Are most of us with Grade 3 Tumors?

[julierene]

I have read that Grade 3 tumors, while more aggressive, respond better to chemotherapy. This is what I was told 2 years ago when I was dx with no lymph nodes positive and why I took chemotherapy. Are most of the HER2 group in that category of Grade 3? THANKS!

[Barbara]

Julierene:

I wish I knew if what you were told was correct. I have been told that a majority of cancers are grade 3. I too was grade 3.

Barbara

[Unregistered]

Are you talking about SBR grade or histologic grade?

[Tracy]

I am grade 3 as well. My surgeon and my onc both said more aggressive tumors respond best to chemo.

[julierene]

Grade 3 Histology

I'm stage 4 now. But at stage 2a, you would think that chemo would have worked. Now that I am on chemo again, I'm worried it's not going to work.

[Alice]

I am also grade 3. There is a range within each grade. I think it goes 1,2,3 is grade 1. 4,5,6 is grade 2. And 7,8,9 is grade 3. I don't remember where I saw it broken down this way if I find it i'll post it.
Anyway if you are a grade 3 you could be anywere from a 7 to a 9, 9 being most aggressive. i was ranked a 9. My onc also said the more agressive tumors respond more to chemo due to the fact that most chemos attack cells that divide fast. This does not mean however that anyones tumor that is grade 3 will respond.
Simply put she said the good news is that I had a cancer that would qualify me for a study and the bad news is that I had a cancer that would qualify me for a study. It's a double edged sword.

[Unregistered.]

This is a question of classification of tumors which reflects how the knowledge regarding cancer has progressed and yet how the majority of dcotors still use our old classification systems originated at a time when we had much more limited knowledge(based on the ability to examine things under the microscope but an inability to know what genes or gene products might cause any particular tumor type to act the way it does).

The old classification system(still in use) was based on microscopic appearance of the tissues. They were graded 1,2, or 3 based on how undifferentiated (abnormal, out-of-control) looking the cells looked under the microscope. This had to do with abnormal and varying size of cells, abnormal appearances of nucleii of cells, how many cell divisions were seen, etc.

A recent paper claims there are no Grade II infiltrating ductal tumors and these should be reclassified using more recent means of classification. So even if some members answer that their tumor was Stage II it might today be re-classified as Stage III.

The most recent classification (not yet in wide clinical use and not expected to be for at least 5 years) is based on multigene arrays(usually done on Affymetrix chips). Tumors are classified into Luminal, Normal, Basal and her2 groups--the her2 group being ER-PR-. Those with her2+ER+PR+ do not yet have a group to fully explain them and they may be about half of her2+ tumors!

Oncologist say that higher grade tumors are more amenable to chemo because they have more rapidly dividing cells (although Ki67 is a much better measure of that I understand) and chemo works by (hopefully) affecting rapidly dividing cells more than normal less rapidly dividing cells.

There seems to be a population of dormant, slowly dividing cells which hides out in the bone marrow especially which researchers call "stem cells"
These tend to be resistant to chemotherapy as they only divide once in a blue moon.


These are like mildew in that they can sit there in small amounts quietly causing no problem, but under the right circumstances (like humidity for mildew) start to divide quickly. Just like mildew they are hard to kill because they only reproduce very infrequently.

Chemo also tends to work best in ER-PR- tumors, but as more and more is learned about breast cancer, it seems they will find that there are subset which do or do not respond to chemo vs therapy x vs therapy y. It was serendipity that they continued to test Herceptin whent initial results were not promising because they were trying to treat too many patients with something which only a few would respond to. Luckily a test was available to work out which subset was the one which was likely to respond.

Hopefully they will in the next few years sort out which genes make which tumor respond to which therapies and treat only those people who need it with only those treatments which are likely to work.

Volunteering for a neoadjuvant chemo clinical trial helps that day come closer, because by serially testing with biopsies and MRIs or other imagine during the course of treatment they can correlate what characteristics each tumor has and which characteristics predicted response to which treatment.
Unfortunately the way clinical trials work is that they have to give the old approved treatment PLUS the new one, making it hard to figure out if it was necessary or if there are better treatments.

If your reason for raising this question is because you still have lingering doubts as to whether you really needed chemo and if it indeed will do what you wanted it to, there are tests available and in the works to help you know that, even if it is now water under the bridge. The OncoDX test is a general test which puts you in one of three categories--low, medium and high risk if your tumor was Stage I and your lymph nodes were negative. There is a 70 gene test in the works in Holland (not clinically available) and
Robin P has pointed out a company called Therapeutic Molecular Diagnostics which can go back, sample your tumor sample embedded in paraffin and look at various markers such as Ki67 (which reflects the speed with which your tumor was growing), topoisomerase II (which Dr. Slamon says reflects whether anthracyclines like doxirubicin are needed besides a taxane to be effective) as well as many others, the implications of which they are not yet sure of.

Will get off the soapbox--again I raise the topic for discussion: Would you rather know that they don't know for sure or be given a dogmatic answer that you later learn was wrong?

[julierene]

I wonder if those slow dividing stems cells were the reason my initial chemo failed. I have always wondered why that happened. I was practically Stage 1, with an ER-PR-, HER2+, 0 lymph nodes, 2cm, IDC. I think the only reason he put me at Stage 2a was because I was 28 and my mother had the same history. He wanted me to feel confident with being aggressive with my treatment. I also had DCIS that was widespread, and in both breasts. The DCIS in the other breast happened to be ER+/PR-. I never understood this. But to be even more aggressive we removed my ovaries, since treatment with Tamoxifen was pretty much unwarranted.

But now, I wonder if the chemo will even do it's job. I can say I feel much better than I did a month ago. My back isn't as bad, and I don't have nausea in the morning anymore.

Always trying to understand this confusing disease... Julie

[michele u]

i was also grade 3

[lisahammo]

Hi Julie

I too, was Stage 2a with Grade 3. I was ER+, HER2-, no nodal involvement, and my tumour was 3mm. I had a lumpectomy, followed by chemo & radiation. When I had my recurrence 8 months later, everyone was shocked, as they really thought I was in the clear. I was told that possibly the HER2 test should have shown up positive. I was also told that most older women (over 65) are Grade 1, everyone else Grade 2 or 3. Again, I was told that Grade 3 responded better to treatment.

Love Lisa

[juanita]

I was grade 3 as well. And I also had read somewhere that younger women not yet menopausal are usually grade 3 because the cancer has to be more aggressive to take hold.

[Susan]

Yes, grade 3 too. Just started herceptin 2 months ago. So far, so good. '

Sue

[chartermom02]

Yes, I also was Grade 3; 41 y.o.; pre-menopausal; Stage 1; ER+/PR+; Her 2+++; 2 cm; lumpectomy; A/C x 4; rads x 35; Tamoxifen, now Arimidex; no Herceptin back then; NED since surgery in October 2000; however, monitoring a new finding in opposite breast-biopsy was negative but will have another MRI in April.

Gloria

[Maggie]

I asked my oncologist what grade my cancer was as I had never seen or was told it. He said my kind of cancer isn't graded and perhaps only 15% have it. It's Infiltrating Medullary Carsinoma. I.2 cent. ER/PR neg HER/2 3+++ strong, no lymph nodes involved. I was Tested by IHC and had to be tested by FISH, too before I got Herceptin. They said they knew it would be.

I have never seen anyone write 3+++ strong before. Has anyone here?

I was treated aggressivly with A/C and 33 rads. Finished treatment 12/23/04.
Started Herceptin every three weeks the end of November. Doing well so far, too!

Maggie

[Becky]

On my initial pathology report, the pathologist could not make a call between Grade 2 or Grade 3 and said so on the report. I sent my slides to Sloan Kettering and Fox Chase and both of those cancer centers said it was Grade 2. Nottingham 6/9.


Becky

[sherri]

Mine was Grade 3 and 9/9.

[AlaskaAngel]

So I wonder how long it would take for us to each be reclassified by the new criteria and after that, how long it would be before it would actually change therapy for any of us...

Especially those who are NED, since treatment never changes for those who are NED until we recur.

The theory about dormant cells in the bone is interesting, given that there is evidence that even most patients with early stage bc are found to have micromets in the bone.

It seems logical to me that if it is true that even most early stage patients have micromets to the bone, the least they could do for any NED HER2+++ who is more than a year out would be to sample for bone micromets -- and if they find them, then they should make it standard practice to prescribe Herceptin so that our insurance will pay for it. (Does this seem like rocket science to anybody?)

To answer the question, I too was Grade 3 (SBR 8-9).

AlaskaAngel

[StephN]

It would seem that the answer to the initial question is "yes."

All my Pathology reports say that the tissue they examined is HIGH grade. This is from 2000, so I imagine would be called differently now.

I was postmeno, but the tumor was advancing through my nodes in breast and lower right axilla.

They also say: Mitotic rate - high (but no number)

The salient point in my consultations was that I was HIGH risk for recurrance, which warranted more aggressive than usual treatment from the outset. That did little to slow things down!

[Montana]

My IDC was Stage 1; grade 2 and SBR was 7/9. The DCIS was high grade with comedo necrosis. Her2+ of 3.6 on ICH and high KI-67. No nodes and .6 cm. Post-meno. I finished A/C x 4 and 33 rads treatment in June 05 and did not receive herceptin as onc said no nodes and only 9% chance of recur.
I'd like to be test for the bone micromets so I could quit thinking about recurrence all the time.

[RobinP]

Grade 3 too.

[DeborahNC]

2003 DCIS was comedo. 2005 IDC Stage 1, grade 2, HER+++, 6/9, neg node. Just finished 3 of rec 6 rounds Taxol, but am calling it quits due to horrible neuropathy. Doing 1 year Herceptin.

[Unregistered]

Hi,

Diagnosed 12./04 Stage IC, .9cm, IDC, no nodes, Her2+, ER/PR-, Grade III. Age 35.

Bilateral mastectomy, A/C and then Taxol dose dense, now on Herceptin every 3 weeks.

Cheers,

Olivia

[RhondaH]

I was grade 3.

Rhonda

[Barbara2]

I was grade 3, also.