Mum diagnosed doing some research for her

Snapperfish

hello all,

Mum was diagnosed back in jan with idc, approx 3.5cm, ER 8/8, pr neg, her2 neg. she was told it was a stage 2a, grade 2/3. Was advised that her lymph nodes appeared clear on all the ultrasounds so her treatment would most likely be lumpectomy with breast reduction followed by radiotherapy.

20th Aug she had the surgery. Clear margins. However we’ve now been told she has 2/4 lymph nodes cancerous, the original tumour has changed in that it now contains cells that are only 3/8 er positive, pr neg and her2 neg. The lump removed was actually 5.5cm plus margins or whatever extra tissue they removed and def a grade 3. This now means she has to have chemo. Her first oncology appt is 14th Sep.

Does anyone else here have experience of this same cancer? Mum wanted me to do some research for her so I thought I’d start here as you all seem so knowledgeable. Thank you all in advance

Snapperfish

sorry I should add that she is post menopausal, was put on letrozole but the lump gradually got bigger with each scan. She is 61 years old.

ElaineTherese

Hi!

Did her doctors send away for the oncotype test on her tumor? Even though your Mum is less estrogen positive than initially thought, that test might give you some idea of whether the benefits of chemo outweigh the costs of it.

Her doctors might not want to do the oncotype test, given the size of the tumor, the positive lymph nodes, and her cancer being Grade 3. Those aspects of her cancer do suggest that she's a good candidate for chemo. I'd imagine they will want to try something aggressive like Adriamycin + Cytoxin and later Taxol or Taxotere + Carboplatin.

If your Mum was diagnosed in January, why did her surgeon just operate on her in August? That's a long time between diagnosis and surgery.

Snapperfish

hi Elaine,

Thanks for the reply. Her doctor said as she was much less ER positive now, the oncotype score would be in essence irrelevant. I did think her treatment might have to be aggressive with everything I’ve terrified myself with on google 😨.

She was put on letrozole to try and shrink the tumour because of where it was in her breast. It was in a 6 o’clock position, quite far back. She is large breasted so he said the op would be more straight forward and less chance of disfigurement if he could shrink it first. Unfortunately because the cells changed the letrozole had little effect on it

ElaineTherese

OK, thanks for the clarification. In the US, doctors are more likely to use chemo than hormonal therapy to shrink the tumor before surgery, but I've heard of a few others who have followed your Mum's path. Being Grade 3 doesn't sound like good news, but if your Mum's going to do chemo, it is. Chemo kills fast-growing cells, and, of course, Grade 3 cells are growing quickly. I was Grade 3, and chemo got rid of the active cancer in my breast and nodes.

As for where your Mum fits in "chemo world" now, her doctors may consider her akin to a triple negative patient. Yes, triple negative has a reputation for being aggressive, but any cancer that is Grade 3 is pretty aggressive. The good news is that women with triple negative breast cancer often have good outcomes. It is the case that triple negative patients have a relatively high rate of recurrence after the first 2-3 years of diagnosis. However, that rate of recurrence decreases rapidly thereafter.

Snapperfish

thank you so much for taking the time to respond to me so informatively. It sounds like mums going to have a rough ride. All the info the drs give you is so confusing so I’m glad we have some idea of what will happen.

Can I ask your opinion please? Last year my mums maternal cousin also had breast cancer. Shes51, pre menopausal. She was found to have a 3.5cm tumour, er positive (not sure how strongly), pr neg, her2 neg, micromets - I think that’s what they called them - in about 2/3 of her lymph nodes. She was put on tamoxifen, had shots to stop her ovaries working, lumpectomy and reduction and then radiotherapy. She too was grade 3, stage 2a. Do you think she should have had chemo? No oncotype scoring was carried out. Sorry for so much info and manyquestions.

ElaineTherese

Regarding your Mum's cousin -- did her cancer respond well to the Tamoxifen + ovarian suppression? If so, her doctors might have thought that the cousin would only need more Tamoxifen + ovarian suppression after her surgery. In contrast, your Mum's cancer did not respond well to the Letrozole, so giving more Letrozole after surgery would not have been considered the best option after surgery.

Remember that both hormonal therapy and chemo are systemic treatments. Hormonal therapy starves cancer cells of the estrogen that feeds them; chemo kills cancer cells that travel through the bloodstream and the lymph system. Both are designed to prevent cancer cells from setting up shop in the bones or in major organs (lungs, liver, kidneys, etc.) and producing an incurable form of breast cancer (metastatic or Stage IV cancer).

In contrast, surgery and radiation are local treatments; they involve removing invasive cancer where it has already been detected.

Both your Mum and your Mum's cousin have been given local and systemic treatments.

Snapperfish

thank you you wonderful lady. You’ve helped me answer a few questions in a very bad dark moment and you answered my call for help.