HER2 Support Group Forums - My Wife Rachel Was Just Diagnosed With HER-2+ Breast Cancer (Please Help ...)

Hi, Ben and Rachel, I am new to this site and that may explain why I can't get the paragraphing to stay in the post. I am 50 years old and was just diagnosed in mid June with node negative Her2 positive ER negative invasive duct carcinoma with a large field of DCIS. My tumour was 31mm (invasive) with 49mm DCIS, but no LVI. I had left mastectomy after initial lumpectomy, because of the size of the DCIS. I am Australian and I happen to be a pathologist in a rural town. I am usually presenting breast cancer cases at multidisciplinary meetings, not being presented as a case at the meetings! I work in the laboratory next door to the oncology unit. So this is an Australian viewpoint for you, although it seems you have made most of your decisions by now. 1. Is TCH the best chemotherapy regimen for her? Do we really need chemo? - Yes and yes. Chemotherapy has been proven beneficial in large trials for early HER2 positive cancer. Our therapy is heavily influenced by Dr Slamon's work, also. In Australia, AC-TH therapy is still used for early breast cancer, particularly if there are positive nodes, but TCH is increasingly used because of the lesser cardiac toxicity. I've chosen TCH and yes, I'm scared but what choice is there - I've got to get any remnant of my little monster zapped so I can live to hold my grandchildren in my arms. Given that my kids are only 14 and 17, that's at least 10 years away (I hope).... and yes, I did go in afterwards to look at my own pathology slides! TH alone isn't really used here much in this setting. Most chemotherapy drugs are paid for by the Australian government. For TCH the government won't supply Neulasta unless your neutrophils count falls below a certain level. It is supplied routinely for AC-TH. The government lags a bit behind the medical evidence sometimes, but it is great how much it pays for. Takes time for new treatments to be added, though. 2. Should we have the second surgery to get clear margins? Would it be better to try radiation to get clear margins? - Absolutely. Radiologist love clear margins. If can't be cleared surgically by adequate margins, radiotherapy may still be required. Radiotherapy is so well targeted now with few side effects in most cases. It's considered a walk in the park compared to chemo here. 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? - The left nipple definitely does not have to be removed. The risk is negligible. BTW It was not recommended for me to have my other breast removed, despite my breasts being difficult, because of fibrosis. However, I did briefly consider it. I do not have a family history and I am older than Rachel. My remaining breast will likely have to be screened with Ultrasound and MRI, given my 3cm lesion was impalpable and not detectable on mammogram (picked up at breast screen on US). But as a perk of my job, I don't have to pay for my MRIs, which may have influenced my choice. My oncologist considered this a personal choice, to be based on how anxious I would be about having repeated screening. 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? - Almost everyone gets a portacath for this chemo in Australia. Mine is called a Power Port and sits on my outer chest near my right shoulder (at the time of mastectomy). Felt like it was inserted with a sledge hammer but now after 2 & 1/2 weeks, feels fine. Will make life much easier. One other different thing here is that BRCA testing is only offered to a small proportion of patients with breast cancer, based on family history, age of patient and type of tumour (more likely if early onset, triple negative cancer and patient has a first degree relative with cancer.) You have to have been seen by a clinical geneticist to have the government pay for the test, but you can pay for it yourself if you have $3000+ to spare. TOPO II isn't used here and OncotypeDx type genetic testing isn't commonly done. Ki67% is used by some labs but not others - considered a bit unreliable as yet, except for research, and in my oncology unit, grade, tumour size, margins, nodes, mets, ER, PR and HER2 status along with clinical factors are the keys to determine treatment. I didn't mean to write this much, sorry. I hope Rachel goes well with her chemo. Mine starts on August 12.....am enjoying myself and the winter sun in the meantime.