Does a grade 3 tumor always mean IV chemo?

Hi djm!

There are pill forms of chemo, but they're not used for early stage breast cancer. Maybe, you're thinking of hormonal therapy, which is a daily pill and is used to address ER+ cancer. Did your doctor order an Ocotype test? That is often used to determine whether or not chemo will be beneficial to the patient.

You might want to get a second opinion re: chemo; the size of your cancer is fairly small. Do you have an affected lymph nodes? That might swing your doctors behind chemo. Best wishes to you!

You and I have very similar diagnosis... Small tumor, ER+ PR+ HER-, grade 3. I had BMX in April with tissue expander placement. I just finished my second of 4 rounds of chemo (1 every 3 weeks) and will follow with radiation and hormone therapy. I had 1 node affected so they are being overly aggressive as my tumor was just barely 1/2cm and already in the node, so an agressive little sucker!

Anyways, wanted to reach out and let you know if you have any questions just ask!!

-Keely

I will find out my oncotype score in about 1.5 hours at my oncologist appointment today. I DREAD chemo, radiation doesn't thrill me either, but chemo....that deflates me thinking of it. I am hoping my stage 1a, 1.7cm, grade 3, ER+/PR+, HER2- tumor can cooperate and score LOW. If it's close to the "maybe" midrange score level, I will do the chemo as much as I don't want to. I am 57 and want to live a few more decades...if this is my chance, I'll take it. I was bummed when the core biopsy resulted in a grade 2 and then the post lumpectomy pathology report upped it to a grade 3. I need a break here.

My 82 and 83 year old parents just moved in with my husband and I in March of this year. My mom has advanced gastric cancer (diagnosed in Dec. 2015). My dad is frail, they manage ok now since they no longer have to care for their own home and we do the cooking, cleaning, etc.. My mom was doing horribly after the radiation early this year and one round of chemo; when she moved in she needed quite a bit of care. She doing VERY well for now and is taking herceptin treatments as she is HER2 +.

The thought of her needing me if she has a set-back in the next few months makes me very anxious. I also work full time as an occupational health RN. My poor husband, our nephew, his sister's 46 year old son was diagnosed with ALS in February and is declining rapidly. We are heartbroken. WHY WHY WHY????? Between our nephew's ALS, my recent breast cancer diagnosis, my parents needs, selling their home for them, the depression my dad suffers from after losing his independence, and my mom's health....it's been a ROUGH YEAR!

djm71 - Whether or not it has spread to your lymph nodes will generally decide the issue of (IV) chemo. If one or more have been affected, they will probably recommend systematic treatment, ie chemo and hormonal treatment after chemo. If not and you have good margins with surgery, they will probably give you the option of hormone(pill) only.

I am so sorry you have to be here. Treatment is difficult enough without the added stress of your responsibilities.

If chemo is recommended for you, know that chemo is MOST effective on faster dividing grade 3 cancer cells. It is less effective on grade 1. So it adds one more weapon to your arsenal, if needed. Chemo for you would likely be only 3-4 months.

The 5-10 year pill will be the anti-hormone therapy, another great weapon. Many at stage 4 achieve NED (no evidence of disease) with just the anti-hormone drugs. You may read that some have a difficult time tolerating this therapy due to side effects, but many do just fine. You won't know till you try it.

Good luck to you.

Well, I was grade 3 but very low Oncotype, so grade isn't the determining factor anymore. The Oncotype counselors on the phone told me 30% of grade 3's have low Oncotype. Your estrogen score is medium, from the biopsy. Ki67% is high, and that is a concern, but the Oncotype has 5 measures of proliferation and ki67% is only one of them: it can be unreliable.

I am surprised the Oncotype was ordered after the biopsy. Usually it is done on the surgical samples.  This happened to me as well and I did not trust it, because the biopsy tests initially had me as Her2+ then another lab had me as negative.  I had all tests repeated after surgery but it took some advocacy on my part and it was hard to summon the energy. I will say-to reassure- that my Oncotype after surgery was identical to the one on the biopsy samples.

Oncotype testing sometimes indicates no chemo for a positive lymph node, but a higher estrogen sensitivity would probably be a key factor.

It is hard to wait to get all the info in but once surgery is over, you will know everything. I watched a lot of movies and then did mad research once I got the results. Until then distraction was best. It sounds like you have a lot of negative distractions with a lot of troubles and hoping you can find some pleasant and relaxing ones too. Good luck with surgery!