HER2 Support Group Forums - View Single Post - Any one else a Stage 1 AND Grade 1 Her2++++?

Lani · 01-31-2009, 12:47 AM

I think the others are referring to being both grade I AND stage I. Stage I refers to the size , grade I to the appearance under the microscope, particularly the degree of differentiation of the cells. I can't quote you numbers right off the bat, but in the papers I read grade I is rare in her2 amplified breast cancer, but not impossible.

Stage I however is not THAT rare in her2s (probably just means it was caught earlier by mammogram, etc before it got to a larger size) According to the latest paper given at this year's San Antonio conference, the additional agressiveness conferred on a 1 cm or less tumor by being her2 amplified warrants treatment with herceptin because of the worse 5 year survival figures associated with her2 positivity, even in those tumors less than 1 cm. None of you specified the exact size of your stage I tumors-- Stage is usually listed as 1a, 1b, 1c etc so it is unclear whether your tumors fell into that <1 cm group. Over 1 cm the advantage of herceptin treatment was even more obvious.

It appears they haven't yet determined whether size/grade or biologic behavior determined by which pathways are activated are the predominant factor driving prognosis. Usually grades end up to be correlated with the predominant pathway eg her2 and often size as well (the more aggressive the tumor the more likely it will larger and more extensive when discovered , but again, mammography may be allowing more of these lesions to be caught earlier so they need not be larger. Also the lesions tend to be of a higher stage ie larger on average for more agressive tumors such as her2 + ones, but that is on average and doesn't hold for any one person's tumor.

If I find a paper covering this particular issue I will try to post it, but few her2 amplified tumors are grade I so I might be looking for quite a while.

By the way, did you think of get a second pathologic opinion regarding the grade? You can do so by having your slides submitted to another facility's pathology department and from what I have seen,charges are usually relatively reasonable, especially if it is unnecessary to repeat the FISH testing or do any additional immunohistochemical testing.

MD Anderson, Mayo Clinic and Stanford offer the service and I would suspect Memorial Sloane Kettering, Dana Farber and Johns Hopkins would as well.

Hope some of this helped.

01-31-2009, 12:47 AM	#5
Lani Senior Member Join Date: Mar 2006 Posts: 4,778	Suzan I think the others are referring to being both grade I AND stage I. Stage I refers to the size , grade I to the appearance under the microscope, particularly the degree of differentiation of the cells. I can't quote you numbers right off the bat, but in the papers I read grade I is rare in her2 amplified breast cancer, but not impossible. Stage I however is not THAT rare in her2s (probably just means it was caught earlier by mammogram, etc before it got to a larger size) According to the latest paper given at this year's San Antonio conference, the additional agressiveness conferred on a 1 cm or less tumor by being her2 amplified warrants treatment with herceptin because of the worse 5 year survival figures associated with her2 positivity, even in those tumors less than 1 cm. None of you specified the exact size of your stage I tumors-- Stage is usually listed as 1a, 1b, 1c etc so it is unclear whether your tumors fell into that <1 cm group. Over 1 cm the advantage of herceptin treatment was even more obvious. It appears they haven't yet determined whether size/grade or biologic behavior determined by which pathways are activated are the predominant factor driving prognosis. Usually grades end up to be correlated with the predominant pathway eg her2 and often size as well (the more aggressive the tumor the more likely it will larger and more extensive when discovered , but again, mammography may be allowing more of these lesions to be caught earlier so they need not be larger. Also the lesions tend to be of a higher stage ie larger on average for more agressive tumors such as her2 + ones, but that is on average and doesn't hold for any one person's tumor. If I find a paper covering this particular issue I will try to post it, but few her2 amplified tumors are grade I so I might be looking for quite a while. By the way, did you think of get a second pathologic opinion regarding the grade? You can do so by having your slides submitted to another facility's pathology department and from what I have seen,charges are usually relatively reasonable, especially if it is unnecessary to repeat the FISH testing or do any additional immunohistochemical testing. MD Anderson, Mayo Clinic and Stanford offer the service and I would suspect Memorial Sloane Kettering, Dana Farber and Johns Hopkins would as well. Hope some of this helped.