ER/PR- HER2/neu+ stage 1

Options
KathyL
KathyL Member Posts: 534

Anyone out there with same diagnosis?  I just had a mastectomy Oct.5.  I am now trying to figure out whether or not to do chemo. (Taxotere+cytoxan+herceptin). My tumor was 4mm.  My onc. said I can go either way; it's controversial.  He said I have a greater than 90% chance that I am fine now without chemo.  Chemo. at best would give me 2-5% better chance of being fine, but with many bad side effects.  I'm getting a second opinion.  I am married, age 36, with 2 kids under age 5.  Don't know which is worse- chemo or no chemo???

Comments

  • Jenniferz
    Jenniferz Member Posts: 541
    edited October 2007

    I was diagnosed May,06 with IDC.  I had a mastecetomy with clear margins and no nodes.  I was stage 1a.  My tumor was less than 3 mm., and was also er/pr-, her2 pos.  I did not receive rads or chemo., and so far am NED.

  • KathyL
    KathyL Member Posts: 534
    edited October 2007

    Jennifer:

    Thanks so much for giving me hope!  How do they monitor you for recurrence? 

  • Jenniferz
    Jenniferz Member Posts: 541
    edited October 2007

    Hi Kathy,

    So far, I have had a mammogram, and will have a breast MRI next spring in addition to that.  My gp, surgeon, and onc. all feel that for right now, that is all that is needed because I took the rather aggressive route.  As my visits drop off, my gp would like more scans.  I'll know more in Dec.

    I hope you continue to do well.

    Jennifer

  • nancy53
    nancy53 Member Posts: 42
    edited October 2007

    you are so young, if i were your mom,i would enc chemo,my oncologist made that recomendation strongly and i concurred. i am stage 1 , grade 3 her 2 positive and adriamycin ,cytoxin ,taxol and herceptin is my best chance, the a/c makes you feel crappy,but if i can do it anyone can,please let me know how you are doing,thanks,nancy.

  • Jenniferz
    Jenniferz Member Posts: 541
    edited October 2007

    Good advice, Nancy.  Kathy, I didn't factor in your age, and I am older than you are--and post menopausal (SP). I didn't really want to influence you one way or the other. 

    I will say, however, that the second opinion is a good thing if you are uncomfortable with your dr's advice.  If more onc's were under our insurance "umbrella", I would have probably done the same thing.

    However, I am finally beginning to start feeling a tiny big stronger in his decision, and like I said, will know more in Dec. 

    Here's hoping for your continued good health--

    Jennifer

  • KathyL
    KathyL Member Posts: 534
    edited October 2007

    Thanks ladies, I appreciate the input.  I'm waiting to hear when I can get my second opinion and hope that will also make things clearer.

  • itslisalouwho
    itslisalouwho Member Posts: 74
    edited October 2007

    Hi Kathy L!

    I'm in nearly the same situation as you are.  :) Although, mine is also ER?PR +.   I just posted the (almost) same question.  Please email me @ itslisalouwho@gmail.com.  I would LOVE for us to share information on a regular basis!

    Lisa

  • jengrsq
    jengrsq Member Posts: 26
    edited October 2007

    Hang in there Kathy,

                                   I am Stage 2 with Her2 positive and estrogen negative. I do know ladies like us we need to be strong and be very thankful for herceptin. Presently I am doing chemo before surgery and then I will be on Herceptin for a year. You are not alone.

    Deb

  • jengrsq
    jengrsq Member Posts: 26
    edited October 2007

    For encouragement maybe we can get some surivors on this topic. Therefore this would give us encouragement.

    Deb

  • KathyL
    KathyL Member Posts: 534
    edited October 2007

    Deb:

    Let me know if you hear from survivors, or find another string with that to read!!  Thanks :)

    Kathy

  • bluewillow
    bluewillow Member Posts: 779
    edited October 2007

    Hi Kathy,

    I'm so glad to see your post and the great replies you received.  I posted a similar question a few months ago and just bumped it up, in case you want to read the very encouraging replies there. 

    As for the chemo, my dr. highly recommended it just as a precaution, and I'm really glad I am doing it.  I am currently doing 4 DD A/C and have #4 on Monday, and am doing just great (tho everyone is different).  The hair loss was no big deal for me and I've worked right through treatment and lead a very normal life.  I hope this helps some and please PM me if you need more info.  I wish you the best of luck, whatever your decision.

    Hugs,

    Mary Jo

  • mimi1030
    mimi1030 Member Posts: 700
    edited October 2007

    Hello KathyL,

    I am new to this board.  I just wanted to give you my mom's story.  She was diagnosed with Stage 0 DCIS 3 years ago, she had left mastectomy, clear margins and clear nodes.  They told her she didn't need Chemo, then a month later they decided she should do a round of Adriamycin/Cytoxin as the pathology revealed Her2neu + Overexpression.  She went ahead and did the chemo however because of negative nodes she was not given herceptin as you had to have one positive node to receive it. They told her she had a 2% chance of reoccurance. This past week she was diagnosed with Stage IV Metastatic Breast Cancer to bones and Liver, she is 52.  She just had her first round of Taxol and hoping she has a good MUGA result will begin Herceptin next Tuesday along with Zometa for bones.  I guess I am trying to say do everything you can to reduce your chances of reoccurance, even though my mom did and it still reoccurred.  But dont let them tell you that you really dont need to do this because you have little chance of reoccurance.  You can never be sure, now my mother a single parent...there are 3 of us.  Me being 35, my sister 26 and my little sister 11 are faced with this awful disease yet again.  We are from England so we have no family here other than the 4 of us.  It is devastating news, but I have faith and hope that we can put her in remission for many years.  She has no symptoms it was by accident on a PET scan that revealed it, she was having a PET scan because of issues with her TRAM Flap reconstruction and then it reveal the spread.  I will keep you all in my prayers. 

  • DianeL820
    DianeL820 Member Posts: 10
    edited November 2007

    Why did you opt for a mast with such a small tumor?  Mine was .45 CM and they said a lumpect was fine.  Now im terrified i made the wrong decision

  • suz41
    suz41 Member Posts: 33
    edited November 2007

    Hi Nancy,

    Your diagnosis is exactly the same as mine.  I had a mastectomy on October 1 and am starting A/C chemo on Monday (Nov. 5) followed by Taxol and Herceptin.  I will also be taking Lapatinib as part of a clinical trial.  What were your side effects of AC?  I'm not sure what to expect.  I am 41 years old with three young sons and a husband....I have a very active, busy life.   Suz41

  • Pharmmom
    Pharmmom Member Posts: 300
    edited November 2007

    My opinion is to do the chemo.  Like the onc said it could go either way.  Whats influencing me is your age.  I was 38(in 2002) when I was diagnosed and he strongly recommended chemo. I was HER2 +++.  I've said this before and I'll say it again, chemo goes after all the cancer cells in the body.  It is thorough.  You have a very young family and I did (do) too.  My kids were 11 and 6 at the time.  Twins and a youngest all girls.  They were why I did the chemo (I was scared to death of it and all that went with it).  I can tell you it was doable.  I did the A/C plus Taxotere.  It was not the easiest thing I've ever done but not the nightmare I had thought it would be either.  I got through it and so will you.  I just wanted to give you my 2 cents worth.  I'm sure you will make the right decision for you.  God bless.

    Barb 

  • DebbieB
    DebbieB Member Posts: 161
    edited November 2007

    Kathy,

    I would get a second opinion for sure.  I know things have changed somewhat in the past few years, but when I was dx'd in 2001, if you tumor was < 1 cm and you were node negative, chemo was not recommended for most idc cases. 

    My own tumor was 2.4 cm and I was highly HER+, grade 3 and ER-/PR -.  I only did the 4 rounds of AC chemo.  Herceptin wasn't even offered unless you were Stage 4.  It's been 6 years and I am still NED. 

    If I had it to do over I would still do the AC chemo!  However, there are risks to chemo and I am now dealing with them.  I have done GREAT until May of this year when I found out my heart is damaged from the Adriamycin.  I had congestive heart failure and am now dealing with severe cardiomyopathy.  And it took right at 6 years for this damage to even show up!  I'm only 51 years old and have not had high blood pressure, high cholesterol, and am not overweight, don't smoke or drink so this was quite a shock for me.  I'm currently on 6 meds and will find out in December whether or not I will be able to control this with meds.  If not, my other option is heart transplant! 

    I would just really discuss your options with your doctors and then make an informed decision whether increasing your odds by 2-5% is worth the risk of chemo.

    Good Luck!  I know this is tough.

    Debbie

  • maryannecb
    maryannecb Member Posts: 1,453
    edited November 2007

    Hi Guys,

    there are lots of us double negative Her2 positve survivors around!

    I wish you all the best as you make your decisions and act on your plans. Chemo and Herceptin are not without risks, some short term ,some longterm... For myself I got throgh both with a lot of help from my team. I am glad I did all I could and for me that was my decision.

    Fists up!

  • LisaH
    LisaH Member Posts: 25
    edited November 2007

    I agree, get a second opinion and then make your decision.  I too would have them factor in your age.  My Onc. put it to me this way...."because you are so young, we expect you to be around for a very long time".  I was 33 at dx and my children were 5 and 8 at the time, so I wanted to do everything I could.  I had a mastectomy and did 4AC, no herceptin because it was not offered to node negative patients 5 years ago!

  • mthomp2020
    mthomp2020 Member Posts: 1,959
    edited November 2007

    Maybe consider doing just the Herceptin.  It certainly has the least amount of side effects, as long as it doesn't affect your heart, and they monitor that and take you off if you start to have issues.  The Adriamyacin seems to have more long-term issues. 

    I did 6 dose-dense A/C, but I was stage IV at diagnosis, so they were extremely aggressive, and I'm 54 years old, so I don't really think they were as concerned about the long term effects!  I didn't have any real problems with it.   I've had a mastectomy, and now I'm doing Taxol/Herceptin. 

    Definitely get the 2nd opinion.  It certainly can't hurt.

  • KathyL
    KathyL Member Posts: 534
    edited November 2007

    Hey all!  Thanks so much for your input.  I FINALLY heard from UPenn and have my second opinion on the 8th.  I actually got a copy of my onc's notes and in plain view (not my mind imagining it), he wrote that the risks of chemo for me are much greater than the benefits, and my prognosis without chemo is excellent based on my tumor's very small size (4mm) and no node involvement.  Was nice to see it in print.  Will be curious what the next opinion is this coming wekk and will let you all know.  I also understans from talking to other patients that the opinions seem to change every so many years-- it used to be everyone got chemo, then only if nodes involved, and now it's "up to you" is the going statement. Hmmmm...

    Diane L: I had a lumpectomy first when they thought I just had DCIS.  I had the mast. next for 2 reasons:  one--my margins still had DCIS after the lumpectomy, and two-- I have little breasts so doing a re-excision would've looked really bad (they took out a 4cm chunk and my breast surgeon told me to take more would have been disfiguring).  I opted for the mast. also b/c it meant no radiation for me.  If you have bigger breasts than me (was not even an A cup after nursing 2 kids) and they got clear margins... there's no evidence that a mast. is better than a lumpectomy :) 

  • KathyL
    KathyL Member Posts: 534
    edited November 2007

    OK, got my second opinion at UPenn today.  Saw their top doc-- the guy in charge of their cancer center.  He agrees with my onco that no chemo's needed!  He says the benefit is minimal even given my age and recurrence risk is very small.  They are focusing on the size and negative node status.  HOWEVER, UPenn has a test that their pathologists can do.  It looks at how much of my DCIS was stable versus in the process of changing over to IDC.  Wow!  Of course, I said do it.  If it shows that I had a lot of evolving DCIS, in essence my "tumor size" would be larger and they may encourage chemo then.  So, it's not over yet.  To be continued in 2-3 weeks...  stay tuned.  Has anyone else heard of this type of test???  So cool!!!  Would encourage others with IDC/DCIS to look into it.

    Kathy

  • Steph54
    Steph54 Member Posts: 26
    edited September 2011

    In November 2005, I was diagnosed with an extensive 4cm DCIS and IDC measuring 4mm. Stage1a, Intermediate grade and 6/9 on the Bloom Richardson scale. Had an SNB and 14 nodes were negative. Receptors are ER 95+ and PR slightly positive. Her2 is +++  over-expressed (OUCH!)

    Anyway, after consultations with two oncologists, both were in agreement that Chemo for me was not worth the risk versus the reward. I was told by both Oncs that I could not have Herceptin without having Chemotherapy first.( I am from Canada but have talked to several girl in the US and they told me the same rule holds true there. It was suggested that I take Femara but was told it was my decision. They did not seem to be pushing it and I declined.

    I really wanted Herceptin  because of the her2 +++. I woud be interested to know if this policy has changed.

    It has been over be 2 years since my mastectomy so maybe too late to consider it, I dont know.

     I have done really well  since my surgeries ---SNB and disecction, lumpectomy with unclear margins, and the the total mastectomy. 

    For the past few weeks I am experiencing pain in my lower right side with some nausea, and am booked for a pelvic ultrasound. Must admit I am a little scared. The discomfort is (what I believe) to be a little too high to involve the ovary. Would love some information about that.

    Hope everyone ends up with the best treatment possible. Of course. the greatest thing would be that we could then put our final treatment decision out of our minds, and never look back to second guess ourselves. Maybe that is easier said than done!

    All the best to everyone here.

    I would love to hear your thoughts and especially about any news regarding prescribing Herceptin without Chemo.

    Hindsight tells me I should have had the ovaries out at the time of my previous surgeries and especially with 7 first  cousins having either BC or Ovarian Cancer. 4 of my cousins passed away in their forties.

    Am glad to be pursuing Genetic Testing with my first appoinment booked on December 4th. If anyone can tell me how it all works, I would appreciate it so much. I do understand it begins with a counseling session but then what?

    Sorry for the lenghty post .

     The best of the very best to all of you ~~

      Stephanie

  • KathyL
    KathyL Member Posts: 534
    edited November 2007

    Stephanie:

    So awesome that you have been well for so long!

    So some thoughts and info:  first, I have asked numerous doctors specifically about use of herceptin w/o chemo and NO ONE is doing it... yet.  I've even looked for clinical trials worldwide and NONE.  Science just hasn't gotten that far yet, but hopefully it won't be too long before someone looks at it's use alone.

    Right sided pain:  make sure they do a transvaginal ultrasound, gives the best picture of ovaries (I've had them, they aren't bad).  Right sided pain (not to freak you out, but I'm a nurse as well as a BC patient) can often be ovary (lower quadrant), liver (upper quadrant), or intestines.  So maybe during the ultrasound they can check your liver, too-- ask for pelvic and abdominal ultrasound.  If liver and ovary are ok, look into intestinal stuff (do know if other signs and symptoms would warrant this as I don't know your full story).

    Genetic testing:  For BRCA1 and BRCA2 in US, they take 1 tube of blood and send it to Myriad Lab (the only place in US that does the tests).  I got my results back within 2 weeks (negative), and they were reviewed by my genetic counselor.  My geneticist suggested following up yearly or every two years to see if anything in the field of genetics has changed that I could be looked at for regarding BC.  The only women in my family with BC are me and my cousin-- we were both dx in our thirties.  She's five years out and doing very well. 

    Hope this helps, best of luck!

    Kathy

  • Steph54
    Steph54 Member Posts: 26
    edited September 2011

    Thanks Kathy ...good information. ( I am also a nurse but an "old" one at best! lol)

    My GP did an internal pelvic exam yesterday and says he does not feel  a mass of any kind on my ovary. I asked if he was usually able to diagnose a tumor by manual exam and he said "yes".This gives me some hope that I am dealing with something less than what I most fear. I am booked for a pelvic ultrasound ---probably a few weeks to wait. The discomfort is so intermittent, it moves up and sometimes down into the groin. I spend half my time trying to diaganose myself!

    Thanks for the info on the gene testing. I have been told it may take up to 3 months here in Canada to get the final result. I have 4 grown up daughters very anxious to hear the outcome.

    Take care,

    Steph

Categories