re-occurance question

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laxmom
laxmom Member Posts: 1
edited June 2014 in Just Diagnosed With a Recurrence or Metastasis
I'm asking this question for my cousin who isn't computer literateSurprised! She has just been diagnosed thru a core biopsy with a re-occurrence of er/pr+ her2- invasive BC in her left breast. Her original BC,Dx in 2008 @ age 50, was in her right breast which was treated with a lumpectomy and rads. She is on Tamoxifen. Does this mean that the hormonal has failed?  Her surgeon told her she is a stage 1A--but how can he know this before surgery? Also, from what I've read, people with stage 1 don't usually have chemo, but if it has spread to the other breast, it seems to me that she has cells floating around her bloodstream. Would that make chemo an option? She doesn't see her ONC until the end of the month and is just a little freaked out. Anything you can share on this topic would be a great help!!
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  • CoolBreeze
    CoolBreeze Member Posts: 4,668
    edited July 2010

    I don't know the answers to all of your questions, but cancer doesn't spread from one breast to another.  Breast cancer spreads to the lungs, liver, bones, etc but not to the opposite side.  So, they consider this cancer a new cancer, not a recurrance of an old one.  They will treat it like it's brand new.  She may not need chemo.

    Surgeons make educated guesses on staging, but you are right, he can't know 100% until surgery to see if it's in her nodes.  He is basing his guess on the size of her tumor.  They are often right though, these doctors.  :)

    I know it sounds counterintuitive but her new cancer could be a different kind than her original one.  If it's ER-, than tamoxifen didn't fail, because this new cancer wouldn't grow in response to estrogen.  If she's already been diagnosed ER+ with this new one, then it does seem like tamoxifen doesn't work for her but I don't know much about that.  It's certainly a question she should ask her doctor.

    She might also request the Oncotype DX test since this is her second cancer.  In ER+ women with smaller tumors, it will estimate the benefit she can get from chemo.  She may not need it at all but if they are both ER+ and she has taken her tamoxifen as prescribed, it might be time to explore something else.

    Good luck to your friend. I'm sure she's scared so it's nice that she has you to help her.

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  • redskies
    redskies Member Posts: 99
    edited July 2010

    Yes, my understanding is that this is not considered metastatic disease.  It is referred to as loco-regional recurrance, and it would be described as occuring in the "contralateral" (opposite)  breast.  "Ipsilateral" refers to recurrance in the same breast

    This article might be of interest: 

    Molecular Predictors of Locoregional Recurrence in Breast Cancer: Ready for Prime Time?

    http://jco.ascopubs.org/cgi/content/full/28/10/1627

    The article (2010) states there is insufficient research to determine the need for systemic treatment, but does discuss the use of oncotypes, etc.,  in determining treatment options.  It sounds as if your cousin has luminal A subtype, which is mentioned in the above article.  Does the path report indicate her ki-67 level?  There is some controversy regarding this, but it is one piece of information to look at.  (Luminal A subtype carries a more favorable prognosis than luminal B.)  For more information on determining subtypes:  http://www.hemonctoday.com/article.aspx?rid=40669

    Typically to divide luminal A and luminal B tumors on a molecular basis, you have to do a microarray analysis, and that can be expensive, time-consuming and impractical on a large-scale basis. What the researchers did here was look at an additional marker, Ki67, to see if that was able to consistently subdivide luminal A tumors from luminal B in tumors that were ER– or PR–positive. They were able to essentially divide their luminal A and luminal B patients based on Ki67 and HER2 status and correlate that with prognostic information, but it was also something they were able to correlate back to the actual molecular analysis on microarray. Frequently microarray analysis is costly, it is time-consuming, etc. The Ki67 is something that is reasonably easy for pathologists to do clinically, despite the fact that there can be a lot of interobserver variability. So to that extent, it is a potentially easier way to help subdivide these tumors. The true question that remains unknown is the clinical application of these results and the ability to base therapy recommendations from this Ki67 data. 

    If you look at the rest of the above article, it indicates that a ki-67 level of 13 or lower appears to indicate a luminal A, in combination with being  hormone positive and her2 negative.

    Your question re tamoxifen failing- I know in the metastatic setting that if there is progression (increase in disease) while on a given treatment, that it is no longer considered effective.

    I also am not sure how the Dr could stage her without at least a sentinal node biopsy.

    Also, I strongly reccommend she get a copy of her pathology report, and make sure it is the final version- some tests require longer to complete, so the preliminary report may differ from the final, and will have more info.

     Wishing the best of luck,

    Lynne

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