out there from the pathology report I’m trying to figure out what really are the items that are more important than others when it comes to possible reoccurrence or the aggressiveness of the cancer. Thanks for the inout

ShetlandPony

My first onc told me, “Biology trumps size.”

Avh112

right but which specific areas of the biology are the important ones

ShetlandPony

It might help me answer if you could give some basic info such as your ER, PR, Her2, Oncotype if applicable, general age range, ki67, mitotic score, tubule formation, pleomorphism, subtype.

SpecialK

avh - yes, lower stage generally is less threatening than higher stage and that is backed up by SEER data. Staging used to be comprised of tumor size, nodal status, and distant metastasis. Breast cancer staging was updated in 2018 to include some other classifiers that help it be more accurate and a more clear picture of aggressiveness. Genomic testing like Oncotype, Mammaprint, Pam50, etc., which can include subtype analysis and luminal type, help outline and calculate the level of aggressiveness by different means than the previous staging alone. Here are links to the new criteria. That said, an aggressive larger cancer may not recur and a smaller, seemingly less aggressive cancer sometimes does - this is one of the challenges of deciding treatment and predicting recurrence.

https://www.breastcancer.org/symptoms/diagnosis/staging

https://www.cancer.org/cancer/breast-cancer/understanding-a-breast-cancer-diagnosis/stages-of-breast-cancer.html

DebAL

shetland, my onc is in the "biology trumps size" camp too.

Special k. I agree with your post. Deciding on treatment is very challenging. There are also other factors that are not seen in our signatures that drive our treatment decisions. No matter what we do recurrence chances linger. We all just make the decision that we feel is best for our unique situation.

santabarbarian

If you have a Nottingham score on your path report, that's a three prong analysis, each scored 1-3...so the score can be 3 to 9. I got a 9. That's aggressive. TNBC, grade 3.

OTOH, aggressive cancers don't tend to go quiet to escape the chemo... they are sharks who never stop swimming. The tumor was medium sized (3.8 cm) but I know it got that size very rapidly. I had done a very thorough self-exam in March, that I could clearly recall, as my sister had a self exam thingy hanging in her shower and it prompted me to do it when I visited her. My breasts are smallish and soft, so pretty easy easy to keep track of. I know there was nothing palpable in March. By July I had a huge walnut sized lump. It seemed to come on overnight.

letsgogolf

My team also told me that biology trumps everything. I understand that node status is thought to be less important than it once was. Even on this site you will find many women who had node involvement and never had a recurrence while some stage 1, node negative ladies have had a recurrence. Very confusing disease because it's hard to predict who will have to deal with this again. Fortunately, the stats seem to be improving and are in our favor overall.

DebAL

well said letsgogolf. It's a confusing disease and treatment decisions can make your head spin. We really dont know who will have to deal with this again. We all choose our treatment path that we feel is best for us. That's really all we can do.

MCBaker

I have been questioning my onco's suggestion for Nerlynx, given 3 mm size of invasive growth associated with 10+ cm of DCIS. I think I will shut up.

beep7bop

I started early 90's with questions on mammograms, which showed ductal hyperplasia on biopsy, then next time it was 2000 lobular hyperplasia, 2003 lobular carcinoma in situ had Lumpectomy,  2012 ductal carcinoma in situ, had lumpectomy, 2019 IDC left breast decided to do double mesectomy I was done with it. That was April1 2019, turns out IDC and ILC both breast upper and lower outer both breast.. Had Pet CT last week and now I am seeing breast surgeon Today which was unplanned. Wasn't to see her again till August. My reconstruction surgery was going to be end of September. MO said to put that on hold. My MAX SUV in left breast is 4.4 with hypermetabolic foci soft tissue in Thorax.  What ever all that means will find out later today. This Stuff was supposed to be gone RIGHT!! Sorry I am in a Bad Mood at the moment. Hope things go better for all of you. Maybe this is just inflammation at least I hope so, but research points to probably not. Wish me LUCK!!

Meow13

Good luck, sorry you are still dealing with BC!

edj3

beep7bop I do wish you luck--let us know what you learn, ok?

SimoneRC

beep7bop,

Thinking about you and sending positive vibes! Hang in there!

Irishlove

Dear beep7bop, Sending you best wishes that you will find all is clear.

bluepearl

Aggressive cancers, statistically only, are 1. triple negative or negative ER/PR 2. Her2+ 3. small but in nodes 4. Pr- 5. grade 3 6. mitotic score greater than 1. But everything can be trumped by other biological conditions in the breast cancer, so the above is just a statistically normal set upas to what is aggressive. It is still better to have a small tumour, be ER/PR +, node negative and low grade. Also, inflammatory breast cancer is probably the most aggressive of them all. Hope this helps, but as some of the ladies suggested, nothing is written in stone.