does size matter?

VAfiend · Guest

I'm talking size of the lump here (now, what did YOU think I meant? Smile

. My surgeon has told me, and I keep hearing elsewhere, that I need chemo because of the size of the lump (2 cm, per the mammogram), even though it at least appears from the sentinel lymph node biopsy that my nodes are clear (still awaiting the pathology report). But I've not received a good explanation as to why the size of the lump compels the chemo, other than "that's the standard of care" (a phrase I am coming to dislike already). Can anyone help me out here?

penelopez · Senior User Joined: 11 Oct 2004 Posts: 165

Hi,

This is my guess based on what I've read.

The larger the lump, the worse the prognosis is. VERY large lumps reduce the survival stats. I believe I once read that a 1 centimeter lump has about a billion cells. I would think that the more cells there are in a lump that the chances increase that some cells could break loose from the lump and travel elsewhere in the body. Also, a slow-growing tumor may have been there for a long time.

I think it is also based on studies that have been carried out. It used to be that chemo was recommended for the larger tumors and not the smaller ones, but the standard has changed because they've learned from these studies that there can be metasases with small tumors, too.

I read that they prefer to "over treat" people rather than "under treat" because they aren't completely sure who needs chemo and are afraid they might miss some people who might be helped by it. As a result, lots more people are getting chemo. Personally, I feel good about using all available "tools" out there as an insurance policy against the cancer recurring.

I'm sure Dr. Leo will elaborate.

Hugs,

Margie

Guest · Posted: Fri Nov 05, 2004 12:55 pm Post subject: Re: does size matter?

I am just joining. So I guess I will just jump in.
I had a similar experience. I was told that once the tumor gets to a certain size they automatically do chemotherpy.
There is a good treatment decision tool on the ACS site where you fill out your pathology and they tell you what your options are and what is best for you.
Since I was just under (by one milimeter) 2 CMs I thought I could get away with no chemo. But after I took that test I realized it was in my best interest to do the chemo. The doctors had already told me that but I was happy to find out on my own as well.
I believe if you go to ACS> Breast Cancer>Nex-cura Treatment Tool you will find it.
Regards,
Martha Anne

lvsysmte · Guest

I had DCIS. DCIS microinvasive, LCIS - seen as micro-calcifications, >5cm in size. ER/PR-, HER3+, Camedo, etc. I was told that I would need chemo for sure but then when I opted for a bilateral mastectomy and my nodes were negative I was told no chemo, no radiation. The risk benefit for using Herceptin did not make sense according to my oncologist. No chemo, no radiation .... but I still wait and wonder

leo · Owner Joined: 23 Sep 2004 Posts: 1574

Hello

Different sizes of the primary tumor change your cancer stage.

For breast cancer,
T (tumor size)
T1 is less than 2 cm
T2 between 2 and 5 cm
T3 more than 5 cm
T4 any size with direct extension to chest wall or skin

regards,
Leo
_________________
Leonardo F - Webmaster Cancer Forums
Disclaimer: this information is for informational purposes only. It is not medical advice.

wayover20 · Guest

I thought DCIS was NON invasive??

VAfiend · Guest

OK, so different sizes change your stage. But why does that make a difference re chemo or no chemo? At 2 cm, I might be I or might be II. I know others in both those stages who didn't have chemo. So, again, why? Is it, as penelopez indicates, because of the increased number of cells?

seeknpeace · Guest

DCIS can be invasive. Because of the "in situ" stat, it is stating that it is non invasive, but, there can be micro invasion in the duct.

My thing is that my dcis was 2.5 cm, comedo subtype with extensive necrosis, high nuc grade. Per the sentinel node, and removal of four nodes, they were all clean. My fear is the fact that I had to have mastectomies due to the diffuse spread of the cancer. The area that was biopsied was 2.5 cm, but, the other ones were not biospsied, so I have this fear that they were cancer of the same sort, and that they were related to a different node, which could have been hot.

I have asked Dr. Leo with no answer yet, and I have to see the onc regarding severe right shoulder, spine and arm pain. I am so afraid that this is a metastasis and if so, so afraid that it is the aggressive type and that I am going to have a bad prognosis.

Have any of you ever heard of anything like this?

MuttsMom · Guest

VA Friend,
Have you had a lumpectomy with clean margins or a mastectomy yet? My "tumor" was 2.5 cm, but when they did the mastectomy, there was still more tissue that surrounded the tumor that was cancerous, so my total "tumor" was 5.5 cm. The size of the actual lump doesn't mean that it ended there and very well could be in the tissue, which is included as the "lump"also. I've seen more and more ladies with small tumors getting 4 rounds of AC, which is 1/2 the chemo that someone like me with a 5.5 cm got. I had 6 rounds of 3 different chemos and then 33 rounds of radiation. Chemo sucks, but it's doable. I opted for a 2nd mastectomy because I was only 43 when dx and I had Lobular which is prone to mirror itself in the other breast. I can say though, had I not done that and I got cancer in the other breast, I would take chemo, no doubt about it. It's really the only chance we have unless you're er/pr+ and then there are drugs you can take daily in hopes of preventing the cancer from coming back.
A friend of mine was stage I, 1.2 cm tumor and had a mastectomy and 4 rounds of chemo. Even tiny tumors aren't any guarentee and she wanted to do everything possible to beat this disease.
Nancy

VAfiend · Guest

I'll find out Wednesday what the margins looked like from my lumpectomy. It was just that my dr was so insistent on chemo before seeing any of that that the size of the tumor based on the mammogram invoked chemo. I feel like a 5-year-old, asking "why", but all I keep hearing is variations of "because of the size". Does the size indicate a greater chance of spread? Is that what everyone is saying? Why would it be an indicator of possible spread, even with clean lymph nodes? Is it because of the number of cancer cells increasing the chance of them cutting loose? That makes sense, but if that's the case, why won't any medical professionals just SAY that? Or is it just a decision based on statistics? If that's the case, why won't any medical professionals just say THAT?

leo · Owner Joined: 23 Sep 2004 Posts: 1574

Hello

Let me explain a bit more about "staging"

I mentioned the T above, to complete the staging one has to evaluate for N (lymphnodes affectes) and M, the presence of metastasis. So a combination of the TNM makes the staging, and one looks up in the chart to know which stage the disease is at. Based on that, treatment is chosen. That is how we choose how to treat cancer. All trials are done in people with disease classified exactly the same way.

regards,
Leo
_________________
Leonardo F - Webmaster Cancer Forums
Disclaimer: this information is for informational purposes only. It is not medical advice.

Guest · Posted: Thu Nov 11, 2004 12:26 am Post subject: Re: does size matter?

My pathology report confirms that my lymph nodes are clear, and that there is no metastasis. The lump was indeed the size shown on the mammogram, 2cm. But the recommendation has been chemo since before the report, based entirely on the size shown on the mammo. And I still don't have an answer from a medical professional to my question -- why does that size compel chemo, particularly now that everything else shows clear?

leo · Owner Joined: 23 Sep 2004 Posts: 1574

Hello

Because as you are a stage IIA, and research has shown that the best treatment for stage IIA breast cancer includes chemotherapy.

regards,
Leo
_________________
Leonardo F - Webmaster Cancer Forums
Disclaimer: this information is for informational purposes only. It is not medical advice.

MuttsMom · Guest

Absolutely what Leo said. Even ladies with Stage I are getting chemo, just 4 rounds instead of 8. It's great that the cancer isn't in your lymph nodes and that they got clean margins, but this disease is tricky and sneaky. Chemo's intent is to get any cancer cells that are floating around and aren't clustered together yet for a tumor to be seen. There's no way to know, especially with you have just a lumpectomy, if there are any cancer cells in the breast tissue itself, that haven't clustered.
None of us wanted to go through chemo, but it's doable and it's the best chance we have in fighting this disease that shows no mercy.
Get the chemo started and that way it will be over quicker.
6 months out of your life taking chemo and the goal being for you to never have to deal with this disease again.......no brainer
Nancy

VAfiend · Guest

My new onc finally had the decency to explain why. Basically, it's a gamble that there are stray cells, that the chemo will get them, and that the chemo won't do more harm than good. But it's been aggravating trying to get any medical professional to say why, rather than just indicate that that's the recommended treatment. Hey, Vioxx was the recommended treatment for osteoarthritis, and look where that went! The medical profession is not a bunch of gods. We're the patients. The least we're entitled to is an explanation of the reasons for the treatment that's recommended. At least a little more than variations on "Doctor God knows best." And if it's guesswork--which, face it, this is--at least have the decency to tell us that!

I'm not being irrational here. My father's death certificate says "complications of cancer." The complication was that he contracted a severe infection after his second round of chemo. That was his proximate cause of death--not the cancer. Now, the cancer would have gotten him soon anyway. The chemo was his only chance and it didn't work out. But it tells me that there's more at risk with chemo than nausea and baldness. If someone's going to subject me to chemo without that being my only shot at survival, don't you think I deserve a good, non-dismissive reason why? Don't we all deserve that much?

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