Questions before mom's appointment

EmmorsMom

Hey everyone...my mom found a lump on the underside of her breast a few months ago. She thought it was a weird muscle thing or that she had a fibroid like her sister gets. She finally went in to have it looked at & got her biopsy results last Thursday. Breast cancer. They said something about estrogen (she couldn't recall if it was resistive or receptive) and they said it looked like she was BRCA+. They sent her test to mayo to have them review it. I'm going with her to her oncology appt tomorrow.

I have a few random questions that I was hoping to get some insight on (please let me know if this belongs in a different board):

1. My mom couldn't remember if dr said estrogen resistent or receptive, but she did say the dr told her it was a good thing she wasn't on hormones after menopause as that could have made it grow. So would that be resistent or receptive? What does this mean?

2. Can they tell if you are BRCA+ in 2 days? I thought that test took month?

3. I'm wondering if we will learn her stage tomorrow with her oncologist. But wouldn't that require some sort of CAT or PET scan? Can they tell the stage just from a biopsy?

4  I want to help my mom know what to ask. Any questions I should make sure to ask tomorrow?

Thank you. We lost my dad 18 months ago to cancer...so this is just so hard. Thank you for any help.

inks

So sorry about your moms diagnosis. If the doctor said that it was a good thing that she was not on hormone replacement therapy then the cancer is probably ER+ and will respond to antihormonals. I have not seen a BRCA test done in 2 days. Did she have blood drawn from her arm? Maybe they were suggesting the BRCA testing on her family history of breast and ovarian cancer. Usually the stage is determined after surgery but they should give you an idea based on the imaging done already where she is at. Since you are seeing oncologist first they may be recommending chemo before surgery to shrink down the tumor. Ask how the location and size of the tumor will determine if she can have a lumpectomy or mastectomy. And what grade and size the tumor is and if she could get an OncotypeDX done to see if she would need chemo. So sorry for the loss of your father. I am glad you are there to give your mom support.

Moderators

Hi EmmorsMom, we're sorry about your mom's diagnosis, and also for the loss of your dad. 

We recommend you, and why not your mom to take a look at the Breast Cancer 101. It's designed for those newly diagnosed and hopefully it will help you understand all the new terms and overwhelming information in this difficult moments.

Best wishes,

The Mods

EmmorsMom

Inks: thank you so much for your reply. Your answers were exactly what I needed to know to feel a little more grounded going into this appointment. 

One more thing, if you will. I was also wondering if it's normal to send out tests to the mayo clinic? It makes me a little more worried (if that's possible) as maybe they aren't sure what they are looking at? Thanks again for your help. I feel prepared for this appointment.

inks

I have no idea why they send the pathology tests out to Mayo. Is it a small community hospital? My OBGYN is at a small community hospital and they send my pap smear out to a university hospital lab. Ask them why they sent the pathology to Mayo. If it is a small hospital I would strongly recommend going to a high volume hospital at least for the surgery. Don't let them rush your mom into anything and do not make decisions on the spot. If possible talk your mom into getting a second opinion just for peace of mind.

EmmorsMom

Well, the first appointment is over. Their estimate is 1.4cm. It is ER+/PR-. 97% ER+, whatever that means. Their test for HER2 was in the middle & inconclusive so that's what they asked Mayo for. Mayo is doing the FISH test to determine HER status. The plan right now is surgery...a lumpectomy or mastectomy.  Then radiation, chemo, hormone therapy. It all depends on what they find when they remove it and check the lymph nodes.

So the oncologist believes it's a Stage 1. If lymph nodes are involved, then Stage 2. My mom was pretty relieved as she had sat in the same office to learn there was nothing to be done for my dad.

I am cautiously optimistic. Any advice?

Another question. My mom had a hysterectomy 30 years ago. Would this affect how well hormone therapy might work?

Thank you!

inks

Did your mom keep her ovaries? And even if those were removed during hysterectomy the body still produces estrogen (fat, brain). Hormonal therapy is effective even in postmenopausal women.

SpecialK

emmorsmom - the percentage of ER+ is determined by looking at a slide with a sample from the biopsy.  Out of 100 cells on the slide 97 of your mom's showed estrogen receptors.  That is how the percentage of ER+ is determined.  It is common to have to check both FISH and IHC testing to determine Her2 status.  It is very important to have a definitive result on this test because it does dictate aspects of treatment. Your mom's order of treatment would be surgery, chemo, radiation, then hormonal therapy.  Depending on her final pathology and lymph node status I would recommend that she have an Oncotype Dx test done.  This is a genetic test that will help determine whether chemotherapy will be beneficial when added to hormonal therapy for early stage ER+ patients.  A low score on this test may allow your mom to skip chemo.  Hormonal therapy is effective for women who have had a hysterectomy, but her menopausal status may determine which type of anti-hormonal drug is used.  Post-menopausal women can take drugs known as aromatase inhibitors, which suppress estrogen that fuels those hormone receptors, by interfering with the enzyme aromatase which converts androgen into estrogen.

EmmorsMom

Thank you, specialK, for the explanation! It was very helpful. Some of the words you used are ones that her dr talked about and that I took notes on (had to take notes! So much info) She did mention the OncotypeDx test. She also discussed aromatase inhibitors...so hearing you talk about them also makes me feel good about the dr my mom is seeing. She has her appt with the bs tomorrow. Here we go...

SpecialK

Glad to help, wishing you both the best. Keep coming back to BCO for clarification if you need it.