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Old 06-29-2013, 09:39 AM   #1
bmorr7
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Join Date: Jun 2013
Posts: 24
My Wife Rachel Was Just Diagnosed Wtih HER-2+ Breast Cancer (Please Help ...)

Hi,

We're new to this group but I thought it might help to post my wife's situation on this forum and our oncologist told us that patients learn the most on supportive forums like this.

My wife, Rachel, is 42 years old and was sadly diagnosed with breast cancer earlier this month. About a month ago, she felt a lump in her right breast and went to see her PCP who referred her to a breast center for a mammogram/sonogram. The mammogram was normal but the sonogram picked up a small suspicious area which was biopsied. The biopsy came back as invasive ductual carcinoma, grade 1 with a modified Blood-Richardson score of 5 of 9 (tubular formation 2, nuclear grade 2, mitosis 1). There was also extensive DCIS, intermediate to high grade with focal necrosis, solid and cribriform type. Lymphovascular invasion was negative.
ER was positive 2-3+ (80% staining) with clone SP1 while PR was slightly positive (10% staining) at 1+ with clone 636. Her2neu was indeterminate with test score of 2 on the initial test (DAKO Hercep test) but FISH was done and was very HER-2/neu positive with a R/G of 11.3 (Red signals 373 and Green signals 33). The report said that the FISH test showed evidence of ERBB2 (HER-2/neu) amplification. The Her2 karyotype was nuc-ish (D17Z1x1-2, ERBB2x2-27)(20).

Rachel was referred to a breast surgeon who checked an MRI which was negative on the left but on the right showed a 7 cm area that was suspicious extending from the chest wall out to the nipple. The area that had been biopsied was a 1 cm part of this 7 cm area. The surgeon said that the other 6 cm might be DCIS. The surgeon recommended a mastectomy and she ended up recommending a bilateral mastectomy to be on the safe side because of the high risk of a new tumor on the left side.

The breast MRI showed an odd looking lesion in the sternum so a PET scan and bone scan were checked whiich were both fortunately negative for mets. The concensus was that the lesion in the sternum was probably a benign cartilage lesion that had probably been there for many years.

On June 19, Rachel had a bilateral mastectomy with right-sided sentinel node mapping. Five sentinel nodes were checked and they were all negative for cancer. On the surgical specimen, the modified Bloom-Richardson score was 6 out of 9 (tubule formation 3, nuclear grade 2, mitosis 1). The invasive tumor turned out to be 0.8 cm in size with 6.2 cm of DCIS which was extensive. DCIS was seen at two surgical margins (at the lateral shave margin and at the deep shave margin). DCIS was also seen in a large lactiferous duct.

A tiny speck of Paget's disease of breast was also noted near the nipple but the surgeon said that the Paget's was removed completely because the nipple was removed (from the right side) and there were clear margins around the Paget's specimen. The nipple was not removed from the left although a mastectomy was performed on the left side. The left breast was normal on the pathology specimens. Expanders were placed by a plastic surgeon after the mastectomies and implants are supposed to be placed in a few months.

Other items from the pathology at surgery was Ki-67 10% and PHH3 1%; 2/10 HPF. On the original biopsy, it was Ki-67 5% and PHH3 <2%.

Our surgeon reviewed the surgical reports with us and she recommended that she go back in next week and try to get clear margins at the lateral and deep sections. She said that she may need to remove a thin layer of muscle to do that. She said that radiation might be an option but she highly recommended a second operation as she said that the complications from radiation would be riskier.

We met with our oncologist who agreed that a second surgery to get clear margins is the best option. He said that after that he wants to start chemotherapy with Taxotere (Docetaxel), Carboplatin, and Herceptin (Trastuzumab). He called this chemo regimen TCH. He plans six cycles of chemotherapy with each cycle (of the three drugs above) happening every three weeks. He says that Herceptin will be given for one year. He said that he plans to give my wife something called Neulasta the day after each chemo cycle to help support her immune system.

He said that my wife has stage 1 disease but that chemo/Herceptin is needed because she has a strongly HER-2 positive cancer and that the DCIS was so extensive at 7 cm. He also checked a BRCA gene test which should be back next week.

Of course, Rachel and I are overwhelmed right now and are looking for help and advice.

1. Is TCH the best chemotherapy regimen for her? Do we really need chemo?

2. Should we have the second surgery to get clear margins? Would it be better to try radiation to get clear margins?

3. Should the left nipple also be removed during the next surgery because of the Paget's on the right. Does the skin around the nipple need to be removed from the right side?

4. The surgeon plans to put in a neck portacath during the next surgery to be used for chemo. Is this the best type of catheter to have?

I'm sure that I left out some details so please let me know if I can share anything else about my wife's story.
Thank you so much for any help/advice that you can give Rachel.

Thanks,

Benjamin
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