83 y/o mom (ER+PR-Her2+), stage 2a, grade 2. Is there hope?

Anonymous · February 2019

my-mother-is-my-light · February 2019

She Will be 84 in late March, otherwise she is in good health.

Her doctor has offered lumpectomy and then radiation and then controlled visits.

I read that older gals do not get as good of treatment as younger ones and this worries me. She was not offered chemo, according to her doctor her tumor is 1.6cms, and has one lymph node involvement.

However she mentioned it is not as aggressive as she has a positive estrogen receptor.

This is all overwhelming and new to me.

I want to ask you all fighting this battle. (and forgive me if I sound ignorant, this is all new to me)

Does she have any hope?

Is radiation enough for an 83 year old?

I know she has lived a long life 83 years, but it's my mother and as her child the thought of her not being around terrifies me.

I want to see her reach 90!

Sending you all my support and best wishes!

Salamandra · February 2019

It is much more common now than it used to be for women of all ages not to get chemo for early stage (1,2,3) cancer. I was 39 at diagnosis and did not get chemo. That said, I had a hormone receptor (ER+/PR+) cancer. Do you know the hormone status of your mother's cancer?

Something like 70-80% of stage 2 breast cancer is successfully treated (ie, goes away and never comes back) by surgery alone. Radiation adds to that. So even if your mom isn't interested in more invasive treatment, which is the case for a lot of older people, there is still an excellent chance that whatever ends up getting her in the end, it won't be breast cancer.

If your mom would be willing to get chemo if indicated, she could ask her doctor for the Oncotype or mammaprint test, which tells you if the tumor is a high risk one that is more likely to benefit from chemo.

The other common treatment that can add a couple more percentage points to a hormone receptor positive person's chance of disease-free outcome is endocrine (hormone) therapy. For a post menopausal woman, first line treatment would likely be an AI that suppresses whatever estrogen the body is still producing. However, it can also have side effects, including bone loss, and women tend to stay on it for 5-10 years. It's hard to tell from your letter whether the doctor offered it to your mom and she didn't want it, whether the doctor didn't offer it because your mother has other conditions that make it seem too risky (osteoporosis or something - although some older women with bone loss issues take tamoxifen instead, which is the first line for pre-menopausal woman and slightly less effective than AI but still helpful), or whether the doc just assumed your mother wouldn't want it.

Anyway, on this 'journey', I learned that a lot of the things I thought I knew about breast cancer (after losing my mother to de novo stage 4 breast cancer twenty years ago) were wrong. This site is very useful for reading about the current state of treatment and research. I would say there is plenty of hope that with surgery and radiation, your mom will have her pre-diagnosis life expectancy without too much discomfort and side effects.

my-mother-is-my-light · February 2019

Salamandra, thank you so much for your reply.

All I know it's my mom's specific BC is

Estrogen (POSITIVE)

Progesterone (NEGATIVE)

HER Neu (POSITIVE)

The doctor did mention that a good news would be that she has positive estrogen, which I suppose means she has a hormone receptor kind of BC.

From my understanding they do not know much about that specific ER+ / PR- and it often gets lumped in with the ER+ Pr + group (your group)

Her2 for her is Positive I suppose since it said on her report that HER2neu was positive.

I am very glad to read that chemotherapy is not a must for many women in early stage (my mother is stage 2a).

I Will continue to find more info about her specific type of cancer in order to be able to answer all the questions… for now, this is all new to me. A week ago all I knew about BC is that it is a cancer that affects the breast…. so with her diagnosis I have been doing a lot of Reading and learning.

I want to be her biggest advocate because being 83, she doesn't really know how to connect with others using technology.

NotVeryBrave · February 2019

What kind of doctor is recommending her treatment? I'd recommend that she see an oncologist before she decides on anything. Better yet - two of them!

Salamandra · February 2019

I think NotVeryBrave's advice is right on. A second opinion is a great thing. The general recommendation is an NCI-designated cancer center for at least one of the opinions.

In the mean time, you might find this calculator of comfort. Even if her tumor were grade 3, it says only 2% of 83 year olds with her situation would die of the breast cancer in the next ten years. (The overall mortality rate is 41% for all 83 year olds and 39% for 83 year olds with your mom's cancer situation). That's without chemo or endocrine therapy. Which may be why the doc recommended that.

Chemo can be helpful but it can also be very hard on a body, so depending on your mother's case, it could actually not only diminish her remaining quality of life, but also lead to deaths from causes related to chemo. I can see why doctors would want to be very careful with an older person. If she were interested in it (I think a lot of older people aren't) it would be super important to have a medical oncologist with a lot of expertise and experience in treating women her age.

Meow13 · February 2019

I would not think chemo would be recommended perhaps being er+ pr- aromatese inhibitors might be a good choice. Her tumor is small and there is no reason to think she doesn't have many years ahead. I won't get too excited about the her2 positive part perhaps they may want to try herceptin. Maybe ask for a couple of oncologist opinions.

my-mother-is-my-light · February 2019

NotVeryBrave: The specialist that recommended the treatment for her was an oncologist/cancer surgeon at UNC. (University of North Carolina). (I checked the reviews the oncologist has, and she has pretty good reviews from patients) but I Will look for a second opinion. THANKS A LOT for that piece of advice!!!

My mom does have issues with knee arthritis and diabetes (although she keeps the diabetes in check, she is so good at it, her sugar count has been within the normal range for several years.) Other than that, she is pretty upbeat and healthy.

That calculator has brought me piece of mind!!! Thanks so much Salamadra. Once one starts to see statistics and the overall picture, it is hard not to feel relieved and hopeful.

Today my mom has an appointment so I am asking them why don't they recommend chemo but I suppose her age is a consideration.

The treatment they offered is: (Not in order)

Lumpectomy

Some form of ink to see how many lymph nodes are affected.

Radiation (not sure how much)

Then, Tamoxifen for five years or more.

my-mother-is-my-light · February 2019

Meow13, regarding her HER2 positive tumor, are there treatments that can Benefit her?

farmerlucy · February 2019

That sounds like a very reasonable treatment. Tamoxifen is easier on the bones than an AI. I would imagine breast cancer is not going to slow her down at all. My 85 year old diabetic father started daily exercise based on the book “Younger Next Year”. He’s lost fifty lbs in the last year and no longer takes any diabetic meds. Exercise is the best medicine at any age.

Rah2464 · February 2019

My own mother in law was diagnosed with a second bout of breast cancer at age 80. She was in the early stages of dementia so a family decision was made to only do a lumpectomy (along with consult with her ONC). No rads or any other treatment. We had her until age 88. She also struggled with diabetes and severe osteoporosis so no one felt it was fair to add additional treatments that could drastically change her remaining physical health. But every case is unique and I am happy that you are getting second opinions. All 80 year olds are not the same and I think it is wise to consider mental and emotional health along with physical health. My best to you and your mother in law during this journey, she is a lucky lady to have you in her corner to help her determine the best path forward.

MCBaker · February 2019

The HER-targeted meds are frequently associated with cardiac problems.

If I were her, mastectomy with no radiation necessary would be a better option. It was my first decision, and was in the final diagnosis, necessary. Sentinel node biopsy goes with that, too. She might be happy with no reconstruction.

my-mother-is-my-light · February 2019

thank you all so much for these messages. They bring enormous peace of mind.

Today her appointment was a series of scans including pelvis, brain, to see if she has any cancer elsewhere.

By monday the results Will be in, so i am naturally nervous and hopeful nothing serious is going on.

I was told it is a fairly common procedure after a breast cáncer diagnosis to scan people's bones and so on, so I am just praying. She says she feels completely normal in fact quite the appetite so I am hopeful this BC Will be the only bad news.

I have you all on my prayers, wishing you the best!

my-mother-is-my-light · February 2019

If she was diagnosed with BC stage 2a, grade 2 and today she had pelvis, bone, chest scan… are they trying to see if the cáncer has spread before they treat her?

if so... is it plausible that stage2 canncer could spread or does it have to be stage 4 in order to spread?

I am sorry this is all new to me, and I am worried sick… we get results monday! Long weekend ahead.

NotVeryBrave · February 2019

It seems to vary widely in terms of how much testing is done - now and down the road. I never had any scans beyond the mammogram, US, and breast MRI. I had a chest xray after the port was placed and an echocardiogram before Herceptin was started. That's it. But some doctors seem to order more testing regardless of perceived need.

As far as staging - until surgery is done, staging is really just their best guess based on imaging. My staging listed was just that. But I had chemo first and there was no cancer left at surgery.

santabarbarian · February 2019

They are probably verifying that there is no spread of disease.

If the cancer has spread locally it can be stage 3 and if the cancer has spread distantly it is stage 4.

AliceBastable · February 2019

My Mom had breast cancer when she was 85. She had a lumpectomy and almost seven weeks of radiation. She lived to 97 and died from respiratory illness, totally unrelated to cancer.

Meow13 · February 2019

My husband's aunt Flo died at 100, she was diagnosed with breast cancer at age 60. Don't know what kind she had, her treatment was lumpectomy and radiation.

Polly413 · February 2019

Didn't the Queen Mother (currently Queen's mother) have breast cancer in her 80's and live to be 102 or something like that? Of course the royals won't report what treatment she had but I doubt she had chemo as she was in the public eye so much.

If you get the second opinion your might want to question closely the need for radiation in a patient of that age. Radiation only prevents local recurrence and does not increase overall survival. Since your mother does not have decades for a local recurrence to happen, it might not be worth the radiation if the surgeon gets wide margins for the lumpectomy or if your mother has a mastectomy. Skin of older patients is sometimes very fragile. Good luck to your mother. She is so fortunate to have you to help her. Polly

bgirl · February 2019

Of course there is always hope. A lot is about balancing quality of life and risk of recurrence. On paper, I have a similar diagnosis this time, but it doesn't tell the whole story. This also means my treatment wouldn't necessarily be appropriate for your mom or that she is being under treated.

I'm 30 years younger and so I have a lot longer for the cancer to come back. This is also my second premenopausal BC in 6 years.

My own mom is 83 also, I can't imagine her tolerating the treatment and tests I have been through in the last 11 months and will continue to do for another 6 months. Not to mention the 10 more years of AIs and ongoing BC treatment. Even at my age I question the SEs vs possible benefit.

Wishing you and your mom the best.

leftduetostupidmods · February 2019

I agree that at her age mastectomy without radiation would be more advisable. Less hard on her body and general health. I also question the Tamoxifen choice. Never heard of it being prescribed to someone so far into menopause and can't see how it would benefit. True, AI would also exacerbate her arthritis.

. I'd go for a second opinion. At her age, as someone said above, it's unlikely she will have that much time to develop a recurrence.

Chemo is a maybe in grade 2. A no in grade 1 and a must in grade 3. The faster the cancer cells divide, the more efficient chemo is, it doesn't work on slow dividing cells.

BC becomes stage IV after it's found to have spread in other organs.

Denise-G · February 2019

My mom was diagnosed at age 80 but was not Her 2 Pos. Her tumor was 1.5 cm - she had lumpectomy only followed by an aromatase inhibitor drug (AI) for two years until she had issues. She is 85 and doing well. We also went to an NCI designated hospital for a second opinion as our local hospital said chemo and rads.

GOOD LUCK!

83 y/o mom (ER+PR-Her2+), stage 2a, grade 2. Is there hope?

Comments

Categories