What do you do when two of your physicians come up with a different diagnosis? You thank God that they treated your cancer aggressively and that in this case, stage does not matter much. As a matter of fact, it seems like breast cancer staging is open to interpretation. This is where my diagnosis has conflicting information.
Stage one breast cancer
According to my breast surgeon, I have stage one breast cancer. This is the surgeon that read the pathology report on the tumors after my mastectomy. He told me on the phone, it was stage one.
This was actually a surprise for me. Based on tumor size and grade, from the pathology report done at the time of biopsy, the best stage I could hope for would be stage two. So, when my surgeon told me it was stage one, I was overjoyed.
Why stage one? The cancer was node negative. This is huge. According to the pathology and visual examinations, the breast cancer is not in my lymph system. Cancers that have not spread to other areas of the body and those that are not in the lymph system are early stage cancers.
Some grading guidelines say that tumors as large as 2 cm can be stage one if the cancer is contained and has not spread to other areas. Using these guidelines, I could be at stage one because the initial measurement of my tumor was 2.1 cm but then it was changed to 2 cm.
However, my oncologist seemed to treat my breast cancer more aggressively than I thought was necessary for stage one cancer. Now I know why. She had a different diagnosis.
Stage two breast cancer
Now, it all makes sense to me. My oncologist told me at a recent visit that my breast cancer is stage two. That makes more sense and it explains why she wanted chemotherapy and hormone therapy as a followup to my mastectomy.
Why would my cancer be stage two and not stage one? Simple, tumor grade and size. I had a total of two tumors. One was a grade II and the other one grade III. These are aggressive tumors and it makes a good case for stage two cancer. The fact that there were two tumors also lends itself to a stage two diagnosis. Then there is size. One tumor was 2.1cm but the other one was much smaller. Physicians consider any tumor over 2 cm as stage two or higher.
Who is right?
Actually, both physicians are correct in their diagnosis. In this case it is truly a difference of opinion. For me it worked out well as my oncologist is the one who is directing my treatment and not my breast surgeon. My oncologist treated the breast cancer as stage two, which is okay. It still allowed me a lot of flexibility in treatment decisions. She would have been less agreeable if I was at a later stage.
I am glad that I have a team of doctors treating me. The team approach allows for differences of medical opinions but it gives me more control as a patient. I was somewhat surprised with finding out about the stage two diagnosis but not shocked, because it was what I was expecting all along.
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