Change in Pathology
 

What I had hoped had been a cure was short lived. I've been Dx'd with spinal metastasis. I fractured L2 in late July, sneezing of all things. I didn't know it was a fracture at the time. I just thought I was getting old and put my back out. When things didn't get better with time, I got help. My PCP sent me to see a chiropractor (that's a different story though). I decided to bring in my oncologist before I went, a very good choice.

After a bone biopsy, it is clear that not only was I not cured, I am no longer in remission. Interestingly, the pathology has changed (great guess, Becky!). In addition to strongly HER2 positive, I am now PR+. Any insight on why the pathology may have changed? It wasn't a question that I formulated at the time of my consult.

Re: Change in Pathology
 

There are two thoughts on why pathology changes. The first is that your tumor may always had a few of those PR+ cells in it. Perhaps too few to detect and those made it through chemo and Herceptin. The other thought is plain old mutation (cancer itself is a mutation). The mutation also stems from treatment and causes some cells to change in order to survive. That is why I said that life finds a way. If one pathway is blocked, it will try to find another that isn't. Herceptin blocked Her2 so some cells "activated" PR which wasn't being blocked. It mutated to survive.

Re: Change in Pathology
 

So if you're now ER-, wouldn't they take you off the arimidex? Just curious...

Re: Change in Pathology
 

I'm so sorry that your cancer is back. This is a bummer. I'm glad that you decided against going to the chiro before reaching out to your oncologist.

I don't know why your cancer changed but it isn't that unusual. The good news is that it is still Her2 so you have herceptin and perjeta at your disposal.

Hoping you a get to NED again very soon.

Take care,
Brenda

Re: Change in Pathology
 

This SUCKS. I am so sorry.

I have read that often the new metastasis/tumor varies greatly from the original tumor biology ... what Becky was saying, basically.

The good news is that Herceptin and Perjeta are available to treat it. Here's to a quick trip to NED.

Carol Ann

Re: Change in Pathology
 

Oh, I'm so sorry. What a tough pill to swallow. I'd be pretty upset if I were you.

On the plus side (pun intended), PR+ gives you another treatment pathway.

Bone mets can be painful and debilitating, but quite a few people live a very long time with them. Here's hoping your new treatment gets you back to NED lickety split.

Re: Change in Pathology
 

Thanks, Ladies!

Waiting on a PET scan to see if we are dealing with anything other than bone mets and then we will choose a treatment plan.

JayKay, I have never been ER+ and only at this Dx was it determined that I am PR+. I have not ever taken Arimidex. It will likely be added as part of my new treatment regime but nothing will be started until we know exactly what we are dealing with.

Through some reading, I have learned that Arimidex was for post menopausal treatment. Is that correct? I am not menopausal. I might be peri though. I went about six months without a period but was a bit hyperthyroid, once my T4 and TSH came into line, I started having regular periods again (I have had two). Is Arimidex used for all woman, regardless of reproductive status or is it possible that my oncologist missed the part where I told him I have had a period for the last two months? Heaven knows we both have a lot on our minds.

Re: Change in Pathology
 

Arimidex and all aromatase inhibitors to include Femara and Aromosin can only be taken if you are postmenopausal. You CAN take them if you get your ovaries shut down chemically or have them removed. Otherwise you can take Tamoxifen. There is another option. It is called Faslodex. It degrades the hormone receptor. However, it is not a pill but a monthly injection. If you take this there is a loading dose. The loading dose is an injection then another in 2 weeks then monthly after that. I am just mentioning it because it is an option and not so bad if you time the shot when you are going to your cancer center anyway for your Herceptin or other treatment.

Since you have mentioned going to Boston, you should call Dana Garber Cancer center and try to get an appointment with Eric Winer there. He is a Her2 expert and see what he has to say. If you want to do this, you should call now as it could take time to get an appointment. He is top notch. A second opinion from him could be enlightening. We are here for you and I am thinking about you.