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Many patients ask what their “stage” is. My advice is not to get hung up on these medical terms. They are mainly useful in working out the best treatment for different categories of patients. I have known plenty of women with Stage III and even Stage IV cancer who are doing fine many years later. However, for the record: There are four stages of breast cancer: Stage I: The tumour is confined to the breast Stage II: The tumour is confined to the breast, but is larger than 2 cm in diameter, or involves the local lymph nodes, usually those in the arm pit, or “axilla”. Stage III: As for Stage II, but more advanced. The tumour is extending to other local structures, but has not spread to distant sites. Stage IV: The tumour has spread to distant organs, like bone, lung or liver.  The “grade” of a breast cancer refers to its appearance down the microscope. The pathologist looks at the shape and characteristics of the cancer cells and “grades” them against well-defined criteria to decide whether they fall into one of three grades: Grade 1: These are slow-growing, quieter cancer cells. Grade 2: Intermediate Grade 3: These are faster growing cancer cells DO NOT WORRY IF YOUR TUMOUR IS GRADE 3! Most young women have Grade 3 tumours and I know countless women who have had Grade 3 tumours over 15 years ago and have never had further problems. Grade 3 tumours may be more sensitive to treatments like chemotherapy and radiotherapy,so from that perspective it can even be an advantage to have a grade 3 tumour. Breast cancer cells have tiny ‘docking stations” on their surface which allow certain hormones to dock and send signals to the cell to grow. The most important of these are the hormone receptors: the oestrogen receptor (spelt “estrogen” by the Americans, and therefore universally abbreviated as “ER”) and the progesterone receptor (PR). When these receptors are present they indicate that it is advisable to deprive the cancer cell of the female hormone, oestrogen, to ensure that the cancer cells don’t grow. There are several ways of doing this and you can read more about it if you CLICK HERE . What if my hormone receptors are “negative”? Tumours that do not express the oestrogen and progesterone receptor are termed hormone receptor negative. For women with receptor negative tumours the presence of circulating female hormones, like oestrogen, are far less relevant. Hormone therapy is not used when the hormone receptors are negative as it has no beneficial effect. DO NOT WORRY IF YOUR TUMOUR IS RECEPTOR NEGATIVE! Receptor negative tumours may, in fact be more sensitive to other treatments, like chemotherapy, than receptor-positive tumours, so, from this perspective, it may even be an advantage to have a receptor-negative tumour. 
Nicole: I read all this stuff about hormone treatment of breast cancer, but my tumour was receptor negative and I felt like I was missing out on something. My doctor explained that patients with receptor negative tumours are not being ‘deprived” of some active treatment. It’s simply that they don’t need hormone therapy. To find out about this CLICK HERE . Patients often ask me how we know that adjuvant chemotherapy or hormone therapy is going to be successful for them. At present, we do not have a reliable way of individualising the decision about adjuvant treatment. We have to base it on the fact that in large clinical trials the group of women who had adjuvant treatment do much better over time than the group of women who did not have such treatment. Within that group, however, there may be as many as two-thirds who do not need the treatment. A major step forward would be the ability to refine the decision as to which subset of women, within the larger group, are the ones that really have a major benefit. Recent reports in the medical literature point to a new technological advance that will allow us to do just this, and several papers at ASCO reinforced our optimism. The technology involves taking the tumour and preparing a genetic fingerprint. This fingerprint is compared to the fingerprint of tumours that are known to be sensitive to chemotherapy, or hormone therapy, and also compared with the fingerprint of tumours that are known to be resistant. In this way, it is possible to select patients who are going to have maximum benefit from the treatment. So far, the clinical studies that have been performed are quite small, and are inadequate for us to use as a basis for large-scale clinical decision-making. However, it is my prediction that this will be the way of the future and may be in routine chemical use within the next two to five years. I am spearheading an approach to the new New South Wales Minister concerned with cancer related matters, Hon Frank Sartor MP, in an attempt to persuade him to invest heavily in this new technology which is likely to be relevant not only to breast cancer but to many types of cancer. | Tamoxifen | Chemotherapy for Breast Cancer | After Treatment - What Now? | Causes of Breast Cancer | Breast Cancer Myths | Family History | Herceptin | Femara, Arimidex, Aromasin | Adjuvant Chemotherapy | Zoladex and Stopping the ovaries | Stage, Grade, Receptors | Zometa, Aredia and Bonefos | Alopecia from Hormonal Therapy | New treatments | Lapatinib 'Tykerb' | | What's New | FAQ Page | Living with chemotherapy | Dietary Advice | Exercise | The Flu Vaccine | Insomnia | Marijuana | Alternative Medicine | Managing Menopause | Advice to Carers | Breast Cancer | Pain | Useful Tips | Chemotherapy: The What and How | MRI Screening | | Your Cancer Information | | Return Home | New Patients | Services and Clinics | Useful Links | Contact Us | Download Page | Cancer Information | |
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