HELP! Language barrier understanding Mom's treatment options

wbird

Thank you so much in advance for your help and patience.

Mom was just diagnosed with HER2+ after her mastectomy, and it's that much more difficult because she's overseas and leaning on me to interpret her diagnosis in a different language.

I will try my best to provide info that you guys have in your signatures, but bear with me if I leave anything out. She just had a masectomy of her right breast, and her biopsy came back HER2+. They mentioned herceptin as a therapy OR another "pill" option therapy she could take (what would that be?!). They did NOT mention chemo.

DX: 2015/04/07. DCIS, 1.7 x 1.0 x 1.0cm. T1mic.

ER+ / PR+

HER2+ / FISH score 5.2??

Thoughts on possible treatment options? Any insight is more than greatly appreciated. Thank you!

ElaineTherese

Since your Mom is ER+/PR+, she will be offered hormonal therapy (which is delivered via a pill). If she is post-menopausal, she will probably be prescribed an Aromatase Inhibitor (AI). The purpose of the AI is to reduce the amount of estrogen her body is producing because her cancer had been fed by estrogen (hence, ER+).

Since your Mom is HER+, she will be offered Herceptin. It is typically delivered as an infusion, sometimes with a chemo drug (like Taxol) and sometimes alone.

Whether or not your Mom gets chemo depends on a number of factors such as nodal involvement, size of tumor, and whether or not it is particularly fast growing (Grade 3 being the fastest).

Good luck with your Mom! I hope she responds well to treatment.

wbird

Thanks so much for the quick response Elaine! It really does help a ton.

She is not post-menopause, so is there another common hormone therapy? And would she be doing hormone therapy in conjunction with Herceptin?

I knew I forgot something, no nodal involvement, 0/4.

MelissaDallas

I believe Herceptin and chemo are only given for invasive cancer, not DCIS. If it is DCIS with only microinvasion I believe it is treated like DCIS with only the AI.

ElaineTherese

wbird -- your Mom can get Tamoxifen, which has historically been given to premenopausal women. I am premenopausal, but I'm being put into chemical menopause through Zoladex so I can take an Aromatase Inhibitor (Aromasin). Yes, you can do Herceptin at the same time as hormonal therapy. I know I am.

MelissaDallas brings up a good point -- was your Mom diagnosed with invasive cancer, like invasive ductal carcinoma? or cancer "in situ"? Cancer "in situ" is not invasive, and Herceptin would probably not be given in such a case.

wbird

This language barrier is killing me... I will ask her to check with her doctor tonight. The part that's typed in English (LOL) is as following:

DX:

Right, Needle Biopsy

Ductal Carcinoma In Situ

ER: +, 3% W

PR: +, 3% W

HER-2/neu: (2+)

Ki-67: (Up to 60%)

HER-2Fish Result: Amplicfication of HER-2/neo Oncogene

Addendum:

According to the result of HER-2 FISH study there is amplifcation of the HER-2/neo oncogene (HER2/CEP17 RATIO = 3.42; Average. HER2 copy number = 5.20 signal cells by counting for 25 cancer cells.

Then her 2nd page report says:

DX:

Permanent Diagnosis:

R/T Areola Base Tissue, Biopsy

-- Microinvasive Caricoma at least (Canno T Exblude Invasive Carcinoma of no special type)

ElaineTherese

I don't have the document before me, but it seems as though the fine needle biopsy (done prior to surgery) suggested that her cancer was "in situ," but her biopsy after her mastectomy said that there was some invasion of some sort. In such a case, she would be offered Herceptin.

Moderators

Dear wbird,

Take a look at this link About Breast Cancer Pathology Report. It might shed some light on the information. The Mods

wbird

THANK YOU! THANK YOU! THANK YOU! It makes sense now that I'm piecing together what you're saying and what she tried to explain.

I think hormone therapy was the pill she was referring to. And herceptin was the IV injection option considering HER2+ and her biopsy AFTER the masectomy.

I'm reading her previous reports actually, and I think she is post-menopausal, as she's 59. AI's sounds like it'd work just fine.

One more question, thanks for all your help an patience! How soon after the masectomy do people start Herceptin?

ElaineTherese

Well, they will probably want to test your Mom's heart before starting Herceptin. Some women have echocardiograms; some (like me) have MUGAs. That will give her doctors a sense of her heart health and a baseline for judging whether or not Herceptin is negatively affecting her heart. I get MUGAs every three months; so far, Herceptin hasn't had any impact on my heart health. But, some ladies aren't so lucky. They will probably also give your Mom some time to heal from her operation as well.

wbird

Thanks again for everything Elaine. And Mods, I appreciate it, I went and looked at the path interpretation links.

MelissaDallas

I believe microinvasion is still treated like DCIS only - not treated like invasive with herceptin & chemo.

ElaineTherese

Thanks, MelissaDallas -- you may very well be right! As an IDC person, I have to admit that I'm not as informed about DCIS as I should be. Certainly, wbird's Mom would not get chemo with DCIS or some variant thereof. But, you can get Herceptin alone without chemo. Also, HER2+ is an aggressive form of cancer -- it is possible that her MO wants to make sure that it hasn't gone anywhere (even if microinvasion seems most likely). But, maybe wbird should second check to make sure that Herceptin is appropriate. After all, the risks to her mom's heart health might not be worth the benefits she would get from Herceptin.

wbird

Melissa, thanks for noting that. I'll check into this