Her2 Score Question

[Hello!]

I'm sorry I don't have a lot of information. Just spoke w/ doctors yesterday about treatment plan. Invasive ductal--9 mm. Doctors couldn't feel any swelling in lymph nodes, but oncologist said could feel tip of liver. Her2 was a bar graph. I didn't see any numerical scores, and the doctor didn't mention any, but she said normally, the range on the graph would be @ 8 or 9. The Her2 on the graph yesterday was 100. The first two doctors (radiologist and surgeon) did not have access to the Her2 score at the time we spoke w/ them. Oncologist prescribed Tamoxifin(?) and scheduled a CAT scan. Was feeling really great after speaking w/ the first 2 doctors and even w/ the oncologist--until she received the Her2 score and palpated the liver, and the plan seemed to change. The first two doctors hadn't seen the hormone receptivity test or the Her2 when we spoke w/ them. Can anyone shed some light here? There was very little time for questions after the new report arrived as the lab was closing and there was still lab work to be done. Forgot to mention--was just diagnosed last week.
Thanks much

[AlaskaAngel]

When surgery is first done they usually can tell what the real size and number and location of tumors in the breast are and whether or not there is any spread to the lymph nodes, but it takes several days for the lab test for HER2 to be completed and to come back to the doctors. Recommendations for therapy for a tumor under 1 cm are usually milder, unless you are strongly HER2 positive or you have lymph node spread, or physical exam happens to raise other questions.

It is hard to hear that your tumor is small but for other reasons could be more likely to come back or metastasize. It sounds like that might be the situation for you. Being strongly HER2 positive means you probably will need to consider more intensive therapy.

If there is any good news, it is that for some who are strongly HER2 positive, Herceptin/trastuzumab has been a breakthrough drug.

This is a good place to ask questions so don't hesitate.

AlaskaAngel

[LovingDaughter]

I understand how scary it is to meet with the oncologists. It's hard to get enough information when you don't even know the right questions to ask.


To echo the last post, major studies have shown that Herceptin is very effective in treating early stage Her-2 positive breast cancer. The results in these studies have pessimists acting optimistic! I have placed all of my hope for my mother in this drug.

You will be in my thoughts and prayers. Make sure to stay positive!

[Cathya]

LovingDaughter;

What a wonderful daughter you are. My daughter only came to see my doctor once....she found it upsetting so my sister-in-law used to come with me. Please watch out for yourself...as a daughter this process can be stressful but your mom is blessed to have you. Believe it or not you will grow accustomed to these visits, develop a relationship with your onc and all of this will not be quite as scarey in the future. Herceptin is a fantastic drug and there are many others (like lapatinib) which are coming fast down the pipe. Our her2+ tumors are aggressive and like to travel but with these weapons we are effectively fighting this disease. Keep coming to this site as it is full of great information and support for those times we need it. Has your mother had an mri or ct scan yet? It was standard operating procedure when I was diagnosed to get a chest x-ray, abdominal ultrasound, bone scan, and mri coupled with copious bloodwork. These are just standard tests everyone gets in the beginning. Hang in there.

Cathy

[LovingDaughter]

Thank you so much for the kind words, Cathy. This site has provided wonderful information for me! Before I was simply reading the clinical trials posted in the New England Journal of Medicine, but now I have access to so many more resources.

My mom has not had a chest x-ray, ultrasound, bone scan or mri yet. Should I push to have these tests run?

I hope that you are doing well! You will be in my prayers!

[Cathya]

The first thing the onc has to do if be sure of what he is dealing with. The only way, regardless of the size of the tumor is to run these tests and do blood work and physical exams. Yes, I would push to have them done. Her2+ cancer is not like others, in my personal opinion. I was negative node wise under the arms but a 1 cm tumor was found by my onc in the supraclavicular node. This totally changed my treatment. Take care.

Cathy

[Cathya]

Ooops. I see by another post that your mother is already on chemo. I suspect that they will hold off all tests (unless they suspect or find something specific) until after the chemo is done. When I was first diagnosed I went through all of these tests right away and it seems to be standard for everyone I know here....in Ontario, Canada. Your mother is not the first one I have heard of on this site where tests are done in different order but....just be sure they are all done at some point. Having found the tumor in my supraclavicular node prior to chemo my onc knew that the spot should be heavily radiated and it was...but...it reacted very well to the chemo and shrunk to nothing within a few treatments. That is my logic for doing these tests up front.

Cathy

[AlaskaAngel]

I am going to post some info about the question of HER2 scoring because so many here may not know the answer. However, I still can't answer the question of how significant it might be to have FISH results that are more definitely positive in terms of how well trastuzumab or lapatinib works.

Here's past posts and info:

Here's one source:

http://www.breastcancer.nzco.net/herceptinFAQ.htm

5. What is the FISH test?
The Fluorescence In Situ Hybridization test illuminates the HER2 genes in the tumour sample to see how many there are. If a FISH test detects more than 2 copies of the HER2 gene, this means that the cell is abnormal and the breast cancer is called "FISH positive" which also means the cancer is now called "HER2 positive". These women are also more likely to benefit from Herceptin®. If "FISH negative", then the women will not benefit from Herceptin®.


Here's a better one, from a post on the her2support.org site, by Al, who does a lot of research:

HER2 testing

Tests can be done to find out whether a woman has HER2-positive breast cancer. Testing can be done at the same time as initial breast cancer surgery, or samples of cancer tissue from previous biopsies, or surgery, may be used.

The two main methods used for testing are Immunohistochemistry (IHC) and Fluorescence in-situ hybridization (FISH):

Immunohistochemistry (IHC)

Immunohistochemistry (IHC) can show how much of the HER2 protein is present in the tumour sample. The HER2 level is graded from 0 to 3+

• 0–1+ means that a normal amount of the HER2 protein is present and the result is HER2-negative.
• 2+ means that a moderate amount of the HER2 protein is present.
• 3+ means that there is a higher than normal level of HER2 protein and the result is HER2-positive.

When a tumour is scored at 2+, UK testing guidelines recommend that an extra test is carried out. This is because a result of 2+ does not always mean a cancer cell has a high level of HER2. In this situation, an extra test (known as FISH) is used to give a definite result.

Fluorescence in-situ hybridization (FISH)

Whereas IHC measures the level of HER2 protein in the tumour sample, FISH testing measures the amount of the HER2/neu gene in each cell. This gene is responsible for the overproduction of the HER2 protein.

There is no number scale for FISH testing. The result is either:

• FISH negative - normal levels of the gene are present, or
• FISH positive – excessive amounts of the gene are present. This is sometimes called gene amplification.

http://www.cancerbacup.org.uk/Cance...sis/HER2testing

[LovingDaughter]

Thanks a lot for the information, Cathy. I am still going to follow up with the doctors to make sure that the tests are done.