invasive ductal carcinoma with her2-positive

julie2uga

My mother was diagnosed today with invasive ductal carcinoma; with her2-positive and 1.2cm lump. Would love any advice or treatment plans that have worked for others with this similar diagnosis. She has lived a very healthy happy life

Moderators

Hi julie2uga, and welcome to Breastcancer.org,

We're so sorry to hear of your mom's diagnosis, but we're really glad you've found us. You're sure to find our Community a wonderful source of advice, information, encouragement, and support -- we're all here for you and your mom!

There are many factors that go into a breast cancer diagnosis and drive the recommended treatment. It's very much an individualized treatment, based on those factors. The factors include all of the pieces of your mom's pathology report -- which probably isn't complete just yet until all tests are completed from the biopsy/surgery. Click the link above to find out what each piece of the pathology report will mean for your mom's treatment.

In addition, we have a helpful page on the main Breastcancer.org site that lays out the usual course of treatment based on cancer stage (which the doctors may not even know just yet!). But when you receive this info, it could be a helpful guide to give you a general idea of what to expect.

We hope this helps get you started and please let us know if there's anything we can do to help! Others will be by shortly to weigh in also.

Welcome, again!

--The Mods

Melbo

the resources the mods pointed you to are great starting points. There are a lot of considerations that go into what treatment is appropriate and what order they go in. Do you know if your mom is hormone positive or negative?(ER and PR)

HER2 positive cancers are generally considered aggressive, which can be scary, but there are actually quite a few medications that specifically target HER2 and tend to work really well against it. The big medication is Herceptin (or a bio similar like kanjinti) — by itself it's usually a well tolerated medication and often hasno major side effects. In most cases though, they pair herceptin with chemo medication. It will depend on your mom's age and other medical issues, which chemo medications are chosen.

A lot of times they start Her2 positive cancers on chemo combined with herceptin. Once the chemo is finished it's time for surgery — either lumpectomy (also called partial mastectomy) or a full mastectomy. During this time the herceptin continues (usually an infusion every three weeks.) after recovering from surgery they may recommend radiation — depending on the type of surgery chosen, or if they discover cancer in the lymph nodes.

Treatment usually lasts a full year. Several months for chemo, time to recover, then surgery, time to recover from that before starting radiation, and then continuing with herceptin.

Sometimes, depending on the size of the tumor, they will do surgery before chemo/herceptin. I'm not sure what the tumor size cut off for that is though.

It's all terrifying as you get started and pretty much none of it is fun. But it's treatable and many, many women have successful treatment and can move on with their lives once they are done.

julie2uga

she is 61. No underlying health issues. She wants a full mastectomy immediately. I wonder if that will help vs waiting or just doing a lumpextomy

julie2uga

And she isPositive for both ER and PR

Melbo

she is what we refer to as “triple positive” — there are a few groups on the boards specifically for triple positive treatment. For hormone positive (The ER/PR part of triple positive) they usually give some sort of hormone inhibitors as well. I wasn’t hormone positive so I’m not as familiar with those options for treatment.

While I understand the urge for a full mastectomy, there have been some recent studies that have shown lumpectomy + radiation has better outcomes than mastectomy. There is definitely some question about exactly why that is though — so take it with a grain of salt. My doctors told me lumpectomy+ radiation was as good as mastectomy as far as outcomes go. I think a lot of it has to do with how wide spread the cancer is, the size of the breast to begin with, and a persons tolerance for surgery as well as the surgeon’s recommendation.

The big thing to remember though is that having a mastectomy is NOT a guarantee that the cancer will never come back. There will always be some breast tissue left behind after a mastectomy and that tissue can cause a recurrence (same cancer coming back) or cause a new cancer down the road. I think there are statistics that go along with all of this, and maybe someone else will chime in with those.

Aram

julie2uga, I am sorry for four mother's diagnosis. There is an active triple positive group you might want to check:

https://community.breastcancer.org/forum/80/topics...

msphil

hello sweetie this is where your mom can get good helpful info from others going thru and others like myself that has gotten through. I was diagnosed in my early 40 s healthy also was making plans for our 2nd marriages when I found the lump. Had 2nd opinion with same result was diagnosed with IDC stage2 0/3nodes 3mo chemo before and after Lmast got married then 7wks rads. Praise God 27yr Survivor and also Our 27yr Wedding Anniversary. Hope this is Inspiration for your Mother. Hope and Positive thoughts. msphil

1982M

Your mother's diagnosis is similar to mine, except I'm 39. I think the biggest difference will be I will have genetic screening where your mom likely won't unless there are other familiar cases. I know my dads mom and two of my aunts did end up getting BRCA testing years ago bc of the frequency of breast cancer on that side and my grandma was 70+.

My tumour is 1.5cm, biopsy says grade 1 and triple positive. Because of the size and I am assuming the grade and clear breast MRI they chose surgery first. My tentative plan (which it's the fully confirmed until post surgery) will be:

1) Lumpectomy and sentinel node biopsy (Aug 12).

2) Chemotherapy paired with immunotherapy. I'm not fully aware of the regime they think is best. I'm hoping taxol x12 weeks and herceptin x 12 months but it could be longer/different. If your USA based I think they add perjeta to the regime but not so sure if where I am does unless it’s in the lymph nodes. This will happen around 4 weeks after lumpectomy I believe but I haven’t seen a medical oncologist yet. The wait is longer here bc of how our system works and it’s summer. So I don’t see them until after surgery.

3) more surgery or radiation or both. I'm hoping for a oncoplastic reduction with radiation (I've been on a wait list forever and was suppose to get mine feb 2022 so I hope it lines up). Or possibly just radiation if I can't get the surgeon I want for the reduction (in Canada in a small city. It's very limited choice and access) OR if genetics come back positive it will be bilateral mastectomy with or without radiation depending on my node status.

Good luck to your mom. I hope treatment goes well for her.

julie2uga

Her low white blood count came by low and her surgeon is having her meet with her Oncologist (early) next week. Any idea what that could mean?

Melbo

for breast cancer you usually have three different doctors — the surgeon is in charge of the surgically removing the cancer, the oncologist is in charge of systemic treatments like chemo, herceptin, or anti-hormonal drugs, and the radiation oncologist is in charge of the radiation treatment. A lot of times there will also be a plastic surgeon who is in charge of reconstruction.

Meeting with the MO (medical oncologist) early is pretty standard. They will likely discuss all of the systemic treatments and help you understand what the options are/scheduling looks like.

As for the low blood white blood count, there are some medications that could help boost it — I’m not sure if that’s why she would be meeting the MO now, or if it’s just the standard schedule. Do you know if she will be having surgery first?

julie2uga

Yes surgery first, on the 23rd.

SpecialK

julie - I am wondering if one of the reasons the surgeon referred your mom to the MO was to address her low WBC prior to surgery. Low WBC leaves your mom vulnerable to infection, which is a risk of surgery under normal circumstances. I would not be surprised if the surgeon also prescribes a prophylactic antibiotic ahead of surgery, which continues for a period of time afterward as well. Is your mom petite? Sometimes smaller women have lower lab counts as the standard ranges were established for adult men, not women at all. For some a lower count - low end of the range, or slightly below - is their normal. That is true for me, and my WBC is lower than normal even though it recovered to within the range after chemo, it now consistently sits just slightly under the low end of the range. My MO is aware of this and is not overly concerned. That said, it is important to have the MO take a look and possibly repeat the labs prior to surgery and weigh in on the best way to proceed.

julie2uga

That is helpful! Yes she is petite 5'1" ~120 lbs. Also, she was on doxycycline for Rosacea and side effects are low WBC plus her low has always been low. I just wonder if that means she's always been fighting the cancer or if it has spread. Or does the body not fight cancer

SpecialK

julie - I am not aware of a particular impact on WBC from newly diagnosed, and as yet untreated, early stage breast cancer - or any indication that a low count is tied to physical response to early stage breast cancer. This would be different for a blood cancer like leukemia, of course. Most of the discussion around blood counts, specifically WBC, are the impact of chemotherapy - often lowers WBC - and infection - often raises WBC. One of the tools in the arsenal with chemo is an injection of a drug (pegfilgrastim, or similar) which stimulates the production of new white blood cells in the bone marrow to counteract the die off of same from some regimens of chemo. There is some possibility that one of the reasons the SO wanted your mom to see the MO prior to surgery is a preliminary injection of this medication to boost her WBC.

4kids4dogs

julie2uga,

Hi. I was just diagnosed as well with IDC. Stage 1A. Estrogen and progesterone positive and HER2 positive. Same as your mom. I went into the breast surgeons office thinking I wanted a full mastectomy also, but listening to the doctor, he explained to me that having chemo and a lumpectomy and radiation is a better option for me. I still have to have a breast MRI and genetics testing, etc, and unless they find something more in the scans I'll b getting, this is the plan. I'm 53 years old. The doctors said they expect to cure me, so I have a very positive outlook. Your mom should too. I'll b thinking of her. Maybe she can join this group and we can do this together!!!

I'm sure you are a great daughter and she has lots of support from you!!

Lots of luck and love!