Chemotherapy or not? Opinions or information needed!!

Hi Fighting, I am sorry to hear about your mom's situation. From what you are describing it appears she has a good doctor who explained the stats. If your mom is not sure what to do maybe a second or third opinion would help and she would also have an opportunity to ask more questions about the stats. I personally, never found those stats of much help. Talking to experienced professionals give me much more than any percentages. Age and personal medical history should play a big role in such decisions as well.

Good luck!

Goodness, since she is HER2+, IMO she absolutely NEEDS chemo! Before the discovery of that over-expressed gene, and before Herceptin, that is the reason why many early stagers, who statistically shouldn't have recurred, did. Hercepetin is like a miracle drug for HER2+ women! I can't imagine why the doctor is so neutral about this!!!!!!!!

If the diagnosis in the signature line is her mom's, it is 1 centimeter and staged at 1B.

Hi, I'm sorry you're here. Judging by the TNM stats you posted, along with the hormone receptor status and HER2 amplification, I would say she most certainly should STRONGLY consider chemo, targeted therapy, and anti-hormonal therapy.

Your mom's tumor being T1c means it's between 1 and 2cm. Building on what Special K stated, when dealing with either a HER2+ or Triple Negative tumor over 0.5cm, the guidelines state that chemo should be considered, and if over 1cm, chemo should be given. That's because these types are known to be very aggressive and more likely to recur in distant areas of the body. It doesn't mean they always will, but it confirms she's not dealing with a slower-growing, more indolent cancer.

Did you mean Ni or N1mi? The difference would be the amount of cancer cells found in the node(s). Assuming there's only one node found with disease, then the first designation would be that isolated tumor cells of less than 0.2mm or less than 200 cells were found. The second designation would mean that microscopic mets were found in the node and measured greater than 0.2mm, but less than 2mm. Generally speaking, cancer found in the nodes means she's dealing with a cancer that for whatever reason, has become mobile. When evidence of this is found, it increases chances that other cells have escaped and entered the bloodstream or lymphatic system--besides the ones visible in the axilla. There are opinions in the research community that when evidence of lymphatic spread from a smaller tumor (generally under the 2-3cm range) is found, it points to a tumor with more aggressive characteristics.

Since you indicated the TNM staging was from a pathologic designation (the p at the beginning) rather than clinical, did they do imaging to confirm an M0 rating? Given this tumor's worrisome findings, if it were me, I'd want to know for sure that the team had looked and found no evidence of distant metastatic spread at this point.

The HER2 amplification, or HER2+ staining indicates an inherently aggressive tumor. Please don't take that I'm only delivering bad or worrisome news. While NO ONE wants breast cancer, the available treatment options for HER2+ disease means that women with this diagnosis now have significantly better chances of long term survival (both disease-free and metastatic) because of targeted therapies. As others have said, Herceptin and Perjeta have been game-changers for these patients. As someone with Triple Negative, I wish I had any targeted therapy available.

The option of anti-hormonals was discussed. While these should definitely be given because she is ER+, they are very unlikely to be the sole treatment of choice given both the amplified HER2 and the PR-. As I've discussed, the HER2+ means she really does need the targeted therapy. Typically, PR- tumors have a more aggressive profile than PR+. That's if all things are equal. Comparing like tumors that only differ in their PR-, generally, though not always (there are no absolutes in breast cancer) means a tumor with a higher rate of proliferation and dissemination when there is an absence of Progesterone Receptors. For instance, in ER+/PR-/HER2- tumors, these are generally Luminal B, and more likely to be Grade 3. ER-/PR-/HER2+ is known for its lack of hormone component, which reduces treatment options. And then there's ER-/PR-/HER2- (Triple Negative) which is a designation of exclusion and has no targeted therapies because it's an umbrella term describing what the tumor lacks rather than what it contains. PR's role is a somewhat contentious area for researchers, but the consensus is that its absence spells a more active tumor.

Please don't take that I've been gloom and doom. Your mother truly does have every reason to expect and hope for a long, disease-free life, particularly if she avails herself to all the treatments. I'm not someone who states someone must always do all of the conventional treatments recommended. I went against medical advice on one major portion of treatment. However, from the standpoint of being informed about what her diagnosis means about future recurrence risk along with the treatment options that can be used for her specific diagnosis, I think this is a time to pull out all the stops and give herself the best shot at living disease-free and putting this in the rearview mirror.

Best of luck.

Best of luck to your mom and you, fighting. You are a wonderful daughter!

A friend of mine who was in her mid-60s was allowed to do Herception only because, along with being a very early Stage IA, she was very ER/PR positive (I can't remember the exact numbers but it was close to 100%), so anti-hormonals were very effective for her situation. It must have worked because she is 8 years out!