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01-17-2006, 01:03 PM

I know of a person with a similar story, except it was known that her DCIS was her2+ and ER + with a few areas of microinvasion. Her sentinel node was supposedly negative. She had a mastectomy and reconstruction and then during a followup visit a lymph node of considerable size was found, when an exam one month before showed no evidence of lymphadenopathy. The node was positive for her2+ breast cancer

An MRI was done, but no other primary tumor was found (the MRI was somewhat difficult to interpret because of an implant)

Her oncologist suggested chemotherapy and herceptin

She sought three opinions--two oncologists in private practice and one at a major cancer teaching hospital, who specializes in her2+ breast cancer

If you look up posts by a junior member named Nicola on this site you will see that she went from Stage 0(DCIS) to Stage 4. This is not supposed to happen by the textbooks--one theory is that there is some other area of invasive breast cancer somewhere in the breast that has been missed (or ectopic breast tissue on the axilla ) or perhaps some subgroup of her2positive tumors where only microinvasion is enough to promote distant metastasis. We are still learning about this disease--once her2neu testing is done reproducibly and well all over the world, perhaps we will discover its natural history more completely and understand its behavior better.

Hopefully Herceptin will also alter its behavior. It is only by sharing these unusual cases that we can point out the need for rethinking dogma.

MD Anderson, Stanford, Mayo Clinic , Dana Farber and Memorial Sloane-Kettering offer "second pathologic opinion" services. You can request your slides be sent their --they maybe able to estimate the price of the service ahead of time.

Has your friend had an MRI looking for cancer in her residual tissues, axilla? Again, these are best done at large teaching hospitals who are experienced in their interpretation.

01-17-2006, 01:03 PM	#4
Unregistered1 Guest Posts: n/a	where is your friend located? I know of a person with a similar story, except it was known that her DCIS was her2+ and ER + with a few areas of microinvasion. Her sentinel node was supposedly negative. She had a mastectomy and reconstruction and then during a followup visit a lymph node of considerable size was found, when an exam one month before showed no evidence of lymphadenopathy. The node was positive for her2+ breast cancer An MRI was done, but no other primary tumor was found (the MRI was somewhat difficult to interpret because of an implant) Her oncologist suggested chemotherapy and herceptin She sought three opinions--two oncologists in private practice and one at a major cancer teaching hospital, who specializes in her2+ breast cancer If you look up posts by a junior member named Nicola on this site you will see that she went from Stage 0(DCIS) to Stage 4. This is not supposed to happen by the textbooks--one theory is that there is some other area of invasive breast cancer somewhere in the breast that has been missed (or ectopic breast tissue on the axilla ) or perhaps some subgroup of her2positive tumors where only microinvasion is enough to promote distant metastasis. We are still learning about this disease--once her2neu testing is done reproducibly and well all over the world, perhaps we will discover its natural history more completely and understand its behavior better. Hopefully Herceptin will also alter its behavior. It is only by sharing these unusual cases that we can point out the need for rethinking dogma. MD Anderson, Stanford, Mayo Clinic , Dana Farber and Memorial Sloane-Kettering offer "second pathologic opinion" services. You can request your slides be sent their --they maybe able to estimate the price of the service ahead of time. Has your friend had an MRI looking for cancer in her residual tissues, axilla? Again, these are best done at large teaching hospitals who are experienced in their interpretation.