Topic: Two Things I Always Wondered About

I had two invasive tumors - my onc said that treatment decisions are normally based on the larger tumor.   My research indicated that outcomes for multicentric cancers are the same as for unicentric cancer and aggregating the tumor size to determine treatment is not warrented;  however, I insisted on oncotype tests for both of my tumors.  The smaller one had a high oncotype score than the larger one.  Luckily, both scores were low enough that I felt comfortable with no chemo.

Regarding the change in grade, I wonder if a tumor could have areas with different grades.   If it was critical for a decision treatment, I would  get the slides re-read. 

Hi PureE,  I had 2 tumors.  One was 2.1 and the other 2.4.  My medical team spent some time discussing if they were connected.  Some felt they were connected like a barbell and that this would be more positive.  Others felt they were not connected and it did not matter either way.  I'm not sure if it truly makes a difference.  The more important factor is if it responds to chemo.  As for the grade, mine was a grade 3 while pregnant and the lymph nodes were grade 2 (taken out post delivery.  My onc stated that when pregnant the hormones make it grow faster and are staged as more aggressive.  The good thing is that yours is out.  When are you due?

My onc said the same as yours that the pregnancy will not affect the outcome.  I had my daughter 3 weeks early due to cancer.  She was 6lb 9oz and is growing like a weed.  Its hard to say why your results are so different.  Grading is not exactly precise and one could see it as a grade 1 and another a grade 2, but to be 1 to 3 seems like something is off.  Maybe your tumor had more than one type of cells. But I am just speculating.  One thing to think about is that cells respond better to chemo if they are grade 3.  They die when they try to duplicate.  Your tumor burden is out.  If any cells got out and are grade 3, they should be eradicated by chemo.

The radiologist who biopsied my 4.8 tumor said it was DCIS. The surgeon said she thought that it might be different and asked for a surgical biopsy (in office.) That came back STage lll.  That makes me think that different parts of the tumor may have different grades??? I will ask next time I see the surgeon.

My tumor was a grade 2 with the biopsy and a grade 3 for the full pathology.  My son in law is a urologist  and he said a lot of tumors come back a different grade than the biopsy and usually higher so he was not surprised by the upgrade.  I think like other opinions listed above that in looking at the whole picture the worst area is the grade, but that is just my opinion, have not been told that.   I was shocked, I guess I thought it was written in stone and would not change.  My ki-67  and the percentages on the PR and ER were different as well.  The biopsy and the  pathology on the whole tumor  were done at different hospitals and by different pathologists.