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Stage 1, grade 1 and pre-menopausal

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Comments

  • Sharon648
    Sharon648 Member Posts: 3
    edited July 2012

    Shellikins

    I am glad you found a supportive men..When are you starting your chemo/look like in aug 2012.i found Mission Hope cancer center in santa Marie a great center..the staffs was so nice and very experience.It everything under one center..Since i live in Paso Robles i get my blood drawn a day before chemo and they fax it over to my Oncologist..one can get they blood draw at the center.Check out mission hope cancer center..Wish you the best..

     Sharon

  • Sherryc
    Sherryc Member Posts: 4,503
    edited July 2012

    Annice thanks so much.  I kinda thought I was in peri-menapause with my bloodwork but wanted to ask all the same.  Thanks again.

  • bcbarbie10
    bcbarbie10 Member Posts: 148
    edited July 2012

    My IHC was 3+, FISH is negative, then a repeat IHC in another center was 3+. i am now being treated as HER2+.

  • Annicemd
    Annicemd Member Posts: 292
    edited July 2012

    Hi bcbarbie if you look through previous pages of this thread you will find a summary by voracious reader about her2 testing difficulties. There seems to be quite a bit of variability between centres which is unsettling. You have gone for chemo and herceptin so you are being very proactive with treatment.

    BW

    AnniceMD

  • bcbarbie10
    bcbarbie10 Member Posts: 148
    edited August 2012

    Yes, annice, i take comfort both in giving it all i've got, and at the same time, knowing i might have a real great prognosis to start with. It's a gray area im in but better safe than sorry for me.

  • KBee
    KBee Member Posts: 6
    edited August 2012

    Hello, thank you for establishing this forum. I have learned so much from reading your posts and hope you don't mind my joining in with a question. I was recently diagnosed with BC (46 yrs and premenopausal). I had a lumpectomy 4 weeks ago- tumor was 1.8 cm, IDC, ER/ PR+/HER-, stage 1, grade 1. Initially, I was told by BS this would be followed by radiation and tamoxifen. When I went for a follow up visit to review the pathology report, it indicated suspected LVI and I learned the MO has ordered oncotype dx to review whether i would benefit from Chemo. Do you have any information regarding impact of LVI and benefits/ appropriateness of chemo? There seems to be conflicting studies. Thank you again.

  • bcbarbie10
    bcbarbie10 Member Posts: 148
    edited August 2012

    In the beginning when my bc was just between me and my SO, awaiting final histopathologic results, he told me anything above 1 cm would benefit from chemo. KBee, having it at 1.8 cm with suspected LVI should probably make you consider.

  • Annicemd
    Annicemd Member Posts: 292
    edited August 2012

    Hi KBee sorry you are her with us. LVI tends to be associated with slightly greater risk of recurrence. Stage 1 grade 1 has great stats so some oncs might vote against chemox for you, some may recommend it, it's a grey area. The oncotype DX should help with your decision. Good luck it's so hard at decision making stage!

    BW

    Annice

  • Belinda977
    Belinda977 Member Posts: 150
    edited August 2012

    Sorry, what is LVI?

  • jenn333
    jenn333 Member Posts: 23
    edited August 2012

    I was 2.1cm stage 1 (per my surgeon - she said the size difference between stage 1 and 2 in my case was marginal so she was staging me at stage 1), grade 1, no node involvement but some LVI found.  My MO (UCLA) didn't recommend chemo with my oncotype score of 14 (9% recurrence risk).  Second opinion MO agreed (also UCLA).  I asked about the LVI and she said it puts me at higher risk but not enough to justify chemo in my case.  I am comfortable with my decision to decline chemo.  Had radiation even though I had a UMX though (multi-focal, close margins, LVI).  On tamoxifen with no problems.  Oh, and today is the first anniversary of my diagnosis.  What a year!

  • Esmerelda
    Esmerelda Member Posts: 156
    edited August 2012

    AnniceMD, I just want to thank you again for responding to my metformin questions. I haven't been active on the boards lately - we just got a puppy and I've been feeling a little...blue, I guess. At any rate, I SO appreciate your and VR's informed responses.



    I'm meeting with my MO on the 21st and look forward to having the metformin conversation then. I also have an appointment at The Block Center in Chicago (one of the best integrative oncology center's in the country) on the 24th. I'm excited to see what they have to "add" to my tamoxifen treatment and will be sure to share if folks are interested.



    Jen333, our pathology is so close! I was 2cm, stage and grade 1, oncotype 15. No chemo. I am always encouraged to "meet"'other women with a similar diagnosis! It sounds like your MO gave some goo recommendations.



    Best to you ~

  • Annicemd
    Annicemd Member Posts: 292
    edited August 2012

    Belinda, LVI is lymphovascular invasion

  • Annicemd
    Annicemd Member Posts: 292
    edited August 2012

    Aw jenn333 congratulations on your one year anniversary! Here's to being a survivor!

    Annice

  • Annicemd
    Annicemd Member Posts: 292
    edited August 2012

    Esmerelda, please do feed back what your MOs and oncs say. It is always very interesting to hear the opinions of experts in different centres (esp the top ones!) and it helps us, in this community, to know if our own teams recommendations are similar to others and up to scratch!

  • KBee
    KBee Member Posts: 6
    edited August 2012

    Thank you all for responding to my question. Yes, it is difficult during the waiting stage. I'm sure like many of you have experienced, there has been a lot of waiting for information/test results since this all began. I've been in a "holding" stage the last two weeks with no medical appointments (waiting on oncotype results). In some way, It has been a nice break-I've been able to regain some concentration at work and at times I actually feel like myself again ( before BC). At the same time, I'm anxious to move forward with the treatment plan and make sure I make good decisions about. Is there a risk to waiting 7 to 8 weeks for radiation, if that's my next step?



    Jenn333 congratulations on your one year anniversary!

  • jenn333
    jenn333 Member Posts: 23
    edited August 2012

    KBee I didn't start radiation until mid November and I was diagnosed early August.  It took me a while to get in to see the MO I wanted after wasting time trying to find someone local (I was treated at UCLA and it's a HAUL from Orange County - I was fed up with the commute by the time I was done with surgery and didn't want to have to go up there for MO appointments).  The one MO I saw locally was a dud so I ended up making an appointment at UCLA after all but couldn't get in by that time until early November.  At least my surgeon ordered my Oncotype while we were waiting.  It wasn't until the first week in November that we confirmed chemo wouldn't benefit me and I started radiation the week after.  All of this is a longwinded way of saying you have time to weigh your options.  Take your time.  Hopefully your delay won't be anything like mine, though!

  • KBee
    KBee Member Posts: 6
    edited August 2012

    Thanks jenn333. I'm sorry you had to wait so long but glad you were able to see an MO you had confidence in. I'm tentatively scheduled to start radiation in two weeks which will be almost 8 weeks since my surgery. I worry that with LVI the cancer is still there. I have my MO appointment this week to review the oncotype results. Hopefully, the results are definitive one way or the other.

  • Belinda977
    Belinda977 Member Posts: 150
    edited August 2012

    Thanks for explaining Annicemd !

  • Sherryc
    Sherryc Member Posts: 4,503
    edited August 2012

    Kbee my tumor was 1.6 and my onco score was 23. In a very gray area and took me by suprise that it was so high.  But I ended up getting two opinions and both said they were comfortable with no chemo.  So I chose not to have chemo.

  • KBee
    KBee Member Posts: 6
    edited August 2012

    Thanks Sherryc and all! I received my Oncotype test results today. The score was 8 and distant recurrence score of 6%. I'm relieved it fell in the low range and no chemo; although I was preparing myself for all possible results. Does the 8 factor in tamoxifen? The MO said that with radiation the recurrence score would go down to 3? Or did she say half? I hope it's because this is still so new, but I struggle with remembering all the fine details of what was said during these appointments. Also, I recently stopped taking birth control due to strong ER+, so my memory may be impacted by the fluctuations?? Anyway, something to celebrate for today and on to RO appointment tomorrow.

  • Belinda977
    Belinda977 Member Posts: 150
    edited August 2012

    I believe your 6% number takes into account that you do take the tamoxifen.  Glad your number was low!

  • Sherryc
    Sherryc Member Posts: 4,503
    edited August 2012

    Kbee so glad your number was so low and yes the 6% does factor in you taking tamoxifen.

  • Annicemd
    Annicemd Member Posts: 292
    edited August 2012

    Kbee yay good onco result, same as one of mine! It does factor in 5 years of tamoxifen. But remember treatments are better now than they were when the onco studies accumulated these statistics so I believe our stats will be even better :)

  • KBee
    KBee Member Posts: 6
    edited August 2012

    Thank you Annicemd and Sherryc! It's so nice to have support here.

  • Belinda977
    Belinda977 Member Posts: 150
    edited August 2012

    I have been looking at many of the other boards here.   I feel like I won the lottery.  To be 45 and have Stage 1/Grade 1.....  plus this thing had been growing in me for a while.  I get terrified thinking about what the scenario might have been.  I hope the fear of it returning fades some after treatment is over.   The community of people here is AMAZING.

    Off to rad treatment number 10 ! 

  • voraciousreader
    voraciousreader Member Posts: 3,696
    edited August 2012

    I wish all the newbie sisters well with their active treatment and sincerely hope that this community and specifically this thread brings comfort to all that need it...

  • Annicemd
    Annicemd Member Posts: 292
    edited August 2012

    Belinda, what a lovely way of looking at it! We won the BC lottery! It's easy to be negative and think why me, I have led such a healthy life... but spinning that round it could be so much worse and you are right to think you are lucky.

    We all get something sometime and it is lucky in a way to get a diagnosis that has such great treatment and outcome.



    Best wishes to all the newbies here from me too! Happy healing thoughts...

  • KBee
    KBee Member Posts: 6
    edited August 2012

    I meant to thank you too, Belinda977. I love your thinking on how lucky we are! I hope your radiation treatments are going well- I begin mine on the 20th. I'm a little nervous but looking forward to putting this next step behind me. Even though I wished not to have this, I certainly have a lot to be thankful for! Thanks for all the positive thoughts :).

  • Belinda977
    Belinda977 Member Posts: 150
    edited August 2012

    KBee, the rads treatment is just starting to feel routine.  I still get a little anxious but it's over so quick that it doesn't last long.  We will get through this!

  • voraciousreader
    voraciousreader Member Posts: 3,696
    edited August 2012

    I came across this interesting abstract.  Sometimes sisters will have Grade 1 tumors but NOT low Oncotype DX scores.  Here is what some pathologists found....Very interesting.

    Mod Pathol. 2012 Apr;25(4):556-66. doi: 10.1038/modpathol.2011.194. Epub  2011 Dec 16.

    A mitotically active, cellular tumor stroma and/or inflammatory cells associated with tumor cells may contribute to intermediate or high Oncotype DX Recurrence Scores in low-grade invasive breast carcinomas.

    Acs G, Esposito NN, Kiluk J, Loftus L, Laronga C.

    Source

    Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, FL 33612, USA. geza.acs@moffitt.org

    Abstract

    Oncotype DX is an RT-PCR-based 21-gene assay validated to provide prognostic and predictive information in the form of a Recurrence Score in patients with estrogen receptor-positive, lymph node-negative breast cancer. Although the Recurrence Score was shown to correlate with several histopathological tumor features, there is a significant proportion of cases showing an apparent discrepancy between Recurrence Score and risk estimates based on the traditional clinicopathological tumor features. In this study, we tested whether a proliferating, cellular stroma and/or admixed inflammatory cells may result in an artificially increased Recurrence Score in low-grade invasive breast cancers. We analyzed the histopathological features in 141 low-grade invasive breast carcinomas, including 41 special type (tubular, cribriform and mucinous) carcinomas, with available Recurrence Score. The tumor stroma was evaluated for increased cellularity and presence of inflammatory cells. Double immunohistochemical stains for pancytokeratin and Ki-67 was performed to assess the cell proliferation in tumor vs stromal/inflammatory cells. The clinicopathological features of tumors with Recurrence Score <18 (low risk) were compared with those with Recurrence Score ≥18 (intermediate/high risk). Carcinomas associated with Recurrence Score ≥18 showed lower progesterone receptor immunoreactivity, increased stromal cellularity and presence of inflammatory cells associated with the tumor. Double immunohistochemical stains showed significantly increased proliferation in stromal/inflammatory cells compared with carcinoma cells in cases associated with Recurrence Score ≥18. A Ki-67-positive stromal/tumor cells ratio of >1 predicted Recurrence Score ≥18 with an area under the curve of 0.8967 on receiver operator curve analysis (P<0.0001). Our results suggest that the presence of increased stromal cellularity and/or associated inflammatory cells in low-grade invasive breast carcinomas may contribute to an apparently increased risk of recurrence according to Oncotype DX Recurrence Score. Careful assessment and correlation with histopathological features in such cases may help in determining the appropriate patient management.

    PMID:
    22173289
    [PubMed - indexed for MEDLINE]

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