How Does Oncologist Know Stage?

amybirnbaum1

Hi All,

Just diagnosied with IDC, grade 3, HER2+ 1.8 cm, biopsy and us show no lymphovascular involvement. Oncocolgist says definitely stage 1. Plan is to have lumpectomy then chemo due to the HER2 postivive, then radiation. I see the surgeon on Thursday. My question is, how can he assure me this is stage 1 until biopsy done on lymph nodes?? THANK YOU

orangeflower

I'm pretty sure he can't, and I don't know why he told you that. My surgeon told me that staging is determined once the surgery pathology report comes back. Even the size of the tumor could end up being different that what is shown on imaging. My imaging said 1.8cm, but the path report determined it was 1.6cm.

My biopsy also said grade 1, but the surgery path report ultimately determined it was grade 2. The path report is the final word.

Your post reminded me of my experience with the mammogram and ultrasound that ultimately led to the cancer diagnosis. I'll never forget the radiologist showing me the imaging, waving his hand at it and saying "This is probably all going to turn out to be nothing." Edit to add: Technically, he was right. It "probably" was going to be nothing...!

I hope that your surgical path report does indeed determine that you are stage 1. Maybe your doctor will turn out to be right.

exbrnxgrl

Between biopsy and imaging a doctor can make an educated guess as to stage but the post surgical biopsy report is the final word. Those educated guesses can be fairly accurate but not always. Post biopsy the estimate was stage I, no nodal involvement. After my bmx? Stage IIB and one positive sentinel node (which also turned out to be wrong but that was just my bad luck). So just wait for your final pathology report after surgery.Take care

ElaineTherese

To be honest, stage isn't very important in your case because your treatment decisions will be driven by the fact that your cancer is HER2+ and Grade 3. Perhaps, the most important item to discuss is whether your lump is small enough for you to get away with Taxol + Herceptin as opposed to heavy duty HER2+ regimens like Taxotere + Carboplatin + Herceptin + Perjeta or Adriamycin + Cytoxan and then Taxol + Herceptin + Perjeta. Good luck!

kathabus

Clinical staging is used before surgery and it is based on imaging and biopsy results. Pathological staging is given after surgery.

Melbo

What everyone else here said is correct. If you end up with chemo first (common for HER2+ cancer) you may never know your actual stage with any accuracy. I think for HER2 cancers they make the chemo first vs surgery first decision based on the size of the tumor they can see on ultrasound, but I’m not sure what the size cut-off is

Almost all doctors base staging off the NCCN guidelines, which you can review here:

https://www.nccn.org/patients/guidelines/content/PDF/breast-invasive-patient.pdf