I Hate Being Graded Without Knowing the Criterea

So, I did some research. I'm that kind of gal.

I want to know EXACTLY why I was told by the first oncologist I saw that I need chemotherapy. I didn't grow up to mearly nod my head at everything the nice doctor told me. (If I had, then I would probably be at least 300lbs., not ovulating, really bad acne, and probably a type II diabetic by now. I had to see 5 different doctors, have 3 MRIs, 1 CAT scan, and 1 really gross 24-hour urine collection to determine that I have PCOS. But I'm damn glad I did. My reason for this gladness is now "helping" brush our very disguntled cat with syrup-sticky hands.)

No, I grew up in a house where you questioned authority. (As long as it was some non-parental authority. Questioning that got you grounded/sentanced to rake leaves or steam carpets.)

Here is rubric I've been able to garner on why chemotherapy might be or might not be appropriate for me:

1. I have Stage I breast cancer, mostly DCIS, with a small invasive component. Small enough that the preliminary pathology report from my mastectomy surgery could not see it with the naked eye or under the first microscope. I'm still waiting for the final pathology results from surgery. This will include my Bloom or Nottingham score.

2. Here is what the American Cancer Society says about how oncologists evaluate your need for chemo.

Adjuvant systemic therapy: Most doctors will discuss the pros and cons of adjuvant hormone therapy (either tamoxifen or an aromatase inhibitor) with all women who have a hormone receptor–positive (estrogen or progesterone) breast cancer, no matter how small the tumor. Women with tumors larger than 0.5 cm (about 1/4 inch) across may be more likely to benefit from it.


If the tumor is smaller than 1 cm (about 1/2 inch) across, adjuvant chemotherapy is not usually offered. Some doctors may suggest it if a cancer smaller than 1 cm has any unfavorable features (such as being high-grade, estrogen receptor–negative, HER2-positive, or having a high score on one of the gene panels). Adjuvant chemotherapy is usually recommended for larger tumors.


For HER2-positive cancers larger than 1 cm across, adjuvant trastuzumab (Herceptin) is usually recommended as well.

I didn't have an invasive tumor larger than 1cm. If they can't find it yet, I'm wondering if that means it's smaller than .5 cm, too. (That's good!)

My cancer is estrogen receptor positive.(That's good!)

My cancer is also HER2-positive +3. Which means it was way overexpressed. (That's bad.)

My cancer was originally diagnosed as low to intermediate grade but the oncologist seems to think that the biospy report (which was all she had to make a diagnosis from since I saw her before I had the masectomy.) was incorrect due to some cells appearing to be more organized and thus able to replicate themselves in a more perfect fashion and quickly. (Remember high school biology? OK, now-remember mitosis? Like that. Only on speed.) This would make the invasive component high grade rather than low grade. (And, needless to say, that's bad. But we area still waiting for the final pathology results which should be in later this week.)

My cancer is not inherited. (I took the BRCA 1 and BRCA 2 genetic tests already.) Of the many things lurking in my gene pool, breast cancer isn't one of them.(That's good.)

Since I've been looking stuff up, I feel better. I hate walking into any situation blind, especially ones in which I'm supposed to have a coherent conversation about toxic chemicals that might be injected into my body...but maybe I'm just too picky.