Tumors Discovered post Neo-Adjuvant Chemo for HER2+

Miza_73

I posted this earlier at the caregiver section, this maybe a better channel to post this.

I am currently a husband and the key caregiver for my wife who is diagnosed with Stage 2 or 3 HER2+ Breast cancer. It is a unique situation where there are no tumors on her breast but the cancer was discovered only at her anxillary lymph nodes.

She had done a 6 cycles of neo-adjuvant chemo therapy with Herceptin and Perjeta and recently undergone a surgery to remove the impacted lymph nodes. Post surgery, we were informed by the doctor that the lymph node impacted were more than what was seen from the PET scan. The PET scan only indicated 6 or 8 but during the surgery 30 nodes were removed for lab test and 27 came back to be cancer positive. The surgeon said that its good that she had removed all the lymph nodes and that there is nothing much to worry about. I asked if this means that the cancer is aggressive, she responded "no", but need to talk to oncologist for further treatment.

I am really taken aback by this recent update and unsure if things have suddenly become extremely critical. We are scheduled to meet the oncologist next week and it was mentioned that my wife may need to have another round of chemotheraphy after her scheduled 30 sessions of radiotheraphy.

I am trying to make sense of all this.

a) why was the tumor not detected during the PET scan?

b) What does 27 out of 30 nodes impacted with cancer mean?

c) If the full lymph node is removed, is she considered safe from the cancer spreading?

d) Does this mean that treatment has progressed to palliative?

e) what is my wife's chance of survival given all these new outcome.

I am trying to prepare myself before meeting with the oncologist next week so that I can have more proper answers.

If anyone have any experience similar to what I am going through, appreciate your kind feedback and advise.

LoriCA

Miza_73 I really can't give you a better response about the nodes than the comprehensive info xxyzed gave in your other post. I just wanted to reassure you again that when it spreads to the axillary nodes it is considered locally advanced. She wouldn't be Stage IV unless it spreads to distant organs or bones (usually determined by a PET scan). Even then, if it is oligometastic - a small number of mets confined to one organ - there is typically an attempt to cure before determining that palliative treatment is the only option (if it continues to spread). In your wife's case, it might be that they are recommending more chemo as a preventative move to make sure there are no cancer cells floating around looking for a new home, but it is standard for HER2+ to go back on Herceptin and Perjeta for enough cycles to complete one year of treatment (18 cycles) after surgery and maybe that's what they meant. If she already had 6 cycles of H&P, she would do another 12 cycles as adjuvant treatment.

Hope that helps ease your mind a bit, and I hope the meeting with the MO goes well.

Lori

Miza_73

hi Lori,

Thank you for the info sharing. We met the onco today, and it’s exactly as you mentioned. The additional chemo is proposed as a preventive measure. My wife is scheduled for her 30 rounds of radio and then to discuss on the chemo session.

The onco said that based on the nodes impacted, my wife is already at stage IV and she is attempting to contain the spread. The onco is also unsure if the herceptin is providing the desired effect but we are still on a 12 month maintenance and to be monitored every 3 months

Let’s see how it goes.