My mom has Stage 2 Breast Cancer according to Histopath results

Yuno

I'm so anxious and worried I don't know what to do, I only knew of this now. Please give me advice on where to start.

My mom's up for mastectomy in the next few days and she'll be having her left breast removed. She had her biopsy last week and the results show there are cancer cells on her lymph nodes. I was told the next step may be radiation or chemotheraphy. I'm so scared for her and will take a few days off from work to take care of her in the hospital.

I was thinking of sharing of information of her results here to know how you usually deal with this.

Thanks for taking the time to read, any advice would be appreciated.

moth

Hi Yuno, so what will happen is that after the mastectomy the pathologist will look at the tumor closely. Staging might change because it partly depends on the maximum size of the tumor and sometimes the mammograms/ultrasounds are not as precise. I got downstaged after surgery....

After the surgery your mom will probably have drains - tubes stitched or taped into the skin, to help drain fluid/blood from the incision. If you read through some of the surgery threads you will see lots of tips for how to deal with it all. She may need to sleep upright for a bit & she will need some help around the house. Pain is usually well managed with medication.

Your mom should already have results regarding hormone receptor status. That will partly determine treatment options after. The biopsy should also have indicated the Grade of the tumor. Grade tells you how fast growing it is.

Decisions regarding chemotherapy are based on how aggressive the tumor is, its spread, its response to hormonal treatments, and the patient's ability to tolerate chemo side effects.

Depending on her hormonal receptor status, she may also qualify for something called OncotypeDX where they analyze the tumor and try to predict its risk of recurrence. That can also help with the decision to pursue or skip chemo.

Radiation is what is used in the area to kill any cells that might escape surgery. It tends to cause fatigue and skin damage but is by most accounts easier to deal with than chemo.

I hope that helps you a bit. It's the 'not knowing' that's the hardest, I find. Once you sort of know what to expect, it all becomes more manageable.

hugs!

Runrcrb

moth summed it up well. As a mother who just went through this, she’s as worried about you as you are about her.

Time and test results will guide treatment. Offer support through food, company and short walks. Help run interference / provide information to family and friends. Take your lead from what your mother wants.

All the best

Yuno

moth, your outline is a tremendous help, hank you so so so much! I'll be sure to use it as a guide on what we should look at next and how to deal with the treatment and recovery. It's also good to know about your case being downstaged after surgery.

My mom's also decided to go for breast reconstruction after her mastectomy. The doctor said it's kind of recommended to have the "expander" because the skin will shrink when she goes through radiation. The current results indicate I think that radiation is a big option for her. I'm not entirely sure how well-recommended reconstruction is as each BC condition is unique from what I've read.

And yes you are definitely spot-on on the "not knowing" part. It really is scary when there's no plan laid out yet. I hope that when everything's set my mom will be on her way to being cancer-free soon! Again, many thanks for the excellent post and the guidance, and much love to you!

Runrcrb, I'm so sorry you're going through this. Putting myself in your shoes, I can't imagine how much harder it must be for you moms to have BC while thinking of your children as well. I now really see the importance of giving emotional support by loved ones while having to battle this.

Thank you for the support and input. I'm wishing you all the best in your journey as well. Hugs and prayers to you and your family!

DATNY

Dear Yuno, do you know the hormone status? That is one of the most important things, that will guide the treatment. If a node was positive chemotherapy + radiation are almost always recommend here. If the cancer is hormones driven, after chemotherapy are prescribed estrogen inhibitors. If it is hormone negative, different medicine is prescribed depending if it is her2 positive or triple negative.

Best wishes to your mom! Mastectomy sounds scary, but it is not that bad as the doctor will remove mostly fat and skin. She may not even need pain medications other than what she gets during the surgery.

Do try to get all the details, including hormone status, cancer size, number of tumors, number of nodes involved and the treatment recommend. You could then discuss that with others here.

Yuno

Thanks for getting back to me DATNY!

I don't know those details yet, my mom said that she'll be getting more info when she meets with the doctor again. It also seems like she doesn't know about the HER2 being positive or negative, her friend told her to have it checked or something. Both of us are still unaware of how to properly check the diagnosis and records, and I can't even accompany her to her checkups because of work.

Searching for "HER2" and all the technical terms is giving me massive anxiety. I'm so scared knowing how the situation might be worse or untreatable, but at the same time not knowing also scares me. This is honestly emotionally exhausting and I'm still at the beginning.

I'm so worried too about the mastectomy being somewhat delayed too because of some papers that still need to be filed and sorted out. The plastic surgeon is also still preparing the expander for the breast reconstruction... It's February 21 currently here and the operation is on March 2! Is that waiting period too long and dangerous? I'm so scared of the delay that the cancer might become worse!

DATNY

Her2 cancer used to have very poor prognosis, but recent drugs are very effective in curing it. However, most statistics you'll find on internet are relatively old; very few are done on women who have had recent treatments, such as Herceptin and Perjeta.

Since your mom has a node involved, CT or PET scan, along with bone scan would be requested here before starting the treatment. I addition, many doctors here would request an MRI of both breasts to see if any other tumors.

Also, the trend here is to first proceed with chemotherapy to make sure the treatment is working. That is what I have had myself, I started with 6 cycles of chemotherapy for 4 months. After three cycles I had an ultrasound which confirmed the tumors were shrinking. The lymph node was shrinking too, although it remained enlarged until the end. The downside of doing chemo first is that if the chemo does not work on the cancer in the lymph nodes, that cancer has additional time to spread during chemo. On the other hand, if that's the case, additional chemo treatment can be done after surgery, but this is not standard, it depends on the doctor.

Finally, do not worry about delay. One or two months will most likely not make a difference.

Good luck with finding all the details. The most important info is to find out if it has spread, and hormone and Her2 status. The treatment is based on these findings. The fact that she had node involved will lead to addition of radiation following chemotherapy and surgery.

Yuno

I finally checked the histopath results myself.

The diagnosis reads: "Invasive mammary carcinoma with lobular features"

Description: "The specimen is received in formalin and consists of thin yellow and white strips of tissue with length of up to 1.2cm.

Comments and microscopic description: "Sections show cores of breast tissue. There is an infiltrating tumor composed mainly of strands with some small nests, and trabecular bars seen. Tumor cells are generally small to medium sized with scant cytoplasm and with relatively large hyperchromatic angulated nuclei or vesiculated nuclei with small nucleoli. There is little tubular formation. Few mitotic figures are seen."

So many terms I am not familiar with yet. Do any of these indicate the grade of the tumor? I think those are all from the biopsy results. No idea about the MRI or CT scan. Should those happen before mastectomy? My mom will meet with her doctor again next Wednesday, 2 days before the surgery on March 2; she'll be confined on March 1.

I read from my mom's chat with her sisters that she has small nodes and 1 big one.

Again, thank you all so much for the help and guidance. And thank you DATNY for sharing your experience. I'll post again for any updates.

pupmom

Yuno, you really won't know much about stage, grade and nodal status until after surgery. Before surgery I was told my nodes were clear and I had ILC. Turns out I had micromets in 2 nodes and was primarily IDC (with lobular features). While it was quite a shock for my husband and I to learn about the nodes, good news is 6 years out I have No Evidence of Disease (NED) and doing great! Your mom can do this!

DATNY

Based on the nuclei and tubular formation description the grade appear to be 2 or more. However, the cells division (mitosis) appears to be low, which I have read is a very good indicator by itself.

I had CT scan and bone scan after biopsy and before starting chemo. Like I said, with node involvement this is automatically done here (standard of care). My surgeon also ordered an mri at the same time to look for other tumors, but I don't think this is a standard procedure. It might be indicated in your mom's case, as ilc (lobular cancer) may not show up well on mamogram and ultrasound.

You should get a second, separate report with hormone and her2 status. This will guide the treatment.

Also, according to my surgeon, reconstruction can be done at any time. After looking over pictures with reconstructed breasts on internet and in my doctor's office, I have chosen not to go for it. The results are far from the original, and the process involves multiple surgeries. Of course, unlike treatment, this is based on personal preference.

Like pupmom said your mom can do this and she will be fine. I know in some countries going through cancer treatment can be very difficult because the care is not standardized and doctors don't communicate as much info as here. But if this is the case you can always come here and see what is done in similar cases.

Best wishes!

Yuno

It possibly being grade 2 or higher scares me immensely, it sounds aggressive. Her results also said it's Stage II B. I really hope it gets down staged and the report becomes after surgery.

I'll ask her again about when the bone scan and CT scan will be done. But I definitely remember her telling me that she's supposed to undergo those, I just don't know when. I'll tell her to request fot the hormone and her2 status too.

You're almost spot on with the treatment outside the US, that's a big part of what gives me anxiety honestly. The doctors not communicating information to us sufficiently kind of seems to be the case here. Or maybe my mom is just not giving me direct answers? I just get all the info from her and have not accompanied her whenever she has her doctors appointment. I'll surely post more here to know the next steps for this.

Pupmom, I'm so happy reading your post. I'm glad you're doing very well after your treatment!

Thank you both so much. Much love.

DATNY

Grade 2 or 3 has its advantages as well, as it responds well to chemo.

Regarding access to info, if you can get a copy of the reports that is a big gain already (there are countries where reports are not released to patients). You can understand what is going on by reading them.

Good luck again! It may be scary and overwhelming at times, and it is normal to feel like this. All of us do, but you will get over this situation and your mom will be healthy once again.