normal treatment for 3- breast cancer

[crabbymom]

I have been diagnosed with medullary cancer of breast and it is 3- grade 3 no lymph node involvement. is it normal to need chemo after surgery?

[PaulMD]

Actually, medullary tumors tend to be less agressive than the usual invasive ductal cancer.  The more common types are of lesser grade and well circumscribed borders.

[BJSaws]

Hi,
I also had medullary breast cancer, grade 3.  My tumor was 1.1 cm with a negative sentinel node biopsy.  I had a mastectomy and underwent four treatments of AC chemotherapy.  My oncologist said that if my tumor had been under one cm, the chemo would not have been necessary, but because it was 1.1 cm chemotherapy was recommended.  I had the surgery in November 2003, finished my chemo in April 2004, and so far everything has been good.  My tumor was ER-, PR-, and Her2-.  I understand that is fairly common for medullary tumors.  Since I was not eligible for the hormone therapies, the chemo was also recommended.
I also understand that medullary tumors always "appear" to be grade 3, but that is not always the case.  It has something to do with the way medullary looks under the microscope.  Perhaps PaulMD can give us more information on that.  

[PaulMD]

Hi there.

The decision to receive chemotherapy or not depends on the stage (usually if positive lymph nodes or tumors greater than 1 cm in size [NCCN guidelines]).  However, a grade 3 cancer can add a new dimension on the decision to undergo additional treatment.  Though medullary cancer generally behaves less aggressively than the usual invasive ductal cancer, a grade 3 finding can influence you and your oncologist to give additional treatment (like chemotherapy).  It will also depend if your tumor is ER/PR positive or Her2Neu positive.  I suggest you discuss these things with your oncologist for proper guidance.  You can also visit the National Comprehensive Cancer Network website.

Regards and God bless..