Has anyone been recommended chemo for Stage 1, Grade 3?

rn4babies · April 2012

I was recently diagnosed with multifocal BC. IDC, Stage 1b, Grade 3 and ILC Stage 1a. ER+/PR+/HER2 neg. Only some ITC's seen in SNB (thus node neg). This was a second primary in a year's time (I had just completed rads on 12/14 for Grade 3 DCIS in the other breast). I am 48 years old, BRCA neg and had started Tamoxifen on Feb1. I had my second lumpectomy on 3/23. I'm still trying to get my tissue sent for Oncotype score (my surgeon dropped the ball on that one). He mentioned chemo at first but now is saying just radiation. I see my MO on 4/26 (if we have the Oncotype score back). Has anyone had a similar DX with a small, Grade 3, tumor? Alot of things that I've read state that alot of times chemo is recommended for Grade 3 despite tumor size. Does the fact that I've had a new primary so soon play a role in the treatment plan? Also, if you were Grade 3, what was your Oncotype score?

WIMusicMaker · April 2012

rnbabies I am so sorry you have to go through this! It just doesn't seem fair! I have similar stats except my tumor was 1.8 cm. My oncotype was 29. I was 50 at diagnosis. I had chemo, rads and just started taking tamoxifen. My first onc did not even want to do an oncotype because he said with a Grade 3 tumor the score will come back higher.

Take care-Mary

CoolBreeze · April 2012

I think chemo is only recommended for small, stage 1 if you are HER2+ or very young. You might have to rely on the oncotype so get after him! 48 is pretty young though.

NancyHB · April 2012

rnbabies: I'm so sorry you're going through this again, especially so soon. I do not have a Grade 3 tumor but rather Grade 2 - we sound very much alike (I was initially ER/PR+ and HER2-, 1.3 cm tumor, 0/7 nodes, Stage 1 IDC). Even at that time my MO suggested 6 rounds of TC (but "hoped" I would make it through at least 4). My Oncotype score came back at 42, so I did 4 rounds of dd AC, and just had my third of 6 rounds of Taxol today. Oh, and the Onco test changed my PR status from + to -. For me, that test made all the difference in the world. Had I not had it, I am not certain I would have done chemo in the first place. I hope your score is very low, which will help in your decision-making.

Good luck, Nancy

voraciousreader · April 2012

First off, the surgeon is not the one steering the boat regarding chemo. His or her job is to get the tumor off to Oncotype DX testing. The MO helps you decide whether or not chemo is right for you. Good luck and don't think you are under the gun to decide. You might want to get a second MO opinion as well.

rn4babies · April 2012

My surgeon never forwarded any of my records to my MO so he had no idea about this new BC! He was also supposed to have the tissue sent after my surgery on 3/23 and never did. I called my MO on Tuesday and they know nothing about it. I have an appointment for 2nd opinion on 5/1.

NancyHB · April 2012

I'm 48 too - everyone involved in my diagnosis kept telling me how "young" I was. It was the nicest thing any of them ever said. My BS mentioned chemo too - I live in a small-ish community and he is the chair of the BC "team" in our town, which meets and discusses treatment protocol. I think he mentioned it because he knew we trusted him implicitly, and he knew that was going to be the likely recommendation. Even looking at the NCCN guidelines, we learned chemo is a treatment option; it was the Onco test that sealed my deal, though. So voraciousreader is right - it's not up to the BS to make that decision, but rather meeting with the MO will give you the information you need. Even then, my MO said the decision was really ours to make (at least initially; they still hinted I had a choice after the Onco test but we knew we really didn't). Before the Onco test results we were looking for a second opinion because nothing seemed set in stone, and we wanted to make the best decision possible.

theBCavenger · April 2012

I have a friend that just finished 6 rounds of chemo. She had a small grade 3 tumor. She never received the OncoType test. Chemo was offered and she accepted.

They offered chemo to me as well. Mine being a grade 1, I insisted on the OncoType DX, and did not need the chemo.

Good luck to you!

slinky · April 2012

My surgeon dropped the ball on my ocotype test, too. I am now one year and a few months out from the BMX and my new oncologist will be ordering the testing. I am BRCA1+. My onc told me if the score is low enough, I might be able to discontinue the Fareston I am on. I am stage 1 grade 2 0/7 nodes, ER+, PR+, HER-.

rn4babies · April 2012

NancyHB - My onco kept telling how "'young" I was for BC the last time. I read so many posts form women in their 30's and early 40's with BC. I never thought of myself as young. It does make you feel good that you're still considered young for some things.....lol.

jezza · April 2012

I had a small Grade 3 IDC tumour. I didn't have chemo and there wasn't an oncotype test around when I was diagnosed....20 years later I am doing well.I did have bi-lat mast because of DCIS throughout one breast and prophylactic on the other because of family history and to give some peace of mind.

Good luck with your decision.

jezza

wonderwoman123 · April 2012

Hi Mary, Thank you for posting your story. I am very similar with Stage IIA, Grade 3, ER+ PR+ Her- and i should be getting my oncotype score tomorrow. I am putting the #12 out to the universe, but as we all know, it will be what it will be.

At the moment i am worried about my boob itself, i had 2 lumpectomies a week apart, and i am finding it is getting sorer, as the swelling comes down. and on the lower side, it feels quite heavy and not red like infected, but a bit of a dark blush to it. I will show it to the Onc on Monday when i go in for the oncotest score.

But if anyone out there had any troubles with healing after their lumpectomies, or any weird feelings etc, i would love to hear about it,

Thanks,

Linda

rn4babies · April 2012

Slinky and Wonderwoman......please post your oncotype scores when you get them. I'm just curious if higher scores are consistent with Grade 3, ER+/PR+/Her2 neg. I've seen alot of Grade 2 scores but not alot of Grade 3.

voraciousreader · April 2012

http://www.nature.com/modpathol/journal/v21/n10/full/modpathol200854a.html

"Although we are describing a multivariate model of the Oncotype DX^TM RS, it is instructive to examine the univariate relationship between the Nottingham Grade and the RS. Figure 1 and Table 4 show the distribution of cases by Nottingham Grade and Recurrence Score, and Table 5 details those cases which appear discordant, i.e. cases that are Nottingham Grade 1 but do not have a low risk RS, Nottingham Grade 2 cases but do not have a intermediate risk RS, and cases that are Nottingham grade 3 but do not have a high risk RS. Interestingly, the range of Recurrence Scores for Nottingham Grade 1 cases is 7-21, for Grade 2 is 4-47, and for Grade 3 is 30-86. Thus, for Grade 1 cases, the 5 that had an intermediate Recurrence Score rather than low were still in the lowest range of the intermediate category (score of 19-21). Additionally, for Grade 3 cases, the one that had an intermediate Recurrence Score rather than high was in the highest range of the intermediate category (score of 30). Grade 2 cases, on the other hand, have a wide range of Recurrence Scores that appear unpredictable. It is worth noting that there were no two-step discrepancies, that is, there were no cases that were Nottingham Grade 1 and high RS, and none that were Nottingham Grade 3 and low RS."

_________________________________________________________________________________

Are there outliers? Absolutely. However, MOST Grade 3 tumors have "high" recurrence scores. Remember though, that the OncotypeDX test is just one tool that is used in the equation as to whether or not chemo is RIGHT for you. You and your doctor have to discuss all of your risk factors as well as your health issues and THEN decide if the benefits of chemo out weigh the risks.

QuinnCat · April 2012

Stage 1 IDC 1.4 cm Grade 3 (8 out of 9) and Oncoscore 39. 0/1 SNB. BRCA2+. Doing chemo now. Dose Dense AC 4x, Dose Dense Taxol 4x.

wonderwoman123 · April 2012

Hi M4babies -

My oncotype score is 14. Totallly surprised me, i was expecting a much higher score being a Grade 3. Mixed feelings... from YES! so glad... to REALLY?? is this right?

I see my MO tomorrow and hear what he has to say. But for now, i suspect i will not be doing chemo, just the 7 weeks of radiation and the 5 weeks of whichever drug they choose for me.

Cheers,

Linda

peggy_j · April 2012

I'm sorry to hear you're going through this.

FWIW, when the pathology report from my biopsy showed that my tumor was about 0.8 cm and grade 2, all my docs said I may need chemo, in part, because I was so young (46). By some miracle, my tumor ended up being smaller and grade 1, so no chemo. (the grade was a big reason). I've since read studies that showed that women under 50 benefit most from chemo. As others have said the oncotype can give more info. Maybe you'd want a second opinion too???

rn4babies · April 2012

wonderwoman.......Let me know what your MO says. I'm guessing that since you are a stage II more than likely chemo will be recommended.

peggy........I have an appointment with my MO on the 26th and already scheduled an appt for a second opinion on May 1st at a large teaching facility. I just hope my Oncotype is back by then.

peggy_j · April 2012

rn4babies, good luck with your appts. Your choice of second opion MO sounds great. Fingers crossed that the onco score is back soon. I found the waiting period to discuss chemo to be particularly stressful. Hope you're able to do something nice for yourself each day.

carolinames · April 2012

I am Grade 3 and my oncoscore was 23.

kira1234 · April 2012

I was a grade 1 and the score was 24.

Anonymous · April 2012

I was grade 3 according to the biopsy...then surgery pathology changed it to grade 2. I was "young" (almost 44) , tumor 1.4cm, high Ki67, no nodes. My Onc was on the fence for chemo and waiting on the oncotype to help decide.

My oncotype score ended up being at the higher end of low...but it was low! ...so no chemo.

Also...my tumor was VERY high ER+/PR+...so we both felt hormonal therapy would be my best weapon.

Sounds like you might want to get a second opinion if you are unsure.

lintrollerderby · April 2012

Hi. I was 34, Grade 3 (9 out of 9), Stage Ic, 1.3cm tumor, no nodes, and I don't know my oncotype score. Because of my age and the TN status, chemo was a given. I did TCx4.

wonderwoman123 · April 2012

m4babies - thanks for reply

Had my MO appointment today. He brought in another oncologist to talk to me also. They explained it this way in regards to my low Oncotype score (14) and my high Grade III.

They said if i was diagnosed some years ago, before Oncotype, i would be a definate yes for chemo because of the Grade III. But that since we have that answer, it is a much more difficult decision. They suggested i look at it like this. Oncotype alone says no chemo, although i am close to the line for intermediate, and studies are starting to open up those margins and suggesting chemo to people a bit to the left lowering that intermediate number from 18.

They said what that tells me is that the oncotype score suggests my genetics of the cell are not as likely to recur. I was given a 9% chance of recurrence and with chemo that would only go down to maybe 7, more likely 8.

The Grade III is the confusing part. And now that i am out of his office of course i am wondering a few things. If the Grade III is aggressive, what if some cells are moving already? What if they are heading for my nodes and down in to my system now before radiation? Then i have a Grade III aggressive cell with the potential to land and form another tumor. I realize that the 5 years of being on whichever hormonal suppressant drug, will make my body not so conducive to the cancer growing since i am a high ER + PR+ person. But at the end of the 5 years, i guess that would be a concern.

Both oncologists said it is my decision. They did not lean towards chemo. They did say it is alot to just get 1 or 2 more %. They also said, they would NOT give me the heavy duty stuff. Likely TC X 4.

I have a large cancer history in my family. One aunt with breast cancer. Many other aunts with a variety of cancer. Also my youngest son had leukemia twice.Age 4 and age 11. So i know a bit about %'s. IN fact he had an 85% chance of it NOT coming back after the first time, and it did. The 2nd time his chances went down to like 25 or 30% that it would NOT come back- and it didn't and he is now 29 years old. So i don't hold too much weight on the % side of things.

Not really sure what to do. If anyone has anything to share, i would love to hear from you.

I am 57, node negative. I had 2 tumors IDC was 2.8 cm; and Insitu - 1.8 cm. ER PR +, HER- ; Grade III. Oncotype score of 14; 2 lumpectomies, 1st one didn't get the margins, 2nd surgery they took a swack of tissue, good margins now. First appointment with radiology oncologist is Thursday to prep for 7 weeks . Decision needs to be made before that, since chemo would go first. I am flip flopping hourly. But that is my nature. I really think things through, consider everything - then make a decision and don't look back - no matter what i am deciding on. Although i must say this is probably one of the toughest decisions to date!

Thanks everyone, sorry that was a bit wordy.

Linda

mmm5 · April 2012

Linda

Does your path report indicate vascular invasion or not?

Your tumors are not super small and given that what is the ki67 score (which indicated how on the move the tumor is) I would look at both of those things before I decided but with grade 3 I personally would lean towards chemo.

allurbaddayswillend · May 2012

I've been recommended for chemo at Stage 1, Grade 3. Docetaxel & Cytoxan Once every three weeks, 4x.

My Oncotype DX results aren't back yet but my MO expects them to be high since I'm already Grade 3. We shall see...

bluepearl · May 2012

Check the mitotic score and the Ki67. If the first is more than 1 and the last is greater than 10%, probably chemo will be recommeded. Any lymph-vasular invasion? Small doesn't necessarily equate with ability to spread; the cancer's aggressiveness does. Some women have had tiny tumors with positive nodes. With a grade 3, I think your onco score will come back needing chemo but be assured that the more aggressive cancers take the biggest hit from chemo! Grade 1 and all your other prognositic factors suggest you should do well in the future!

jude14 · June 2012

I was a grade 3 and onco score of 18. I did not do chemo. Lumpectomy with rads and on AIs for five years which will be up end of this year. Was 58 at the time

LtotheK · June 2012

One can't always assume with Oncotype. My grade 3 was a 12, which was a surprise after my doctor told me to expect a high score. Both of the older women who had grade 1 tumors in my chemo group had high Oncotype scores. I wouldn't rely on grade alone. I chose to do chemo due to my age, and many oncologists suggest chemo with a grade 3 regardless. For me, had it been under 10, I would have said no to chemo. But at 39 with LVI on first biopsy (none at final), it seemed a good plan.

rn4babies · June 2012

My Oncotype was 27. I just completed my second round of T/C.

allurbaddayswillend · June 2012

I finally got my Oncotype back. It was 30. Frown

poop. So now because of that and my body's seeming reaction to everything (! allergies and intolerances and side effects and complications !) My MO is recommending the 6 month AC+T chemo. But yep, Stage 1 Grade 3, 47 years old.

Has anyone been recommended chemo for Stage 1, Grade 3?

Comments

Categories