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Lani · 07-24-2007, 08:46 AM

especially her2+ disease as it makes enzymes which breaks down the barriers to cells leaving via the blood stream, makes the cells have the ability to migrate more vigorously, makes the cells rather invisible to the immune system--which is why before herceptin her2+ bc was know for often recurring earlier than other bcs and causing death within one year of recurrence on average rather than within two years as with her2- breast cancer (got the above info from Dr. Slamon's lectures).Thus it is felt that long before the tumor became visible on mammo or palpable tumor cells were spread to the bone marrow where they lie dormant like mold on a bathroom shower curtain, just waiting for the right conditions to occur to spring back to life and making more of themselves.

Some think it is the angiogenic (new blood vessel growth encouraging) substances that inflammation brings --it is necessary to make such substances with inflammation as that is the way the body heals injuries and new blood vessel formation is the first step to stopping the bleeding, plugging the puncture in the body, attaching the two sides of the broken bones together, etc)

That is why it makes sense to look already for dormant metastatic disease cells in her2+ bc. Dr. Braun of Germany has done lots of studies showing that those with her2+ isolated tumor cells in bone marrow biopsies have a shorter survival and studies in Metastatic bc patients have shown that those with the most circulating tumor cells, especially those whose ctc numbers increase with treatment, have the shortest survival. There is a fear that they may scare some people unnecessarily if they find the results unfavorable--but from what I have read no normal patients have circulating tumor cells, and those that are ER+ may mean less, but those that are her2+ may mean more. Your doctor may feel uneasy with this as it is hard to make a decision based on information one doesn't yet fully know how to interpret--but it might help your" female intuition" help you make this difficult choice

Neither of these are called the typical "tumor markers" ordered routinely.

I only mentioned them as they are commercially available and MAY be paid by insurance in your case as you were diagnosed with stage 4 even though that may have been wrong.

Couldn't hurt to bring it up.

If you could travel for a consult, Dr. Pegram just took up a position in Miami. He and Dr. Slamon are responsible for most of the work on herceptin.

As it is your right breast--at least you don't have to worry as much about your heart. You did not originally say you had two tumors nor have you given information (at least I don't remember seeing it regarding the pathology of the second tumor)about it. If you had four tumors in different quadrants then, of course, a mastectomy makes sense.

They are finding the size of tumor nowadays is felt to matter less than it has in the past--more importantly with a large tumor is whether it responded to neoadjuvant (preop) therapy and you did not have that, so no useful info there.

Sorry if I rambled..hope you got some useful info with this...

07-24-2007, 08:46 AM	#11
Lani Senior Member Join Date: Mar 2006 Posts: 4,778	breast cancer is felt to be a disease which metastasizes early especially her2+ disease as it makes enzymes which breaks down the barriers to cells leaving via the blood stream, makes the cells have the ability to migrate more vigorously, makes the cells rather invisible to the immune system--which is why before herceptin her2+ bc was know for often recurring earlier than other bcs and causing death within one year of recurrence on average rather than within two years as with her2- breast cancer (got the above info from Dr. Slamon's lectures).Thus it is felt that long before the tumor became visible on mammo or palpable tumor cells were spread to the bone marrow where they lie dormant like mold on a bathroom shower curtain, just waiting for the right conditions to occur to spring back to life and making more of themselves. Some think it is the angiogenic (new blood vessel growth encouraging) substances that inflammation brings --it is necessary to make such substances with inflammation as that is the way the body heals injuries and new blood vessel formation is the first step to stopping the bleeding, plugging the puncture in the body, attaching the two sides of the broken bones together, etc) That is why it makes sense to look already for dormant metastatic disease cells in her2+ bc. Dr. Braun of Germany has done lots of studies showing that those with her2+ isolated tumor cells in bone marrow biopsies have a shorter survival and studies in Metastatic bc patients have shown that those with the most circulating tumor cells, especially those whose ctc numbers increase with treatment, have the shortest survival. There is a fear that they may scare some people unnecessarily if they find the results unfavorable--but from what I have read no normal patients have circulating tumor cells, and those that are ER+ may mean less, but those that are her2+ may mean more. Your doctor may feel uneasy with this as it is hard to make a decision based on information one doesn't yet fully know how to interpret--but it might help your" female intuition" help you make this difficult choice Neither of these are called the typical "tumor markers" ordered routinely. I only mentioned them as they are commercially available and MAY be paid by insurance in your case as you were diagnosed with stage 4 even though that may have been wrong. Couldn't hurt to bring it up. If you could travel for a consult, Dr. Pegram just took up a position in Miami. He and Dr. Slamon are responsible for most of the work on herceptin. As it is your right breast--at least you don't have to worry as much about your heart. You did not originally say you had two tumors nor have you given information (at least I don't remember seeing it regarding the pathology of the second tumor)about it. If you had four tumors in different quadrants then, of course, a mastectomy makes sense. They are finding the size of tumor nowadays is felt to matter less than it has in the past--more importantly with a large tumor is whether it responded to neoadjuvant (preop) therapy and you did not have that, so no useful info there. Sorry if I rambled..hope you got some useful info with this...