Does the staging change often after surgery??? (Mastectomy)

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Juleseyes
Juleseyes Member Posts: 20
edited January 2019 in Waiting for Test Results

Hey everyone, my moms surgery was dec 18th as a mastectomy and we have had to wait until next Tuesday to find out final pathology. It's been gut wrenching for me. My entire Christmas break I've been obsessively researching and feeling like I'm in a fog. Her tumor was 2cm (as per biopsy) and a biopsy took an even tinier (micromestases?) from a swollen lymph. I would assume she's in an "earlier stage" although he didn't say but he did brush off my questioning of Mets and stage 4. How often does the stage change after surgery? Like do they open you up and take some lymph's and just suddenly find it everywhere?!! Mammos aren't that perfectly accurate I would think. But, doctors know what they're doing and know how to stage. He practically did a feel-test on her breasts and pretty much stated that she was earlier stage. Oh she's also ER+PR+ and HER2- (also grade 2, moderately differentiated, invasive ductal carcinoma...)

I mean, I would think if the surgeon and her doctor were worried about spread they'd have ordered tests by now. I know it might seem like I'm just looking for some reassurance but between dec 18 and now has just been torturous. My mother is my life.

I've also researched the heck out of cancer staging and treatment guidelines. It seems pretty standard to start with surgery (unless it's metastasized everywhere) but I've seen a few ladies on this site talk about starting with chemo if it's in any lymph's??? Can anyone shed some light on that? Sorry I know this is a lot of questions.

Here's the other weird thing regarding the size of her tumor: on her path report it says:

Clinically: they say a mass of approx 17mm x 16mm was seen. Biopsy: a 9mm tumor was found in the sample. Gross sample: 4 cores of tissue measuring 5.4 cm total length and 0.1cm diameter. What does this mean? Is the tumor 2 cm or 1 cm???

Also clinically the node was seen with an “eccentrically thickened cortex” of 5.3mm SA. Yet in the core biopsy it was 2mm found of carcinoma in that lymph node.


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  • Misha13
    Misha13 Member Posts: 240
    edited January 2019

    Juleseyes-I’ll do the best I can to answer what I know! Firstly, you’re a great daughter and your mom is lucky to have you!

    Yes staging can change after surgery, but it is unlikely that your mom will suddenly change stages dramatically. It sounds like she’s a stage I or maybe II because of the cancer in the lymph node. It also sounds like her tumor is small. You said the tumor was grade two, that’s good-it’s not a super aggressive cancer. Another reason to stage it I or II, but even if it was a grade 3 cancer, it is still small, so stage I or II.

    I had cancer in a lymph node at diagnosis and so I had chemo first before surgery. My lymph node had a lot of cancer, so that’s another reason why. The fact that your mom had surgery first is a good sign for a low stage. Even with my lymph node and 2cm tumor, I am stage II.

    After the pathology is returned, they will determine the next steps. Lymph node involvement usually means chemo. Before they start chemo, your mom will have an MRI and a Pet scan to look for metastasis, unless they’ve done that already before her surgery. It is doubtful that there is any metastasis!

    Enjoy the rest of your Christmas break, enjoy spending time with your mom and don’t let fear about what-ifs ruin another day. I hope I have been able to help a little!

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  • Salamandra
    Salamandra Member Posts: 1,444
    edited January 2019

    Waiting for results is so hard. Next Tuesday, do you mean the 8th? I hope it comes with lots of good news!

    If it says 9mm tumor, it sounds to me like that was the actual tumor size. But you may have to wait for final pathology to know for sure. In any case, under 1cm and under 2cm are both considered early stage, so it would not change her staging.

    Usually women get 'neoadjuvant' - meaning before surgery - chemo if the tumor is very large or if it has certain hormonal properties. I could be wrong but I think this is most likely for triple negative cancer, where ER, PR, and HER are all negative. For hormone positive cancer, especially as early as your mom's, there's a good chance she won't need chemo at all, and they need to take out the tumor and test it to check.

    Staging can definitely change after surgery but it can also stay the same. Mine stayed exactly the same - my surgeon made an accurate prediction. In some cases, staging can actually get better after surgery and more testing. For example, if someone has a large tumor (I think up to 5cm) but surgery shows clear lymph nodes and their oncotype score comes back 10 or lower, then under the new guidelines they would be stage Ia, even though before surgery a tumor that size would be at least stage II.

    Remember that staging is prognostic. It's predicting what may happen in the future. So even if staging goes up, it doesn't have any certainties. Similarly, even if it stays the same, it's no guarantee that your mom will be safe forever. This brush with mortality is hard for us to wrap our heads around. But it sounds like your mom is absolutely early stage. She isn't dying now. Eventually she will, we all do. Enjoy each other in the mean time!

    Hang in there!

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  • Juleseyes
    Juleseyes Member Posts: 20
    edited January 2019

    thank you, your words definitely do help. I guess it just breaks my heart that even a tiny tumor could have metastasized. How can such a tiny thing change the prognosis so dramatically?? Without symptoms they don’t seem too keen on scanning, I think they find it unnecessary in earlier stages and it could create false alarms. But..what if it’s tiny. And it’s just hiding out on the liver. How can anyone ever know early enough? Ihope there is a breath test one day to find all cancers early. No one deserves this.

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  • Juleseyes
    Juleseyes Member Posts: 20
    edited January 2019

    salamandra, thank you for your words as well. Yes, I think the wrapping of my mind around mortality in general is the strangest part. She’s likely already had the cancer for a year or two, yet suddenly now my world falls apart. And yet, she was always dying. I was always dying. You just assume in your 20s that your mom will be there to walk you down the aisle and be a grandma and it seems shocking for anything else to be true. Yet many people ensure losses so suddenly. Life isn’t fair in general. Hopefully the waiting is the worst part and there will be brighter days ahead

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