HER2+ means that your cancer has an overexpression of the HER2+ protein which encourages the rapid reproduction of cells. That is why HER2+ cancers are considered to be aggressive. Breast cancer cells can circulate throughout the body through your bloodstream and/or lymph system. If they find a new home (in the lungs, liver, brain, bones, etc.) they are still considered breast cancer cells. Herceptin and Perjeta are targeted therapies which block the action of the HER2+ protein and reduce recurrence. Hope this helps!

Hi Chocomousse:

Size matters and the guidelines provide DIFFERENT recommendations based on size and nodal status.

For example, in contrast to your case of a 3 mm IDC (tumor ≤ 0.5 cm), many of the ER+/PR+ HER2+ ladies here have tumors greater than > 1 cm.

For hormone receptor-positive HER2 positive tumors greater than 1 centimeter, the NCCN Guidelines recommend:

"Adjuvant endocrine therapy + adjuvant chemotherapy with trastuzumab (category 1)"

That is the highest level of consensus under the guidelines (category 1), and all three interventions are recommended.

In contrast, for tumors like yours, the recommendation under the NCCN guideline is different. For ductal carcinoma (IDC) node negative (N0) tumors ≤ 0.5 cm that are hormone receptor-positive and HER2 positive the NCCN guideline states (emphasis added by me):

"Consider adjuvant endocrine therapy ± adjuvant chemotherapy with trastuzumab (category 2B)"

Note the differences in bold in particular. With these smaller tumors, the word "consider" is included, so adjuvant endocrine therapy (e.g., tamoxifen) is an option. In addition, there is a ± symbol to indicate that chemo and trastuzumab are not always recommended. It will be a personalized risk/benefit analysis for you.

I don't know if you saw my reply to you from earlier today. There is a link there to a thread for people with small HER2+ tumors like yours, whose situations are more comparable to yours.

https://community.breastcancer.org/forum/68/topic/...

With all invasive cancers, there is always some concern of distant and undetected spread, which could form a metastasis if the cells manage to survive and replicate in another part of the body. If breast cancer cells do manage to escape their location in the breast via the blood stream or lymph, they tend to establish themselves in particular locations such as the bones, lung, liver or brain (that is their usual habit).

HER2 positivity is a risk factor that increases the risk of distant spread by some amount. Larger tumors also have an increased risk of distant spread.

Tumor markers tests are imperfect and lack the sensitivity to detect a few rogue cells that may become problematic in a few years.

Surgery is a local treatment. The main purpose of giving trastuzumab (anti-HER2 antibody) plus chemo is that these are systemic treatments that can reach cancer cells wherever they may be, especially any that might have escaped the breast.

There is a lot of support here if you do decide on such treatment.

BarredOwl

choco,

I had nearly the same diagnosis as you had, and I had a mastectomy at UCSF, where I was told by my MOs that even though it was very small 7mm and node negative they didn't want to treat me too much or too little ( seeing that it was HER2+.. ( nothing to fool around with) I sent my pathology to my MOs at Cedars Sinai in Los Angeles (where I had been treated 25 yrs ago for bc back in 1990 when I was in my 30s) I wanted a second opinion. They advised no chemo or herceptin... Just arimidex... UCSF however recommended Taxol for 12 wks and herceptin for the rest of the year. I already wanted another mastectomy. After reading studies I decided to go with the UCSF treatment plan. I'm glad I did. I finished chemo in mid April and they suggested cold capping so I kept my shoulder length hair despite chemo. Chemo is never a picnic , but I've done this before so I figured why not do everything suggested just so I would have no regrets. Talk to your doctors and there are many of us here who've been through this , there's lots of support available from everyone here. Take care.

Thank you all so much, I understand much better now. I'll check out your post and the link, Barred.

Hi Carolina59, I didn't think that HER2 could prevent mets, I just thought it was exclusive to breast tissue as HER2 proteins are receptors on breast cells exclusively.

"HER2 (human epidermal growth factor receptor 2) is one such gene that can play a role in the development of breast cancer. Your pathology report should include information about HER2 status, which tells you whether or not HER2 is playing a role in the cancer.

The HER2 gene makes HER2 proteins. HER2 proteins are receptors on breast cells. Normally, HER2 receptors help control how a healthy breast cell grows, divides, and repairs itself. But in about 25% of breast cancers, the HER2 gene doesn't work correctly and makes too many copies of itself (known as HER2 gene amplification). All these extra HER2 genes tell breast cells to make too many HER2 receptors (HER2 protein overexpression). '

Choccomouse,

Cancer that spreads outside the breast is still breast cancer. I think this is the source of your confusion. Cancer that spreads to the liver is not liver cancer. It is metastatic breast cancer with all the characteristics of the original tumor. Thus the aggressive treatment

Wabals, that explanation makes sense. Weird that breast cells can cause cancer outside of the breast.

running cello,

My periods stopped with chemo as well and resumes about 5 months after the "big" chemo stopped(October). At first my periods were very heavy until about 3 or 4 months months ago, they were very light and became a little irregular(which they have never been). I went 6 weeks before starting my period where before I was always right on every 4 weeks. I just had a hysterectomy so won't have to worry about that anymore but think the Tamoxifen did play a role in that. I have heard some women don't have periods at all with the Tamoxifen. Hope this helps!

Take care,

Kathy

thanks for the words of kindness my period has been pretty regular except with this last month it coming twice. I mentioned it to my oncologist and she said its your period just going back to normal.. I need to pick an OBGYN, no sexual activity until I began tamoxifen but I'm just nervous with the transvaginal ultrasound and pelvic exam I just envision them hurting. I know many see an OBGYN before intercourse but in my culture that's not common and it's done post intercourse.

When you say spotting is it quite literally just blood out of nowhere and it's for that one moment or is it like an irregular period for to

Ok any ladies out there I need your help !! I went to the web site for cancer math and it asked for tumor size ..

Can some one tell me how to put that in there my pathology report states this. 2.5 x 1.8 x 1.5 cm I can't put it in there that way and I'm not good with math. does anyone know how I would put that in there? thank you.

Also how accurate is this site ?

ang7894 I think the site is pretty accurate but not so if you have a tumor over 5cm or a lot of node involvement because they haven't studied that in this too.

Thanks SpecialK. That makes sense. So those meds attack HER2 wherever it is even when it's not overexpressed.

gretagirl, I also had my lumpectomy before my diagnosis and have wondered about mastectomy vs an additional lumpectomy (margin not perfectly clear). My surgeon is saying lumpectomy with rad is just as good. I would be interested in hearing others thoughts.

Hi All!

We would really like to put together a slide show showing all your faces to show the amazing diversity of our community, reaching around the world. Please share with us here https://community.breastcancer.org/forum/135/topic..., or PM us. We may also present this at our annual fundraiser in October.

Photo (best quality possible)

Where you live

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Quote about how the community/BCO has helped you.

Thanks Everybody!

I'm in the chair now getting my last Herceptin treatment. I'm so excited to be done! My MO still wants to see me in three weeks to make sure I feel good and my labs are good after my surgery. I'm scheduled on the 25th for my ooph/saling. I also saw my cardiologist this morning. He said my last echo looked really good. Still wants me on heart medication to protect my heart. Not excited to still be taking more drugs but definitely don't want heart issues either.

MX = LX + rads. The stats are almost identical. You need to do whatever makes it easier to sleep at night.

mommato what type of drugs are you taking for your heart