To:不知如何時好

太太(60歲)在一個月前診斷出乳腺癌 invasive mammary carcinoma ,半個月前做的根除手術.腫瘤大小為15MM X 15MM X 11 MM, ER Positive at 100%, PR Negative at 0%, HER2- Negative for overexpression at 1+, , 腋下淋巴切除了三個，未發現轉移. 12/5在一個醫院Biopsy 的pathology report說是 7-8 of 9， GRADE 3， 動手術的醫院手術Surgical Pathology final report 說是grade 2 。Modified Bloom Richardson score: 6-7/9.
Nuclear score is 2-3/3
Tubular score is 3/3
Mitotic score is 1/3
AJCC Pahologic Tumor Stage: pT1c PNO(sn)pMX
手術前做了MRI 和X ray 胸透視。醫生說未發現轉移。是STAGE I, GRADE 2 or GRADE 3? 需作Hormonal Therapy.

請問：
1)現在需要做周身骨掃描和周身CT.嗎？醫生說考慮到副作用，不需要做周身骨掃描和周身CT。
2)醫生解釋了adjuvant on line Decision making tools for Breast Cancer. 說了做化療和不做化療的利弊。聽起來似乎做不做區別不大。讓我們做決定。請問做不做化療哪？
3)醫生要做DNA檢查，以進一步確定，但需14天，如做化療會不會晚？

1．  骨掃描意義不大，因為很早期。其實骨掃描副作用不大。

2．   化療的對生存率可能提高2-3%左右，這是過去的說法。有的人願意接受，有的人不願意。現在要根據Oncotype DX的recurrence score決定是否化療。這可能就是#3 DNA檢查。

3．   不會。

4．   診斷以最後切除的為準，是GRADE 2。

[不知如何時好]

Thanks! We will do chemo. My wife's doctor asks her to decide whether to do Chemo or not. What she is worry about is that she got 原發性血小板減少症 when she was youn. She is alright now.We already told her doctor about that.

[郝大夫]

回複不知如何時好的評論:

This score is in the area where the benefit of chemotherapy is uncertain. There is a clinical trial open right now for this group of patients. I am not sure whether your wife is seen in an institution where the trial is open. Otherwise, I would favor chemo because of high grade and recurrence score of 26 which is more toward 33 (chemo recommended) than 17 (chemo not recommended) although benefit is uncertain and is small if there is any. Take care.

[不知如何時好]

郝大夫：The Oncotype DX的recurrence score 出來了：26。做不做化療哪？