Does what my surgeon said sound accurate?

You never know.  You see my stats below and I had an oncotype test done and the score was 17.  I had two opinions on chemo.  The first opinion said no chemo.  The second opinion said chemo would be a benefit.  I am also 45 and premenopausal and decided on chemo.  It isn't going to be fun but I want to be here for my young son who is only 4.  If this gives me a better chance, I will do it! 

What I found out after the final pathology was:  my Grade 1 tumor was upgraded to Grade 2; oncotype score; angiolymphatic invasion in the tumor; after BLMX they found one more small area of cancer at 2mm that was not detected before the BLMX. 

The bottom line is that the pathology could change after the lumpectomy.  Are they doing the oncotype test?  You may ask.  If your score on that is really low then chemo may be able to be avoided.  My score was technically in the low range at 17, but the intermediate range starts at score 18 so that did not make me feel so secure. 

I hope you don't need chemo, but remember if you do, it will blast anything floating in your body that surgery won't get.  I know the waiting and antcicipation is hard......especially where chemo is concerned.  I agonized over this...cried daily.  Now that I know I am going chemo, I am OK.  My compromise is doing cold caps to keep my hair.  If that works like they tell me, I go through chemo looking just like myself and be done with all of this right after chemo and move on with my hair in tact! 

Good luck.  THe lumpectomy was not that bad in my opinion.  I was back to the gym the next week and back to teaching aerobics 10 days later. 

I was grade 2 but because I was 42 and premenopousal I did chemo.

Bio:

Welcome to the boards, and I am so sorry you have to be here.  This will be the toughest part of your journey - until everything is known, and a treatment plan, whatever it may end up being, is chosen.  Then you dig in and fight this beast.  So much has to be determined, which will happen only after the lumpectomy and full pathology.  If you are deemed to be ER/PR +, you have many options, and the good probability of no chemo to begin with.  There would be hormonal drugs that you would be on, at least initially.  Now, they are not without their side effects, but each person reacts differently.  Some fly through with no problems, others have side effects.  If you should be triple negative, such as myself, then no hormonals will work on this cancer.  We have no targeted drugs, other than chemo, that can fight this very agressive cancer.  We are not without hope, and I stress that strongly should it be triple negative.  If you are ER/PR + (which is better) but HER positive, then you would be put on herceptin, which, again, does nothing for HER negative gals, whether hormone positive or negative.  Should your tumor be less than 5mm and your are triple neg, a lot of oncs forgo the chemo.  It will depend upon what your onc feels is the safest way to go.  Chemo was not pleasant and I was not one of the lucky ones that suffered minimal side effects.  There were times I just wanted to quit the whole thing and let nature take its course, but I was Stage 1, Grade 3 (triple neg is 98% of the time an agressive tumor no matter how small), and did not want to die.  I chose to use the biggest guns I could to fight this and am now glad that I did.  Remember - as this is very important- you only get one chance out of the gate to try to kill this crap FOREVER.  Don't be afraid of the chemo - it could be the deciding factor in whether you die of old age and not from cancer.  As bad a time as I had, not everyone does, and I am still here a year and a half after chemo - so it is doable.  Pleasant, not so much, but definitely doable.  I am a widow, had to keep working full time as a legal asst., raise my 15 year old grand-daughter (which oftentimes is more difficult than the chemo was!), and was 62, allbeit a young and healthy 62, upon diagnose.  If I can do it - anyone can do it!

Keep the faith, put on your boxing gloves sister, and fight with all you have.  Keep us posted on your progress and final path report.  Should you be triple neg - most important that you choose an onc that is very familiar with treating triple neg, as it's a whole different ball game.

Whatever path is chosen, know that I wish you nothing but complete success.  We are always here for you - 24/7.  God bless.

Hugs,

Linda

Hi Nancy,

As others have said your oncologist will be able to make more definitive recommendations after your pathology report comes back.  But based on my understanding, what your surgeon said seems consistent with national guidelines, etc.  Usually to be in the "no chemo" recommendation, they want tumor no bigger than 1cm and no nodal involvement (including micromets).  1 cm with no nodes is kind of the grey area.  Then if there are any features that tend to be seen as less favorable (e.g. high grade, young/premenopausal patient, vascular invasion, Her+, triple negative, more than one tumor, issues in both breasts, etc) this may tip towards a chemo recommendation.  I was 1cm with no nodes, but due to my age at the time (40) most oncs recommended chemo - though I spoke to one who would have done ovarian suppression instead. 

If your surgeon is saying stage 1 or IIa, this could either be because he thinks the tumor is around 2 cm but possibly slightly bigger (stage 1 only goes up to 2cm), or because he thinks your tumor is under 2cm but there is always the possibility of nodal involvement.  If he thinks your tumor is bigger than 1 cm, then chemo is often recommended under those circumstances.  Likewise if there is nodal involvement.  So his statement seems consistent with what I've seen before.  Good luck to you!! 

Meredith

P.S. - I did chemo (TC x 4) and it was not a picnic but definitely doable.  Much better than I anticipated.

Oncotyping can only be done on Hormone positive cancer, not triple neg, so she will need to find out her receptor status first.  Hopefully, she will be hormone positive.

My surgeon pretty much told me that I would need chemo at a consult that I had with him prior to surgery. He based it on tumor size alone at that point. WHen I had my post-op my tumor size was 3.7 cm and I had 6 positive LN, he said we didn't need oncotyping because I would need chemo based on the surgery results.

Get your results, do your research, and find an oncologist you  trust, and see what he says. And as mentioned previously, don't hesitate to get more opinions if you aren't comfortable with what you're hearing.

Ultimately, too, listen to your gut and follow it.

Best of luck and a warm hug.

I do agree with your surgeon. My sentinel node biopsy was negative and the 6 nodes they took out were also. However, they did find a very very small invasive tumor -so I was not only DCIS anymore but IDC.  My oncologist explained to me that even with a small chance that some cells had escaped my breast, why would I take a chance?My chemo was considered prophylactic. It wasn't easy but if it takes away even a bit of a chance of recurrence, it was worth it. You really can't know for sure what is going on there until the surgery and the final pathology report. He is probably just preparing you for the "might' of what may be.

I wish you luck and you are in my  prayers and remember - it may be a tough road, but you can get through it and come out smiling on the other end. I never thought I would feel this much better and I am still on herceptin, but I am slowly feeling like my old self.

Isabel

ishobie said "My chemo was considered prophylactic"

Isn't all chemo for those of us who have no mets prophylactic? Granted based on our diagnosis there could be cancer cells in our body but they don't know for sure one way or the other unless you have symptoms and test results reveal something.

I have no nodes and no LVI. There is a chance that the cancer did not spread outside my tumor. There is no way of know if it did or didn't for sure. Yes I had scans before surgery.

Hi all-I am brand new to the site. Have been lurking a couple of days, but doing lots of reading on the other pages on the website. I had a lumpectomy on Feb 3 and had my post-op with surgeon yesterday  (Friday, Feb 11). I already knew the tumor was approx 1.9 cm and that it was grade 3 prior to surgery. The surgeon then shared that I was Stage IA, with no cancer in the margins, and the nodes were all cancer-free (3 were removed). This should have been great news and it was. However, for some reason I was not at all prepared for his recommendation to see an oncologist next. Both my husband and I knew that radiation would be required but have not yet met with the radiologist. But the surgeon asked twice prior to surgery and then after if we had met the radiologist yet. We hadn't because my surgery was moved up two weeks due to a cancellation. Just not enough time. We also knew that chemo might be needed if the tumor was larger and/or there was cancer in the nodes. 1.9 was confirmed in the path report, making it just under the one guideline. Clear nodes makes the other guideline. We don't yet know the ER/PR receptor status. That will take another week. So why, if I'm clear on two counts, do I need to have chemotherapy? I was devastated and cried all day yesterday, even though my results were so good. He said it isn't a sure thing, but something that should be reviewed with the oncologist. I just don't understand why we weren't told right off the bat-regardless of size or nodes, you'll need an oncology consult. I would have been so much more prepared. Radiation? I'm ready. Chemo? I would have been with some prep. Now I feel like I've received the C diagnosis all over again. 

Sorry this is so long, but seems so similar to what others are going through. I have been given two oncology referrals in two different towns (I'm in a rural town-one oncologist 30 miles away; the other 90 miles away) and I plan to see them both to get two opinions. I have not heard about the Onco test. Does he do that or the surgeon? Or will that be part of the missing lab report still to come?

Also, what is a cold cap? I'm gonna have lots of questions for y'all, I'm afraid! 

HI there Huskerkk, I had a bit of a larger tumor, also grade 3, and no nodes.  I completed the Onco DX type test. Did your surgeon order that? If no, you may want to call him and ask him to order it so you Onco has it with the rest of the patholody.  Its for mainly node negative, hormone positive tumors and helps to determine effectiveness of chemo vs antihormonal.  They're also now starting to use the Onco on women with her2+ and 1 node , so expanding it's use. You can look it up at genomic health website or google Oncodx test. It will pop off the official site.

My onco score suggested Chemo would not benefit me as much as antihormonals would so that is the way I went. 38 radiation treatments. No chemo. Doctor (Onco) did say women with my grade tumor who also have no nodes and my score range normally chose no chemo, but it was up to me and ultimately my choice. Your Onco will go through the absolute benefit in reduction with you from adding chemo.

Good luck to you. I know this was the hardest part of all the decision making for me. BTW- all surgeons also suggested I would need chemo too due to size and grade... but Oncodx score helped fill in more of the pathology picture.

Bevin

I think the surgeon was just trying to prepare you. It seems everyone is suggested to do chemo with just about any cancer dx, all the choices will be given to you by your oncologist, then YOU make the decision. I believe in 2nd opinions, and even 3rd. Wishing you a quick recovery !

Your IDC is grade 3 (highly aggressive) so you will probably have chemo to make sure that no cells are elsewhere in the body.  It doesn't matter about the lymph node status as 20% of metastatic BC  travel through the blood stream and never go through the lymphatic system.

An oncotype test will probably not be done as the grade 3 status will put the risk factor up for recurrence.