Grade changing from 2 to 3. How can that happen?

mine came back as grade 2, but my MO kept saying grade 2 and 3 because she was pretty sure there was probably some grade 3 in there too. Also, there are lots of women that post here with stage 3, grade 3 tumors that are many years down the road and doing fine.

Tumors are not always homogenous, or the same throughout, so that could explain why the small amount taken during biopsy was a grade 2 but when they tested the whole tumor there were areas of grade 3. Grade means how fast the cancer cells are dividing. I don't think the difference between a grade 2 or a grade 3 tumor is going to change your treatment plan and should really not be a big worry to you. Are they doing an oncotype test to determine the benefit of chemotherapy?

Surgery, radiation, hormone therapy, and chemotherapy treatments all serve a different purpose. For the most part, you can't do one to skip another. The exception is for node negative, small tumors not close to the chest wall. In that situation, a mastectomy can be done and radiation can be skipped.

Surgery and radiation prevent local recurrence of cancer. For many node negatives, surgery alone removes all the cancer in the body, however there is no way to know for sure. Radiation is done to kill any stray cells left in your breast only. The purpose of radiation and lumpectomy is to save the breast, but if cancer cells have already escaped the breast, radiation will not kill them. In other words, radiation will not save your life.

Unfortunately, even if you are early stage/node negative, cancer cells may have escaped the breast and be circulating through your system. At this time these cells may be too small to be found on imaging or scans, so one knows if they are there or not. Radiation WILL NOT kill these cells. That's why you will be offered hormone therapy, to remove the fuel that will allow these escaped cells to grow,

Hormone therapy and chemo are systemic therapies that can prevent a distant recurrence in your bone, brain, liver or lungs (organs bc is likely to spread to). In general, grade 3 tumors respond better to chemo than slower growing grade 1 tumors. Hormone therapy is often the first line of treatment for grade 1 ER+ tumors. If you want to better understand the effectiveness of hormone therapy, read through the stage IV threads and see how many have remained stable or NED (no evidence of disease) for years on hormone therapy alone. Its a powerful little pill. Don't let Dr. Google scare you. Many tolerate it very well.

Good luck to you.

Amy -- I didn't have your exact experience, but found a couple of times with surgeons/oncologists that they had missed something in the report -- I'm not sure either time it would have made an issue with my treatment decisions, but it did confirm to me that I wanted to get a copy of every report and read it. I have a big green binder with tabs -- and all of my reports are in there. It probably also provided me with some sense of control, when I felt I had none. In any case, that would be my advice to you -- get copies of all your reports.

Re: second opinions -- I'm a fan -- had my slides read by two pathologists and saw two medical oncologists -- definitely gave me peace of mind when they agreed.

Also -- personally I found the diagnosis process to be a bit of a roller coaster -- I kept thinking I just needed one more piece of information and then my treatment plan would be set and we could get this show on the road. Unfortunately for me, it didn't turn out that way -- there were many twists in the road. I just say that because, it might have been easier to get through if I had recognized that earlier -- might have been less stressful -- who knows.

Take care and hang in there.

Ridley

PS -- I had a lumpectomy originally and then ended up with mastectomies (one of the twists) , which you could still do -- might be able to avoid radiation that way.

Grade 3 confirms malignancy . Only after the removal of tumour they do biopsy which will let us know the stage of cancer and if it is triple negative or triple positive or double negative and HER2 positive.

You asked if anyone went for a second opinion.

I went for a second opinion and I am so much happier with the Medical Oncologist that I have now than the first MO who I visited. I am SO LUCKY that my current MO is my doctor. I also went to more than one Radiologic Oncologist before I decided where to have my radiation treatment.  I know that the radiologic oncologist who ended up treating me definitely did the job correctly and I am SO THANKFUL that I chose him.   

However, if you go for a second opinion, be prepared for different views, different options, and different choices.  It is very confusing especially happening at a stressful time in your life. Every doctor may have a different outlook.  It is hard to know who is correct.  When faced with entirely different paths of treatment, you must really trust your doctors as well as your own intuition.

I chose lumpectomy and radiation plus hormone therapy because that is what my current doctor team recommended.  If I went with the other MO/RO, I would have had a double mastectomy, chemo, and a different course of radiation treatments as well as hormone therapy.  (I would have had the same dose of radiation either way.  I had higher dose radiation for less weeks rather than lower dose radiation for more weeks.)

That being said, EVERYONE recommended hormone therapy because of my ER+/PR+ and HER2- status.  You have to do what is right for you but please consider the possibility of hormone therapy.  Hormone therapy is different than chemotherapy.  Hormone therapy is Tamoxifen or an Aromatase Inhibitor.  You may not have side effects.  Even if you do have side effects, there are other hormone therapy medications which may work better for you. 

I agree with what everyone else in this thread stated so I will not repeat what they said.

I did not have a change in grade. I only learned the grade after my surgery when I received my pathology report.  However, my large lump was biopsied and I was told that it was benign.  That was the second time that lump had been biopsied.  Both times, the pathology report stated that the lump was benign although the name of the benign finding changed from the first biopsy to the second biopsy a few years later.  However, after my lumpectomies, the pathology report stated that the "benign" lump had Invasive tubular carcinoma and pleomorphic LCIS all over the lump, in addition to many benign findings.  This is because the diagnosis is based on which cells in the lump that the biopsy removed and tested.  That is the reason why your grade changed from 2 to 3, and my lump changed from benign to malignant.  It is not an incorrect diagnosis.  It is just that the lumpectomy is more reliable than the biopsy.  Your lump must have had both grade 2 and grade 3 cells in it.  However, you must trust your doctor to read the pathology report correctly.  If you don't trust your doctor, then change doctors.

Good luck.  I will send you positive thoughts and wishes.