newly diagnosed, lumpectomies done, biopsy received. Opinion?

hmfish

Hi all,

My mother who is 63 years old, was just diagnosed with breast cancer. Both left and right lumpectomies were performed last week to remove the tumor (no neoadjuvant treatment before surgery), and just received the biopsy report:

Right breast:

• low to intermediate grade of DCIS, 2 foci
• size of tumor: 1.4cm and 0.8 cm
• OR +ve
• PR -ve
• HER2 equivocal
• KI 67: up to 2%

Left breast:

• IDC, grade III
• tumor size: 2.2cm
• OR -ve
• PR -ve
• HER2 +ve
• KI 67: 60%
• no lymphovascular permeation
• isolated tumor cells in 1 out of 7 sentinel lymph nodes

I have done quite a bit research lately on breast cancer, and my understanding (and also from what the doctor told me) is the the right breast is fine and not much issue, but the worrying part is the left side, where the KI67 is very high and is grade III, which indicates it is very fast growing, and also one lymph node was detected with tumor cells.

My questions are:

• Is it really that serious for the left side based on the biospy? That means my mom needs to start treatment (radiation, chemo, targeted drug) as soon as possible?
• Her doctor recommended all three treatment: radiation, chemotherapy, and targeted drug (Taxotene, Carboplatin, and Herceptin). Is that a common approach? Perjeta is not included, but I heard this is a newer and perhaps ever more effective drug for HER2 +ve?
• My mom has weak bones and is Calcium deficient. Would these drugs have a much worse effect on her? I heard now the side effects are much more manageable? I am thinking of hiring an in-house helper to take care of my mom since I am working full time...
• Any other advice/suggestions?

Thank you all first for reading and answering!! This sure is a tough time for my family, so I appreciate any input you may have!!

keepthefaith

Sorry to hear about your Moms' DX. I don't have the same DX as her, but that looks like a common treatment plan. You can always get a second opinion before treatment starts if she is unsure. Usually, surgery is done first and there will be a few weeks before chemo or radiation starts. The aromatase inhibitors (hormone therapy) can cause bone loss. If she hasn't already, it may be a good idea to get a DEXA scan done to test her current bone density. She may also be low in Vit D if her calcium is low. Tamoxifen is another option, usually prescribed to pre-menopausal, but also for menopausal patients. It works differently than the Als and does not cause bone loss...it may actually improve bone density. I have osteoporosis and was RX'd Tam instead of Als.

If you are in the States, the American Cancer Society should have resources if your Mom needs help with house-cleaning, rides to appts, etc. You may also check with the social worker at her medical facility. They are a wealth of information.

Good luck! Your Mom is lucky to have you. Prayers to you both.

Moderators

Hi hmfish, and welcome to BC.org. We're sorry for your mom's diagnosis, but glad to see that she has you, and that you've found this wonderful Community for great information and support!

You may want to take a look at our section for those newly diagnosed called: Breast cancer 101. It's very helpful for all you need to know at the beginning. And if you decide to pursue a second opinion, here's more information on how to do that. Hope this helps!

Best wishes for you and your mom!

The Mods

MTwoman

hmfish,

I am so sorry for your Mother's DX! I will let the other women with experience in IDC give your information on that. What I want to suggest is more on your comment "the right breast is fine and not much issue". While her DCIS tumors were low grade and (based on the KI 67) slow growing, it is very uncommon to leave DCIS in place and consider it fine. There is a lot that is not known about what conditions cause DCIS to become invasive. What is known is that it can and does. Your Mom's treatment will be driven by the IDC, to be sure. But they will most likely be recommending LX, or perhaps MX, depending on whether the tumors are close enough together, the size of your Mother's breasts etc. I ended up with MX, as my DCIS tumors (3 of them) were in different quadrants. I hope that you and your Mom find much support here! ((hugs))