Urgent question on behalf of a friend

Vic · 09-15-2010, 08:45 AM

Good Morning,

My friend's mother-in-law, 78, was just diagnosed with bc and a huge 9x11 cm tumor. She also has early Alzheimer's, but still has a love for life. My friend raised the following question:

"Is it possible to have a biopsy and Not know what kind of cancer? 3 months before surgery? Does this sound weird to you?"

Actually, some of her details are misleading to me, because she also added:

"oncologist told us that the biopsy sample was too small and so he wouldn't know what kind of cancer until the surgery which he thinks should happen in 3 months-mastectomy and then radiation and maybe chemo. In the meantime she is supposed to take an estrogen blocking drug that should shrink the tumor. This thing is huge! And how can you not know what type of cancer from a biopsy? Does this make any sense to you?"

I don't know how to advise her, because it seems like they know something about the estrogen factor of the tumor. Reading into it a bit, there are also family dynamics at play concerning her age, but this daughter-in-law says even with Alzheimer's, this woman has an extraordinary love of life.

"I think the oncologist saw alzheimers and said screw it. But...this woman my mother n law still has a love of life. I'm not sure how far to push this."

Your thoughts on this would be helpful so I can help her!

Thanks,

Vicki

Becky · 09-15-2010, 02:21 PM

Hi Vicki

I hope you are doing well. I think what the oncologist is saying is that they took enough of a sample to say its breast cancer but not enough to do much else. It would seem that they did do a hormone profile on it, at least I hope they did before saying she has to take an AI to shrink it. We all know that won't work if the tumor isn't ER+ at least. Your friend needs to find out if they absolutely know if it is ER and PR positive (and if it is highly positive). It would also be nice to find out if it is Her2+ just because if it is also Her2 and hormone positive, she might get really good results taking both (to shrink it).

It seems like they are blowing off the poor woman. What a tragedy!

They may know the prognostics though (ER, PR, Her2) but just don't know the grade, if it is ductal or lobular, that kind of stuff just because of the sample size. It sure would be nice to know if it has spread beyond the breast.

Joan M · 09-15-2010, 03:46 PM

Vicki,

I suggest that besides asking the specific questions noted, your friend get a copy of the biopsy report, which would give the diagnosis.

My mother was diagnosed with breast cancer a few months ago. Her tumor was about 4 cm. She has moderate Alzheimer's disease and just turned 87. She seems to understand but never speaks. She's also in a wheelchair. The oncologist recommended only Femara to try to control the cancer, because my mother is ER+. He did not suggest a mastectomy and radiation. However, my mother is 9 years older than your friend's mother.

My brothers and I are waiting for the next mammogram to see whether the Femara is working.

Joan

Rich66 · 09-15-2010, 06:13 PM

Becky brings up an interesting point. Usually they do a PET to see if it is metastatic before deciding on surgery...especially if it's that big at time of discovery.

Jackie07 · 09-15-2010, 11:41 PM

Could it be inflammatory breast cancer? That's the only type I know would get so big in a short period of time. Perhaps the doctor wanted to see if the drug will shrink the tumor first. It makes sense to me since I've read some of the members going through the same procedure - shrinking the tumor before having mastectomy.

Vic · 09-16-2010, 07:43 AM

Good Morning Fabulous Women,

Thank you for sending your thoughts on this. I'd only seen Becky's last night and will forward the others to my friend today. I really appreciate your help as I know Joanne, who is in the healthcare industry is very concerned. As I told her, she's got the right attitude and with her mother-in-law's fighting spirit and a love of life, no matter what other medical issues are confronting her, her medical team needs to give it their very best. First off, here's Joanne's response to your posting I sent, Becky:

"Vicki,
Thank-you so much! This info is going to be really helpful. When we transfer Irma up here next month I will know exactly what to ask the new oncologist. I heard the Kaiser oncology dept. in the Antelope Valley is great and I happen to have worked with a few of the primary care docs at Kaiser in the past so I'll have back-up. She had a chest x-ray and a CAT scan has been ordered which we will have done when she gets here and then we will know more.

Again...Thank-you for your time and effort. I'm going to get" Breast Cancer for Dummies" for sure!"

So, her2 women, thanks again for all this excellent info. for her to consider. I'll let you know how she's doing when I hear from Joanne.

btw, Becky, I LOVE your new photo and I do hope you have another West Coast trip as I miss you and our conversations more than you know and I'd love to catch up and continue again when you're here.

XO,

Vicki

Lien · 09-16-2010, 08:41 AM

Hi Vicki,

My biopsy didn't show cancerous cells, and yet, when they did the lumpectomy, there was a 0,6 mm invasive tumor and some DCIS. So those biopsies don't always tell you the whole story.

I think tumors don't usually grow as fast in older women, so could it be that she just didn't notice it growing?

A second opinion sounds like a great idea. And hopefully the AI will do it's shrinking magic.

Love

Jacqueline

Soccermom · 09-16-2010, 09:44 AM

Vic, all the information above is excellent, Just want to add my Moms experience..
DX 75 stage 1, Tamoxifen, lumpectomy, DX 80 contralateral breast lumpectomy,Arimidex (dementia diagnosed) DX 83 mets,Navelbine IV, Arimidex.

I wish I had been more saavy back then and had input in her treatment options.NAVELBINE was really easy on her..no hair loss and minimal SE's. It successfully held her mets at bay for a few years, The biggest problem was that the she was not always compliant (she'd forget)with self adminstered treatment (AI's) from the onset of her DX w dementia. This must be taken into account when choosing a treatment regimen.
It seems to me that in our society an older woman w a BC DX can easily fall through the cracks or be undertreated if they have no one to advocate for them.
I hope that your friends Mom will do well with whatever treatment the family decides upon,
Warmly,Marcia

09-19-2010, 06:36 PM

Hi Vicki,
I imagine this is both sad and quite scary for your friend. The biopsy was likely a needle biopsy in which case they wouldn't have enough sample to give concrete diagnosis. The testing of the estrogen receptive or HER2 status is not usually done until they have the entire tumour to work with - again, they need more sample than the needle biopsy provides ... because 70%+ of all breast cancers are estrogen-receptive they are trying the blocker in the hopes of improving the tumour size and risk while waiting for a surgery date. The three month wait is awful but I don't know that it is at all unusual. Given the size of the tumour, I would think that both chemo and radiation will be given but the state of her health will be a factor. Chemo can be very hard on the immune system and can render the patient highly susceptible to other infections - a real worry for an elderly patient, especially if she lives in a high-traffic home like a residence for elderly people. For this reason, they may consider radiation by itself. I wich your friend and her mother-in-law all the best.