Stage IIIB prognosis

My mother -55 years old- has been detected with breast cancer. The hospital reports say that it a Stage II Notttingham score of 6-7 points. However they the same report also mentions the spread into her lymph nodes- Her reports say that T2, N3a, Mx. They found some cancer cells in 33 out of 37 lymph nodes. Also she is hormone negative.
Was stage II, a wrong diagnosis? Is she not a stage IIIB with the extent of lymph node involvement? Currently there was no distant metastases seen-based on xrays, bonescan etc. But does Mx indicate that they cannot access the spread and that it may have already spread?
She underwent a radical masectomy in Feb-1st week. Also got a port inserted for beginning chemo which is scheduled to begin next week. Currently its 6 doses spread every 21 days followed by radiation.
By the way, all this is going on in India. What prognosis do you hold for this kind of a case- I understand that for Stage IIIb- there's 45% survival rates (for 5-year) vs 65% for Stage IIb. She is also hypertensive and diabetic. I am leaving for India in few weeks. Do you think that she still has the ability to beat the odds? Do you think that the prognosis of Stage II was wrong and this would make treatment options different than if she is a stage IIIb? Should we just prepare ourselves for the worst? Please help.....

[Dennis MD]

Hi.
I would just want to clarify that Nottingham grading is different from the AJCC staging.  
Nottingham histologic grade is based on several parameters as seen in the pathology report.  These are tubule formation, nuclear pleomorphism, and mitotic count.  There is a corresponding score for each of these parameters.  Grade 1 has a score of 3-5 points (low histologic grade, favorable), grade 2 has a score of 6-7 points (intermediate histologic grade, moderately favorable), and grade 3 has a score of 8-9 points (high histologic grade, unfavorable).  
On the other hand, the AJCC TNM staging is based on the size of the primary tumor (T), regional lymph node status (N), and distant metastasis (M).  
Your mother has a T3N3aMx stage based on her pathology report.  This means that the tumor is more than 5 cm in greatest dimension, with metastasis in ipsilateral infraclavicular lymph node/s.  Mx is designated when the site of metastasis is still going to be determined.  However, you mentioned that there is no distant metastasis (M0) based on her work-ups.  Her stage would then be T3N3aM0 or stage IIIC.
Prognosis of breast cancer depends on several factors.  These include stage of the disease, tumor size, nodal status, histologic grade, hormone receptor status, Her2Neu status, lymphovascular invasion, etc.
I agree with her present treatment plan (systemic chemotherapy and radiotherapy).  At present, breast cancer therapy is rapidly evolving.  There are numerous clinical trials in the treatment of breast cancer, with the end point of improving the overall survival.

[shwetasaokar]

Thanks for the analysis. Her tumor was less than 4cm- that's why its T2 as her reports indicate. But is she really a stage IIIC- because of just the number of lymph nodes involved?

[Dennis MD]

Hi.
Sorry.  I must have misread your post regarding the stage of your mother’s breast cancer.  
T2 means that the tumor is more than 2 cm but not more than 5 cm in greatest dimension.  
N3a means that there is metastasis in ten or more axillary lymph nodes, or metastasis to the infraclavicular lymph nodes.
T2N3aM0 is designated as stage IIIC based on the AJCC staging.