Biopsy results/HER2 +3

billy1973

Hi all,

my mother was diagnosed with breast cancer .

She had the operation 50days ago but we got the biopsy results just yesterday.

Her doctor said all went fine,she did cleaned her up to the armpit

I'll try and translate as close as possible as english is not my language for these medical terms.

She had the cancer removed without a mastectomy, just a small part of the breast removed.

The biopsy result says pT2N1, tumour size was 2.4cm, 3 out of 8 lymph nodes were infected included the sentinel (guard) lymph node,all 8 removed.

ER and PR are negative.

Ki-67 ~60%

C-erbB-2 (HER2 positive +3).

I'm scared about the HER2.

The doc hasnt read the results yet but i phoned him and said that needs chemotherapy for six months and after that a pill for HER2 and maybe some radiation.

We havent been refered to an oncologist yet,probably next Monday.

If someone can answer the following 'silly' questions i'd be very grateful:

-Does she belong in the group with 5 year expected life?

-That HER2 value means the cancer is very aggresive and has spread to other parts of her body already?

We were told that  will have to do a tomography test and a 'bones' test 

-How bad are these results?Is it too late?

I think the doc made a wrong estimation when he made the operation,because he said back then that she will might take a pill only.Now he says the only way is chemotherapy

She is 67 yo

Again excuse my language 

I'm ready to face that situation but need some info on the above results,just to calm myself down a bit

Regards from Greece

mjm1

Hi Billy,

I'm going to post twice - the first one a quick one to say - there is a good chance it's going to be ok, please breathe. My Mum has HER2+ as well.

I will write a longer reply to your qs now, but had to post that first in case you are in turmoil.

xoxo- Miriam

billy1973

Thanx Miriam,

if you need any other info from the biopsy i can provide it

mjm1

Ok, post 2.

First of all, yes, HER2+ is an aggressive form of cancer, however they have developed some excellent treatments. The main one of these is Herceptin, which is given in combination with chemotherapy. This brings the survival rates for HER2+ more or less in line with more common types of breast cancer.

2.4cm is medium sized. Not great, but not awful. Any positive nodes is bad, but fewer is better than more. You will only know if it has spread based on the results of the scans they are doing. If it has spread, in some cases women can survive for many years on Herceptin - my mums oncologist says she's got patients who have been on it for as long as 13 years (and still going) after their cancer spread. There are women on these websites who've been going even longer. Obviously not everyone with cancer that has spread is this lucky, but it's nice to know that sometimes they can keep it at bay very well.

However, hopefully it has not spread.  If it has not spread, and she gets good treatment, her chances of not only being alive, but having no active cancer (although always a chance of relapse) in 5 years are good.

I am concerned that they did a lumpectomy without giving her radiation - in many parts of the world they only do lumpectomies with radiation afterwards. I am concerned that it has taken them 50 days to get these results to you, and are only organising treatment now. I don't know whether it's better for her to have radiation then chemo+herceptin, or the other way round, but I think given HER2+ is aggressive, she should be seeing an oncologist and starting treatment as soon as possible.

My mum is 62 and was diagnosed in January. 

How is your Mum's health otherwise? Does she have any heart problems? I only ask because Herceptin can have some effects on the heart.

There are all sorts of wonderful new drugs being developed for HER2+ cancer. It used to be a terrible kind of breast cancer to have. It is not anymore. I am wishing you well on the scans - I so much hope they are all clear.

xo-Miriam

PS they are not silly questions at all and your English is very good.

Moderators

Hello Billy, and welcome to Breastcancer.org.

As well as the helpful and reassuring support that Miriam has given you, the main Breastcancer.org site's section Your Diagnosis includes information about the details typically presented in a pathology report. If you look at the links down the left side of the main Your Diagnosis page, you can click to learn about each area of the report.

Best wishes to your mother, and to you.

• The Mods

billy1973

Thanks again,

the doc was very confident that the operation went fine thats why the biopsy wasnt treated as an emergency one and took so long.

Mecication,radiation and finally chemo were the options we had for treatment,he thought our case was only medication.

What i dont get is since he removed the nodes why not suggested the scans immediately after that if there was a little chance of metastatic cancer?

I thought by removing and cleaning the nodes up to the armpit eliminates metastasis.

By experience,how big is the chance of metastasis with a +3 HER2?

Or HER2 is more about cancer  reappearing in the same area and thus its called aggresive?

Or aggresive means spreading fast to other body parts?

Can you trust the eyes of the doctor?No

So the next step will be scans,but what type of scans?

Are these 50 days affordable or we lost a lot of time?

Regards

mjm1

Hi Billy,

the medication he was probably expecting was the pills that women with hormone receptor positive (er+ or pr+) cancer are given, such as tamoxifen. With HER2+ but hormone receptor negative, chemo + herceptin is the standard treatment, and the pills they give for hormone+ cancers won't help . Herceptin is given as an infusion like chemotherapy.

I don't know the chances that it will have metastasised, waiting to find out the results is hard.

HER2+ is aggressive meaning that it is usually a grade 2 or 3 out of 3, which means the cells divide and grow quickly. I think this means it can grow quickly in the breast, spread quickly to the lymph nodes, and is more likely to spread. But it certainly doesn't mean any or all these things will have happened. Mum's was 2.2cm, negative lymph nodes and no metastases. She was told that after surgery (she had a mastectomy), if she didn't have further treatment (she had chemo and herceptin), there was a 45% chance it would be back within 5 years.

The scans are to check the main areas that breast cancer goes to if it spreads - one for bones, and one for liver, lungs and brain. Some doctors do these scans more often than others.

The surgery is designed to stop the primary cancer developing and get rid of it. The radiation is to kill any remaining cancer cells in that area. Systemic treatments such as chemo and herceptin are to try and get rid of any metastases, and/or to kill any tiny cancer cells that may still be in the body after surgery, to try to prevent future metastases. I didn't know that either until this year - you would think surgery gets rid of it all.

It would have been better not to have the delay, but delays do happen for various reasons. My Mums surgeon says he prefers to start people on chemo 3-4 weeks after surgery, but she had an infection and couldn't start til almost 6 weeks after surgery. Other people have longer delays. I don't understand not giving her radiation after removing a lump and lymph nodes though? Here in Australia, you either have just the lump removed plus radiation, or you have a mastectomy. I do think your doctor may not have done the best thing, however delays are not altogether uncommon so try not to let it add to your worries at this time. Just make sure she gets to a good oncologist, ideally with good breast cancer & HER2+ experience.

It might be worthwhile trying to find a good oncologist yourselves if you don't trust the surgeon? Are there any highly regarded breast cancer clinics / hospitals where you live (or close enough to travel to for treatment)? Or another doctor you trust more that could give you a referral to an oncologist (I don't know if you need a referral in greece or can go directly to an oncologist)?

I'm so sorry you are going through this. I found the time when we didn't know if it had spread or not, and before treatment was underway were very hard. Once you have the scans, and a good oncologist you can trust, and the rest of the treatment begins, hopefully it will feel better.

best wishes

billy1973

The fact that the type is T2N1 without the letter M does not ensure that there is no metastases?

SpecialK

billy - there is a difference between local or regional metastasis (to the axillary nodes) and distant metastasis.  Surgery removes the mass in the breast and the local/regional metastasis, and chemo and Herceptin treat the possibility that there are cells that have escaped that area.  The purpose of chemo and Herceptin is to prevent or destroy those cells before they can become a tumor in the bones/lung/liver/brain.  Her2+ cancer is aggressive because it signals cancer cells to multiple rapidly, that aggressiveness is not limited to the tumor in the breast.  Your mother's cancer has already moved outside the breast into the lymph nodes, so the scans will help her doctors determine if it is anywhere else.  Her2+ breast cancer can recur in breast tissue, or it can move to other areas of the body.

Am I reading this correctly, that you are not finding out the hormonal receptor and Her2 status until 50 days after surgery? If so, I might be looking for another doctor - that is an unacceptable delay in giving you information to make treatment decision about. 

Any node positive patient, and particularly any node positive Her2+ patient, should have these scans done - it is routine.  They need to understand whether or not she has a distant spread to determine her course of treatment.

The normal order for your mother's treatment should be surgery, then chemo with Herceptin for a number of treatments, then Herceptin continues for the balance of a year, but radiation is started several weeks after she finishes the chemo portion.  The radiation will be done concurrently with the remainder of Herceptin.