Her-2 status with DCIS

I was diagnosed  in Sept last year with a stereotactic biopsy.  I had my lumpectomy in Oct and they didnt test it for even the hormone stuff.  I requested it from my surgeon and got the whole thing including the her-2, and am glad I did.  Now, I can see why I should do hormone therapy.  I dont think its automatically done, but it doesnt hurt to request it and get it like I did.  My estrogen was 98% which they call favorable, progest, 24% favorable, and her-2 0% which is favorable.  Their was another test that was 18% and it said borderline.  It has something to do with recurrence but I understand that the range in that one could go over 60 or so and that 10 or below is a lower chance of recurrence.  the 18% doesnt bother me too much in that it could be higher.  I had the grade 3 with necrosis and that definitely puts me at risk too.  I just started Tamoxifen 4 days ago and that test helped me a little to sway me to take it.  I say the more info the better.

I went back to my lab report.  If Her-2 is 5% I thought that to be negative.  I found another report that considered >1% positive.  In any event, I think that they use this marker along with the rest of the report to determine the best course of treatment.

BC treatment is an international standard.  Breast conserving surgery is different only in that they take more.  I had a quadrectomy, biopsy of SLN 2, radiation therapy, no chemo and Arimidex.  Other than dealing with hypothyroid and Arimidex SE, I'm doing OK--NED.   

I think often to the Coesistone aspetti inferiore al 10% di carcinoma in situ con comedonecrosi. Loosly translated that said (Coexist ....appearance inferior to the 10% of cancer in situ with black cells).

I want to believe that they were all captured in surgery and radiation.  

I pay more attention to my nutrition and diet these days to help my body along.

Consider that the lump was not found on an echo mammo 8 months prior....I found it with self exam in August and by Sept began the infamous journey that we are all on.  But there can be many explanations for not to find the lump before then.  

My labs....

Quadrantectomia + Biopsia linfonodo sentinella (quadrectomy & sentinel lymph biopsy 2)

QII Mammella Sinistra:
5x5x3 cm orientato
Max di cm 1.5.  Il tumore dista cm 1.2 dal margine superiore
cm2 dall'inferiore e laterale, cm 1.8 dall mediale, cm .7 dal cutaneo, cm 1.2 dal fasciale.
Diagnosi:  Carcinoma invasivo duttale NAS, grado 1/III sec. Bloom Richardson.  Coesistone aspetti inferiore al 10% di carcinoma in situ con comedonecrosi.  Itologicamente I margini di resezione sono esenti da localizazione neoplastica.

Recettori Ormonali:  Estrogeno recettore: presente
elementi neoplastici negative: 10%, …debolmente pos.: 20%, …moderatamente pos.: 40%, …fortemente pos.: 30%
Progesterone recettore:  assente
EN neg: 80%, …debolment pos. 10%, ….mod pos. 10%, fortemente pos 0%

FATTORI PROGNOSTICI
Ki67: pos nel 25%,  C-ERB-B2: pos nucleare nel 5%, BCL-2 neg.
Discorso:  Regolare.

So....

c-erb 2:( Her2, erb 2 , c-erb-B2 ) [Mine was 5% so they prescribed Arimidex )

Si tratta di un fattore di crescita identificabile in una proteina recettoriale di membrana, che ha funzione di dire alla cellula di proliferare.E' costituito da due braccia uno esterno ed uno interno alla cellula:dominio interno ( cb11 ) ed il dominio esterno.
Nella cellula tumorale i geni che codificano le proteine di membrana c-erb2 positive sono tantissimi e l'indagine immunoistochimica di routine basta da sola per valutare l'overespressione di membrana; ma per capire l'overespressione dei geni si procede con la FISH (Fluorescens In Situ Hibridization) un tipo di analisi quantitativa.
I tumori iper espressi ( IIC 3+ ) ( FISH amplificati ) non rispondono alle terapie ormonali ma rispondono bene alla chemioterapia.
Questo perchè c-erb2 amplificata condiziona il tumore nel senso che lo rende più aggressivo:i pazienti con c-erb2 negativo hanno sopravvivenza lunga; viceversa c-erb2 positivo purtroppo no.
Quindi si cerca un elemento che possa dire a quale tipo di terapia il tumore risponde.
Es: al paziente c-erb2 negativo si fa l'ormono terapia,se ha gli indicatori estrogenici positivi. Se il paziente è c-erb2 positivo si preferisce l'ormono terapia con aromatasi e non Tamoxifene. 
Per trovare il suddetto elemento si può usare anche l'HERCEPT-TEST: è una tecnica immunocitochimica semi-quantitativa che determina l'overespressione delle proteine di membrana erb2 nel cancro della mammella.
 

Recettori Risposta Prognosi
ER +    PGR +           77 % 91 %
ER +    PGR -             46 % 93 %  (These are my receptors)

ER -     PGR +             27 % 88 %
ER -     PGR -              11 % 77 %

Bcl 2: (Mine is negative -- so expected that my body will not resist the radiation therapy and hormonal therapy)

Marcatore citolplasmatico. Si tratta di un proto-oncogene che codifica una proteina la quale è in grado di prevenire l'apoptosi ( morte cellulare normalmente programmata ). La Bcl 2 è un elemento indiretto sulla funzionalità ormonale, nel senso che la sua sintesi è correlata alla funzionalità della via recettoriale.
Ci sono tumori che al 100 % esprimono recettori ormonali ma non hanno poi una risposta alla terapia ormonale.
Alla positività di questo marcatore è associata un'elevata resistenza alla chemioterapia e radioterapia.

 

Hi, did sureon say why he would only check if it is grade 3.. mine was grade 3, with a small microinvasion, and no one checked.  Told me they didn't need to.  Just curious, what your doc told you.

Thank you Beesie, good explanation.  

Jude,

From your description, it sounds as though you had DCIS along with invasive cancer.  When you have invasive cancer along with DCIS, because the invasive cancer is more serious, the DCIS in effect becomes irrelevant - it gets taken care of with whatever treatments you have for the IDC.  So that's a very different situation than having DCIS alone.  For DCIS alone, HER-2 status is not relevant, and chemo & Herceptin wouldn't be required.   With IDC, HER-2 overexpression is a sign of an aggressive cancer and chemo and Herceptin are the standards of treatment. 

I wish I could offer some advice or even some comments, but I really don't have any experience with HER-2 positive cancers.  As a suggestion, to 'talk' to women who have a similar diagnosis to yours, you might want to repost your question in the HER-2 Positive discussion forum.  (((((Hugs)))) to you! 

Jude, I don't think you can forward your post, but you should see the words "[Edit][Delete]" in the bottom left corner of your post.  If you click on Edit, you'll get the text box back.  From there, if you just highlight all the text and 'copy' it, you can then paste it into a new post in the HER2 forum. 

Hi Truman......I'm Canadian. Interesting how things are done differently in another country. Tell me....what has your experience been with how you've been treated in the UK. Is it the same as here?

Trueman......the most important thing is getting wide clear margins. Here they follow that up with radiation to kill of any stray cells. Some people choose to go for 2-3 rexcisions to get good margins. When that fails they only good option then is mastectomy. Thats what I had to do. It does seem drastic but does end up this way sometimes. There are good options though for reconstruction if you want that done. Good luck.