[Becky]

Dear Chelee

I don't think this is a new cancer at all. Many things may have happened and some have been already discussed on the board.

Firstly, the cancer may have totally mutated but I don't think this is what really happens when there is a pathology change - especially when the patient has had previous chemo or other therapy.

I will explain this using your pathology.

Originally, you were highly Her2+ (confirmed by Dr. Slamon no less) and you were 5% ER+ (PR neg). Let's first focus on the hormone status.

What 5% ER+ really means is that when a pathologist first tested your tumor for hormone status they observed that only 5% of the cells of the entire tumor were ER+ and the remaining 95% of cells were ER neg. Since you were also highly Her2+ this means that (in general) 5% of the cells were ER+/Her2+ and 95% of the cells were just Her2+ (all this is generally speaking).

So you took your TCH chemo and the year of Herceptin. I am sure, as Dr. Slamon even said, that the Herceptin did a great job - especially on the ERneg/Her2+ cell line but it probably did not do the whole job on the ER+ line. Therefore, when you recurred, what was left was the cells that were ER+ and therefore, they proliferated and that tumor is now 60% ER+.

Now, thinking out loud again, you are barely Her2+. Is that TRULY correct? I am sure by this pathology report it is but remember, you began Herceptin treatment prior to this surgery so this is not a pathology of what was there prior to the Herceptin/Zometa treatment either. Perhaps the original mets were more Her2+ than this is showing (perhaps).

The main point - and I have said this repeatedly before, is that if one has bc mets to the bones, even if the original cancer was NOT ER+ or was weakly ER+, one must suspect that the bone mets are more highly ER+ as ER+ bc (if metted) likes the bones. That is why I advise biopsy if possible and if not possible, assume that the bone mets are ER+ and take an antihormonal (Tamoxifen, an AI or Faslodex) and try it for 3-6 months and see if it starts helping. If it doesn't, it doesn't.

You are in a quandry as you now might not be able to continue Herceptin although you should. You also have more ammo to start Faslodex immediately as you are now more hormone positive.

We must remember that our cancers are a mosaic and that our treatments may do well on some cell lines and not others. That is why I am a huge advocate that even if one is weakly hormone positive, you should take an antihormonal at least while on Herceptin therapy (wipe out 2-3 receptors at one time) and if high positive, continue on the antihormonal for the obligatory 5 years.

It is good that the cancer became more hormone positive. I think you need to continue with Herceptin even though you are only 1+ as this change may have occurred with your recent two Herceptin treatments.

Sorry this is sooooo long.