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Clinical vs Pathological Staging

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bjoangtx View Drop Down
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    Posted: Jul 10 2010 at 2:27pm
I never know where to post my questions but I figured here was as good as anywhere.
 
If you have neo adjuvant chemo which staging is considered the one you identify as what stage you have?
 
If you have positive nodes before chemo but not after are you node positive or negative? I know if you have cPR you have a good prognosis but if nodes respond and primary tumor is residual then what?
 
I guess it seems that even if nodes respond they where around for a while before they responded and there's no telling where they went, right?
 
Also how much does BRCA testing cost? If you have no known family hx but are basal cell type TNBC should you be tested? I have a dtr? I'm guessing she now has a family hx? Should she be tested?
 
And breast density how do you find out about that? Is it on the mamogram reports? I understand it's about density not size but I don't know how to determine.
 
I get so angry when the Dr's act like I shouldn't ask the questions or I won't understand the answer. So paternalistic.
 
Oh and does hazard ratio translate to some kind of percentage? I've honestly tried to understand it but I'm just not getting it.
 
Thanks, you all always seem to have information and you share it freely. I understand everyone doesn't want to know but it makes me feel more potent and less a victim to know and make my own decisions.
 
Thanks
 
Joan
St 2 Gr 3 2/5 nodes dx 8/9 age 56 Neoadj ACT @ x 6 @3wks bi mst. 12/09 Infect expander 12/31 remvd, replcd 1/27. 28 rads 4/10 Brkn rib 5/10 PET   6/10 NED Recon 9/17 & 12/10 Ki67 85% basal
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123Donna View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Jul 11 2010 at 1:42am
Hi Joan,

I don't think I can answer all your questions, but I'll try to answer some of them.

It is my understanding the stage is what you were when diagnosed.  If you had a positive node then it would be node positive.  However, with neoadjuvant chemo if you get cPR that is really a good thing, especially if the nodes were clean when you had surgery. 

BRCA testing costs over $3,000.  I think it was around $3,300 or $3,600 but my insurance paid for the test.  I had no family history of breast cancer and was able to get the test.   I think it's a good idea especially since you have a daughter.  Did your path report say you were basal?

I wasn't sure what you mean about breast density.  I was always told I had dense breast or fibrocystic. 

I don't understand the hazard ratio either so maybe someone can chime in and explain it for us.

I too hate it when doctors become paternalistic and don't want to answer our questions.  I'd probably look for a different doc if I was treated that way.  Just my opinion.  Fortunately my onc is very open to all of my questions.  I usually bring with me a list of questions or things I want to discuss.  She is always willing to review them and take the time answer.  One visit I didn't bring anything with me and she kept asking me if I had any questions or anything else to discuss. 

Donna
 


DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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bjoangtx View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote bjoangtx Quote  Post ReplyReply Direct Link To This Post Posted: Jul 11 2010 at 1:59am
Donna,

I was node positive at dx. After neo-adjutant I had partial remission. Node was gone but tumor was still there. My Dr says I'm basal and I checked the path report I'm egfr + and that lines up with everything I've read about determinants for basal.

As for the density, I just read some studies that stated that dense breasts have greater probability of recurrance. I've always had calcifications but noone ever mentioned density. I'm not sure how they determine it.

Also if you have a bi lateral mastectomy can you even have a local recurrance?

My initial dx was 1 year ago the 27th of this month. I was in the middle of chem before I understood what TNBC was. I read an article about it in the waiting room of my therapist. Talk about an exciting session.

I asked my oncologist about BRCA testing and he said if there was no family hx then there was no need to test. I don't know if the ibnsurance will pay for if I don't have a Dr behind it. The thought of going out to find a new Dr wears me out. Especially since I don't have to see anybody for a couple of months. I did okay with the chemo-I didn't feel great but I had time between treatments to group emotionally . But I swear that the radiation gave me full blown PTSD. I feel nauseous just driving out there.

I'm scheduled to have the expanders replaced in September. I honestly just want to forget the whole year. I'm still exhausted. Worked all the way through tx.

It's like I stopped treatment and now I have all these feelings. I hate it.

Guess I needed to vent.

Joan


St 2 Gr 3 2/5 nodes dx 8/9 age 56 Neoadj ACT @ x 6 @3wks bi mst. 12/09 Infect expander 12/31 remvd, replcd 1/27. 28 rads 4/10 Brkn rib 5/10 PET   6/10 NED Recon 9/17 & 12/10 Ki67 85% basal
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ann u View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote ann u Quote  Post ReplyReply Direct Link To This Post Posted: Jul 12 2010 at 2:48pm
Instead of going through your doctor to do the BRCA testing, I would seek out a certified genetics counselor.  Most major hospitals have one one staff.  They will do a complete history, draw blood for the test if you decide to do so, and will submit the bill to your insurance.  Myriad (the company who holds the patent on the test) will hold your sample until your insurance approves it.
 
I know that some insurance companies will not pay for the test until you have been diagnosed with BC.  Also, if you test negative, no need for your daughter to test.  If you test positive, your daughter, should she decide to test, will only be about $400 since they will know exactly what mutation to look for and don't have to do the whole panel.
 
Hope this helps
Ann
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