Staging help

Anonymous

Staging help

Boobicles

Hi there, could someone please tell me to interpret my post surgery report into staging? I’ve not been informed what stage I’m at and have been given the following info:

IDC , T2, N1 Er- PR- Her2 positive, G3 N2 (4/15)

I know what all the above means but I don’t know how it translates to staging? I know I can ask my oncology but she’s on hols at the moment.

Thanks in advance

Beesie

Are you N1 or N2? You mention both. Assuming the 4/15 means that you have 4 nodes positive, then it's N2.

T2, N2 would make you Stage IIIA based on TNM staging:

There is also a new prognostic staging model that would also put you at Stage IIIA:

Moderators

Boobicles, the following article from our main site may be of help too:

Getting Your Pathology Report | Breastcancer.org

Hope this helps!

The Mods

Boobicles

hi Beesie and thanks for your reply. My report actually states both, N1 and N2. I just know that 4/15 lymph nodes were cancerous and that the anterior margin was involved

Boobicles

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kathabus

I’m glad there is a current staging question! My tumor was 2.5 cm...so T2, Grade 2, 1 node, 0M. Mostly everything is below. I’ve been told by all my doctors that I am Stage Ib but I can never find anything that supports that. I don’t doubt it...but just can’t find supporting evidence on my own for it.

Beesie

Boobicles, were you diagnosed via biopsy in August and then had surgery in October? The way I'm reading the report is that your clinical assessment prior to surgery assumed T2 and N1, but your surgical pathology turned out to be T2 (35mm) and N2 (4 nodes positive). Your final staging is based on the surgical pathology. That's the info I provided in my previous post.

kathabus, the AJCC Staging Manual is the basis of staging in North America and the information is publicly available. European staging is set by a different organization but is consistent with AJJC staging. As per the chart in my previous post, you are Stage IIB in the traditional TNM staging classification. Using the new prognostic staging, you are Stage IIA:

You might want to ask your doctors to explain why they say you are Stage IB when that's not what the AJCC staging manual shows for a T2N1M0 tumor that is Gr2 and ER+/PR+/HER2-.

Boobicles

Beesie, yes that’s correct. I was originally diagnosed in August and then had the OP in October. That makes so much sense now, thanks so much for explaining it to me. I really appreciate it.

kathabus

I think I found the disconnect. You are using clinical prognostic staging, whereas the doctors use pathologic prognostic staging after surgery. Glad I figured this out because it was driving me nuts

Here is a calculator and the link to the pdf. (Sorry my picture is fuzzy...)

The Komen link explains the recent changes made and how the staging changed. I found it helpful.

https://qxmd.com/calculate/calculator_594/ptnm-staging-for-breast-cancer-ajcc-2017

https://cancerstaging.org/CSE/Physician/Documents/AJCC_PPT%20-Breast%20Webinar%2011-8-17.pdf

https://ww5.komen.org/BreastCancer/StagingofBreastCancer.html

Beesie

kathabus, thank you! I was using the same staging document but I pulled up the Clinical instead of Pathological page.

But that begs a question... why in the world would the exact same diagnosis calculate to a different stage clinically (i.e. based on biopsy and imaging estimates) vs. pathologically (based on surgical pathology)? That's completely illogical. According to the staging manual "Pathological Prognostic Stage applies to patients with breast cancer treated with surgery as the initial treatment. It includes all information used for clinical staging plus findings at surgery and pathological findings from surgical resection." Okay, so someone is clinically staged and then has surgery. "We now have a final diagnosis post-surgery and it's exactly what we thought it would be, so the stage is changing from what we estimated." Huh??

Boobicles, I did recheck your diagnosis against both the clinical and pathological prognostic tables, and it comes up as IIIA in both cases.

Boobicles

Thanks so much Beesie.

kathabus

I hear ya, Beesie

Boobicles

Beesie may I ask you another question? On my report it states that the anterior margins were involved. Does that mean that there’s a possibility that some cancer cells are still in my body (despite having had chemo and rads)? Thanks in advance.

Beesie

Did you have a lumpectomy or mastectomy?

And being HER2+, did you have chemo prior to surgery or after surgery?

The anterior margin is the margin at the skin. This is less concerning than a margin within the breast tissue but yes, there is a possibility that some cancer cells remained after surgery. The goal of rads (and chemo, if it was post surgery) would be to kill off those cells. Of all the close margins, anterior is the best to have (given that we'd all rather have no close or positive margins; I had a close (1mm) margin at the skin) because a localized recurrence should show up quite noticeably as a nodule under the skin.

Positive anterior margins in breast conserving surgery: Does it matter? A systematic review of the literature

Boobicles

Thanks for your in depth answer. I had a lumpectomy and chemo and rads after. Initially it was planned that I’d have the chemo first but they found a new primary cancer in my kidney so they took everything out at the same time.

I then was on Perjeta and Herceptin but they had to drop the Perjeta because despite heart meds my EF dropped too low. So only on subcutaneous Herceptin now.

Do you know what the risk is of the cancer recurring with my stats? Sorry for bombarding you with all these questions.

Boobicles

ps I’m 43 years old

Beesie

Boobicles, sorry I can't help on that one. Your recurrence risk is something you will have to get from your Oncologist.

Boobicles

Will do. Thanks so much for all your help