Confused on Staging

Clinical staging is based on what's found in the biopsy and what the imaging looks like. What's found in the biopsy is incomplete information, because it's just a small sample of the cancerous tissue, and the findings may change once the surgical pathology is available. What the imaging looks like is at best an estimate - it's not unusual for tumors to end up being larger or smaller than they appear in imaging and nodal status often cannot accurately be assessed through imaging.

Pathological staging is based on combining what's found in the biopsy pathology and what's found in the surgical pathology, providing the actual tumor size and nodal status. Other diagnostic tests, such as CT scans and PET scans, may also be used to determine if mets are evident (which would automatically move the diagnosis to Stage IV, regardless of tumor size and nodal status).

Generally pathological staging is more accurate. In fact, clinical staging is not even assessed or given to the patient in most cases. Where clinical staging is relevant is in situations where the patient will be receiving treatments prior to surgery that might affect the size of the cancer, for example neoadjuvant chemo or hormone therapy.

Your question "which freaking stage am I" can't be answered without you providing information about your diagnosis and your treatment. Was there a difference between the estimate of the size of your tumor and the amount of nodal involvement prior to surgery versus what was found in the final pathology? That would explain the change between your clinical staging and pathological staging. Did you have chemo prior to surgery? If you didn't, then it's likely that the pathological stage is more relevant for you.

Is it going to come back? Is the question each and everyone of us face. The challenge is to move past the worry. Staging whilst important is no guarantee of being cancer free indefinayeno matter the stage. Try not to fret and good luck x

justme1964. I understand the anxiety. My staging is also wierd with 2 positive nodes. It is my understanding that there is new staging that incorporates hormone status. Which is why people with a large tumor and positive nodes have earlier stage with er positive her negative. My staging got better although my surgical pathology was worse than scans and biopsies. Makes no sense.I just don't pay attention to it. Staging also used to be based on node status. But they don't want to take nodes out anymore and mri doesn't see small macromets. So they really don't know. I had severe anxiety over this as my surgeon didn't explain properly. I wanted more nodes taken but instead will get radiation. I also had to get 3 opinions on chemo one from Sloan. Which Sloan do you go to? I am near Middletown but don't go there. I feel that was a mistake and hate my some of mydrs and hospital. I am eating whatever I want right now, doing chemo, including a lot of sweets. I heard cancer does not feed off of sugar that is a myth. That your body will make sugar if you don’t eat it. Lol. Alcohol I’m not sure about. Drank a lot in my younger years. Not so much now. I wonder if that was a cause.

justme1964, sounds like you are close to me. I grew up in Middletown and live in Jackson now. Where are you? What hospital did you go to first? I go to the one in Neptune, and hate it. I did have a second opinion with Bromberg in Sloan Middletown and loved her, but stuck with my MO as I thought I liked him too. But I got passed off to rude staff and never see him. Did you do radiation in Middletown? I am supposed to do it in Neptune when chemo is over, and I really do like my RO so far, just hope it doesn't go downhill like the surgery and the chemo. I still have to have reconstruction surgery, as I had a failed TE due to infection. So that keeps me from Sloan also, as I don't want to go in the city. My PS is in Shrewsbury. But due to radiation my plan has changed from implants to DIEP, and I have 6 months to gain weight, so I plan on eating a lot of ice cream, lol. Yes stop reading the sad stories. Focus on the technical information and positive stories. I find myself there too sometimes, but mostly avoid them. I find comfort in knowledge and hate the Drs. that tell me not to google. If you are not comfortable posting private details, you can private message me.

Ladies,

Let me give you some perspective on what “caused" your bc. The answer? We don't really know. Currently known genetic mutations are only responsible for a small portion of bc cases. Although everyone should eat a healthy diet, maintain a healthy weight etc., eating sweets or drinking alcohol (in modest portions) is not going to cause cancer and should never be the reason for self induced blame or guilt. Again, I'm not talking about a diet centered around cake and margaritas, but occasional treats are not to blame for cancer.

Someone once posted that they felt very guilty about eating 10 potato chips. Really? I think the guilt and self flagellation are far worse than 10 potato chips or a piece of cake . I understand that you want to find a way to not recur or become metastatic, but you also want to live life with joy. There is no guaranteed way to prevent recurrence. Unfortunate but true. Do the best you can to find a balance between self care and joy.

I am 8 1/2 out from a stage IV dx. I've been fortunate enough to have had no progression since initial tx. If I want a drink, I have one. If I see a delicious, well made pastry, I eat it. I just don't do these things everyday. If I am going to live with bc, I going to live life with joy, not deprivation. Joy makes me happy and happiness contributes to my overall well being. I was not cut out for the controlled lifestyle existence filled with lots of forbidden indulgences.

You did not cause your cancer and living on a very restricted diet or beating yourself up over a treat will not guarantee that you won't recur. Do the best you can and be very kind to yourself.

justme64, thanks for the info. I've talked to a few NJ people in north and south jersey. You're the closest to me, about 45 minutes. My son and I go to the Princeton Escape Room, because we did all the rooms in Freehold, lol. I understand your anxiety, especially with ILC, they keep saying it comes back later, 15, 20 years later. I feel like the endocrine therapy may just put it off and it may lie dormant. But I'm pushing to do everything I can and be aggressive, and at some point we'll keep busy living our lives and try not to think about it. The first two months I didn't get out of bed, just read and read on my phone, thinking I was going to die. But I got over that hump and started acting like me, starting fixing my house and redoing my daughters room. I realized I was really happy to be home from work and will milk it for as long as possible. Just keep busy. Did you have surgery in Princeton? Are you on hormone pills? What kind of chemo did you do? You don't have any info under your name. If you added it, it may not be designated public. I keep worrying, maybe I should have done TC. I didn't do enough. If I'm going through the torture anyway, lost most of my hair, but not all, feel sick for a few days to a week each cycle. Sloan recommended CMF, and the other Dr. said no chemo, so we went with Sloans plan. They said less permanent side effects. It does appear to be more tolerable than other chemos. I think it's the Nuelasta that is getting me. You can private message someone by going to the menu. There is a row for Private messages.