HER-2+ in Node only???

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nobleanna007
nobleanna007 Member Posts: 641
edited June 2014 in HER2+ (Positive) Breast Cancer

I am sorry after reading my own topic I saw what I did! DUH!!!! I am going to blame it on pain meds!!!! My friend has ILC in both breasts which came back negitive for Her-2 The last biopsie she had was on a Lymphnode and it came back positive for HER-2. She is very confused and I have not heard of this. Is it possiable does anyone know!!!

                                         Thanks!!!!!!

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  • jill323
    jill323 Member Posts: 412
    edited March 2009

    Nobleanna -

    Well... I have to admit, I have been on this board a while and this is the first I have seen of this, which is probably why you have not gotten too much of a response.

    There are a couple thoughts that have come to mind:

    1) Her2 is usually diagnosed first via a method called ICH.  If the Her2 overexpression is borderline, it can swing either way, and can be very objective.  If that happens, they usually send it out for a test called FISH which is much more discriminating.  Do you know if your friend's tumor has been tested by ICH or FISH or both.   If tested by ICH, was the one in the breast characterized as 2+?     (What I am getting at is that perhaps the one in the node appeared over expressed via ICH while the one in the breast may have appeared borderline - especially if evaluated by two different pathologists).

    2) I have seen some cases where there have been slightly different characteristics of two different tumor types - but usually that is in the case of LCIS/ DCIS vs. ILC/IDC.  In other words, it is possible to have two different tumor types at the same time with different characteristics, but usually that shows up as an insitu component and an invasive component.

    3) The other possibility is that your friend's cancer is "multi focal".  In other words, the cancer that is presenting in the node is not the same as in the breast and that there is another tumor.   Did your friend have a surgery yet ?   Was the ILC diagnosed after surgery or via biopsy ?   Now.. I would not get her freaked out on this one.  It is only a remote possibility, especially if the ILC diagnosis came after surgery and they have already looked through the breast tissue.  I am just brainstorming here.

    This is an interesting situation.   Check into the things above, and let us know what you find out.  I hope the mystery gets solved (and in a good way for your friend).

    Jill

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  • nobleanna007
    nobleanna007 Member Posts: 641
    edited March 2009

    Jill,

         Thank-you so much for your response. She has not had surgery yet. Maine wants to do chemo first and when she touched base for surgery and reconstruction in Boston they questioned why she is not having surgery first. So now she is really confused and is going for a second opinon in Boston on the 26th. Your also right she does have 2 kinds of cancer in each breast ILC/IDC and I am not sure how many nodes on one side are involved. She just asked me knowing I was Her-2+++ if this was possiable or like you said it was 2 diffrent pathologist looking at her biopsie tissue. I will know more after she has gone to Boston.

         I had not heard of this happening either so I felt bad when I could not help her. Her diagnosis is so diffrent then mine. And her treatment plan is so diffrent and she asks me question's that I just can't answer for her.

                                             Thanks again!!!

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  • HensonChi
    HensonChi Member Posts: 357
    edited March 2009

    Hi,

    My breast cancer was not Her2 but it turned Her 2 in the node.  Doctor said it is a little strange but Cancer will do what it wants.  I was ILC in the breast ER and PR positive grade 2.  In the node it was HER+++ and grade 3.  Wierd right? 

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  • TenderIsOurMight
    TenderIsOurMight Member Posts: 4,493
    edited March 2009

    Cancer is marked by sojourns, or time from one event to another. For example, time from in situ to time to invasive (if you believe this). Time from no node to time to some node. With ER+ breast cancer there seems to be cross-talk with the HER family of genes, and perhaps an as yet unclear (but talked about) timeline events occurs here too.
     
    One thought is perhaps the node reflects the more recent event in the timeline, and hence the most up to date immunologic reflection w.r.t. HER testing. In other words, perhaps your friends HER node + stance is the most recent in the sojourn of her individual cancer. I am sorry for her news which causes us upset. Better to know though so the remarkable HER antibody drugs can be used, than not. It's the borderline HER cases which cause me great unrest for reasons stated clearly above.
     
    This gives credibility too, imho, to trying to re-biopsy any new lesions in possible recurrence or metastasis (not your friends situation!). This sojourn of our own tumors are unique to us, and retesting our markers may yield beneficial information and treatments.
     
    Edit Update on biopsy in possible new lesion: first it's worth mentioning (sorry I forgot) that about 10% of biopsies to evaluate for mets turn out to be benign. That's a number to keep in your head during a stressful biopsy. Here is an abstract which I just read which may put this into perspective:
     
    Does confirmatory tumor biopsy alter the management of breast cancer patients with distant metastases?Simmons C, Miller N, Geddie W, Gianfelice D, Oldfield M, Dranitsaris G, Clemons MJ.Division of Hematology and Medical Oncology, Princess Margaret Hospital.
    BACKGROUND: Decisions about systemic treatment of women with metastatic breast cancer are often based on estrogen receptor (ER), progesterone receptor (PgR), and Her2 status of the primary tumor. This study prospectively investigated concordance in receptor status between primary tumor and distant metastases and assessed the impact of any discordance on patient management. Materials and methods: Biopsies of suspected metastatic lesions were obtained from patients and analyzed for ER/PgR and Her2. Receptor status was compared for metastases and primary tumors. Questionnaires were completed by the oncologist before and after biopsy to determine whether the biopsy results changed the treatment plan. RESULTS: Forty women were enrolled; 35 of them underwent biopsy, yielding 29 samples sufficient for analysis; 3/29 biopsies (10%) showed benign disease. Changes in hormone receptor status were observed in 40% (P = 0.003) and in Her2 status in 8% of women. Biopsy results led to a change of management in 20% of patients (P = 0.002). CONCLUSIONS: This prospective study demonstrates the presence of substantial discordance in receptor status between primary tumor and metastases, which led to altered management in 20% of cases. Tissue confirmation should be considered in patients with clinical or radiological suspicion of metastatic recurrence. 
     
    My best to you both and all here,
    Tender 
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  • TenderIsOurMight
    TenderIsOurMight Member Posts: 4,493
    edited March 2009
     
    Just want to say there is ongoing research to develop a possible HER vaccine in breast cancer. I didn't mention this in my above post, but it is related to sojourn and HER status.
     
    Please look at the home page of breastcancer.org for vaccine therapy being developed. Also if you use the 'search' function on the forum entering HER, vaccine I believe a thread will pop up.
     
    Tender 
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  • nobleanna007
    nobleanna007 Member Posts: 641
    edited March 2009

    Thanks Tender,

            I will know more when she gets back from Boston. I just want to help her and she is not much for boards,even though I have told her how much they have helped me. Just reading diffrent things on diffrent opinions or things I never heard of like the Diep recon. was never brought to my attention. Really burned my butt. It was thanks to these boards I learned about it. I will update when I find out more.

                                                                Thanks again.

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