Late local recurrence
Comments
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Katiha, yes, the surgeon was following protocol. It is normal to not remove lymph nodes during an excisional (surgical) biopsy, and that is in effect the surgery your mother had. It's pretty much the same surgical procedure as a lumpectomy, but an excisional biopsy is done prior to a diagnosis of cancer, and the objective of the surgery is to remove the entire suspicious mass/area for pathological assessment so that a diagnosis can be made.
When I was diagnosed, I had a needle biopsy that uncovered a high risk condition, then an excisional biopsy in order to evaluate more of the suspicious tissue - that's when I was diagnosed. I did not have a Sentinel Node Biopsy done during the excisional biopsy and instead had it done when I later had a mastectomy.
Even if the surgeon realizes during the excisional biopsy surgery that the mass is cancer (most cancer is microscopic so it's not usually something the surgeon would know by looking), the SNB procedure requires injections of dye and/or isotopes into the breast prior to the start of surgery. So once in surgery, if the injections weren't done, the surgeon can't just go in an remove nodes because he might select nodes that are not the sentinel nodes, and that would not be effective. The sentinel nodes are the nodes that the dye/isotopes flow to first, and the way that lymph nodes are laid out, that's not something that would be obvious to the surgeon without the dye. The surgeon could remove all of the first level of nodes - then he's sure to get the sentinel nodes - but then he would be removing more nodes than necessary. That's undesirable because the more nodes removed, the greater the risk that the patient might develop lymphedema. The SNB procedure was developed specifically so that fewer nodes could be removed while still effectively checking the nodes for cancer.
All that to say it definitely would not have been appropriate for the surgeon to remove lymph nodes when doing surgery that was intended to remove a benign fibroadenoma.
So it appears that the surgery has followed protocol and the recommendations do as well. But a second opinion remains a good idea.
And since the HER2 has come back 2+ (I assume thats what you mean by HER2++... I previously read that to be HER2+ but I think I was misunderstanding), it means that the IHC test found the HER2 to be equivocal, in which case the FISH test must be done to determine if your mother is HER2+ or HER2-. If the doctors in Latvia didn't mention doing a FISH test, that is a problem and it's a good thing it will be done in Germany. As an FYI, the IHC test has a very large equivocal range for HER2, so it's very possible that the FISH test may came back HER2-. That's quite common.
However if your mother is HER2+ (or triple negative), with a 1.2cm tumor, if she is node negative, then the North American treatment protocol doesn't not recommend chemo prior to surgery. Chemo prior to surgery is recommended for HER2+ cancers that are larger than 2cm in size and/or node positive. That said, sometimes chemo is done first even for smaller HER2+ cancers.
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Hi MinusTwo!
The thing is she had the tumor removed during first surgery on July 8th.Now she will be having second surgery for node biobsy and possible mastectomy.
we are going to do FISh in Germany.So there is no way to shrink the tumor as it has been removed during the first surgery that was supposed to be for fibroadenoma.
Fibroadenoma turned to be cancer.
I hope I am explaining clear enough, sorry if I am not good at explaining.
Kate -
Beesie, thank you again!
You are spot on on HER2 and what we are trying to determine. Yes her2 came back as her2++ and what I researched it needs FISH.
They did NOT do FISH in Latvia so we are definitely will be doing it in Germany together with the rest of the material ( I read there is up to 5% mistake probability in the pathology report).
thank you for a detailed explanation of the protocol and glad that the doctor did follow it.Kate
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Hello amazing ladies!!
I am back again with some more questions.
We got mom in for German consultation, was pretty hard to get in within one month before second surgery.
Mom is not sure about the doctor. He is a professor and head of oncology but his primary speciality is hematology. Do you think it’s ok?Thank you in advance!
Kate -
While an MO who specializes in breast cancer would be better, since it was difficult to get the appointment, and with this doctor being the head of oncology, it's probably fine. He can bring in anyone else if necessary.
Interestingly, my MO, who specializes in breast cancer, is also a Hematologist.
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Thank you, Beesie!
He is also the head of the Breast Center in that clinic.
I think it’s going to be ok.
Mom is flying next week to drop off the material for new tests. They offered us to ship it via FedEx, but mom is terrified they will lose it and bringing it herself.
Then going back on August 17th for consultation.
I am somewhat relieved we have a schedule and a plan
Kate
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Hello everyone!
I am back.
We just got back mom’s pathology report from German clinic.
It’s triple negative after all, did FISH. But they are saying it is grade 3 not 2:(
So even worse results.
Also it states it has distinct nuclear pleomorphism. I am reading that this is has worse prognosis than regular one?
I hope to find some support here again as I am really upset with results.
Kate -
Hello all,
I am freaking out.My mom was diagnosed with local recurrence of TBBC back in July. She now has a node biopsy on 26th of August.
This week she did some lab test that are part of the pre-surgery protocol and found out that her Bilirubin is higher then normal.
I read that it can be a sign of tumor in it. Can someone explain me what can it be?
she had high bilirubin few years back before the diagnosis and it went back to normal, so she has a history of it.Maybe we are just freaking out before time.
With liver metastasis does blood test suppose to show anything else besides bilirubin?
Thank you all,
KateP.S. thank you I moved it here
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Kate, sorry I missed your post on August 14th. I assume the doctor in Germany advised chemo, given that your mother's cancer is triple negative? What did her doctors at home say?
I can't offer any advice or information about the bilbiruben - it's not something I know anything about - but hopefully someone else will come by with information.
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high bilirubin can be a sign of liver damage and/or metastases but there are other causes related to biliary ducts, gallbladder and pancreas function so on its own probably not a reason to panic, esp with prev hx.
Are her other liver function blood tests (LFT) normal? Those would be alanine transaminase (ALT). Aspartate transaminase (AST). Alkaline phosphatase (ALP). Albumin and total protein. Bilirubin. Gamma-glutamyltransferase (GGT). L-lactate dehydrogenase (LD)
Albumin, total protein and Hgb can also be indicators of liver health.
The thing is, you can have normal LFTs and have mets to the liver. I did. My LFTs didn't start going bad until after I was dx'd with mets.
You could push for a CT abdomen to be sure.
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Hi Beesie,
Yes, German doctor said that chemo is def happening since she had arrhythmia in fall he suggested not AC chemo but carpoplatine plus paclitaxel.We do not yet of suggestions of Latvian doctor as she will see him on 26th only.
But if he will refuse to do chemo mom is determined to go to Germany.As my husband laughs- she will find chemo on black market to survive this
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Hi Moth,
yes, everything else is normal.She has been also drinking this toxic mushroom since June, that supposedly resolves rumors and cancers.
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Hello everyone!
My mom had node biopsy today and all nodes were clear, they tested 4.I am wondering if now her chemo regimen will be shorter because of that?
What is the standard chemo for someone without nodes involved?
Will appreciate all the responses!
Kate -
Kate
I think in general even w/o nodes if TN - or in general with grade 3 chemo is given. The platinium based chemo plus taxol is very effective.
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2019whatayear,
Yes, we know that. But I heard somewhere, that the amount of chemo is different depending on nodes involved for instance 4 vs 6?I might be very wrong, just wanted to hear if anyone know anything about it.
Kate -
Great news on the nodes!
I can't comment about the chemo... I don't know if a different chemo regimen might be suggested because your mother is TN but node negative. Hopefully someone comes by who knows.
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Thank you, Beesie!
Always a pleasure to see you!
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