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Old 06-15-2011, 04:49 PM   #1
Kim in CA
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Question Her2 Serum ?

Hello Everyone,

Had my six week doctor visit last Tues. since being off Herceptin. Had labs drawn at 5 weeks, so we could discuss results. My CA15-3 was still in normal range (20.4) but Her2 serum result wasn't back yet. Finally got her2 serum results today, and they were slightly above normal at 15.3.

At my dr. visit on Tues, we agreed to retest both CA 15-3 and her2 Serum again in 6 weeks. Now that I know my Her2 Serum is elevated (albeit only slightly) I don't want to wait six weeks to retest. When I asked the nurse to ask the Dr. if we could move my labs up 2 weeks, she called me back to say he wants to keep it at 6 weeks.

My gut is telling me that if the cancer cells are starting to become active because I've stopped Herceptin, that it's better to find out sooner than later, so I can restart the Herceptin. That way we could possibly nip it in the bud without having to add chemo.

I'm awaiting a call back from my Dr. because I don't understand his reasoning on this one.

Do any of you know if there are many false positives with the Her2 test? Your thoughts or opinions would be appreciated.

Thanks,
Kim
__________________
Diag. Feb 1997 4.5cm IDC <10%ER+, PR-. 5 out of 36 nodes +. Mastectomy followed by 3 rounds Adriamycin/Cytoxin.


5/1997 Hi Dose Chemo w/ Stem cell rescue. Spent 4 weeks in isolation ward. Then 6 weeks radiation.

9/2001 widespread mets to liver. 8 mos Taxotere/Herceptin brought me almost to NED. Stop Taxotere & add Femara .

11/2002 liver resection to remove spot that turned out to be necrosis. Officially NED!

7/2003 Tumor markers rising add Xeloda Disastrous reaction, 8 days hospital, but tumor markers came back to normal!

June -Dec 2004 UW Vaccine Trial.

7/2005 MRI single 11mm brain met
8/2005 Gamma Knife.

Brain MRI @3 months NED!

2006-2011 brain/body still NED

8/04/11 Taking Herceptin break, will monitor with tumor markers.

6/20/12 Tumor markers begin to rise. CA15-3 is 31.3 and Her2 Serum is at 17.1 Decide to repeat in one month.

7/23/12 CA15-3 now 49.3
Her2 Serum 26.8

8/6/12 Back on Herceptin
CA15-3 now 76
Her2 Serum now 49

11/7/12 Add weekly Taxotere for 4 cycles

2/2013 Stopped Taxotere added Perjeta. MRI shows approx. 50% reduction liver mets. CA15-3 still elevated @ 55. Will continue on just Herceptin & Perjeta.

November 2014 Continuing on Herceptin, Perjeta, and
Femara indefinitely. Guess I'm NED again, but watching those tumor markers carefully!

Dec. 2015 PET scan reveals mass in perirectal area of abdomen.biopsy confirms. Still Her2+, but no longer ER+. Bye bye Femara

Jan 2016 Begin Kadcyla

March 2016 PET scan shows tumor now barely visible, still NED everywhere else.
2016/2017 continue Kadcyla

November 2017 brain MRI reveals small focus of T2 hyperintensity with possible 4mm enhancing nodule. Short term follow up MRI suggested. Stay tuned...
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Old 06-15-2011, 08:04 PM   #2
Julie2
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Re: Her2 Serum ?

Hi Kim,

My normal Her2serum reading when I was in remission was 8. After developing mets it is ranging from 10 to 20. The only time I had a false positive (increased by 3 points) was when I took serum test during the menstrual period.

Julie
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Diagnosed in Sept 2004 while pregnant with the second child. Stage 3b, tumor 4.5cm, 4 auxillary and supraclav node positive. Her2+++ FISH 9.4 and er-,pr-.
Had dose dense neoadjuvant AC,Taxol then mastectomy,radiation+xeloda+Herceptin.
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Old 06-16-2011, 03:13 AM   #3
Ellie F
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Re: Her2 Serum ?

Hi Kim
Have no words of wisdom to add as we don't get these tests here in England and totally rely on scans!
Hadn't realised you stopped herceptin but it seems reasonable to get a repeat done before any bc gets chance to grow into a problem.
How have you felt since stopping herceptin?
I still think we don't yet know how long NED on herceptin is long enough?
Sending very best wishes for this blip to be nothing. you are flying the flag for all of us.

Ellie
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Old 06-16-2011, 10:25 PM   #4
Chelee
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Re: Her2 Serum ?

Hi Kim,
I can't answer your question on the Her2 test but I know if this was happening to me I would feel the same way you do. After being NED so long I would not want to wait the 6 wks either. I hope your onc gets back to you right away to put your mind at ease. Waiting is so difficult. Chances are all is OK...but I would want to retest now too. Let us know how it goes?

Chelee
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DX: 12-20-05 - Stage IIIA, Her2/Neu, 3+++,Er & Pr weakly positive, 5 of 16 pos nodes.
Rt. MRM on 1-3-06 -- No Rads due to compromised lungs.
Chemo started 2-7-06 -- TCH - - Finished 6-12-06
Finished yr of wkly herceptin 3-19-07
3-15-07 Lt side prophylactic simple mastectomy. -- Ooph 4-05-07
9-21-09 PET/CT "Recurrence" to Rt. axllia, Rt. femur, ilium. Possible Sacrum & liver? Now stage IV.
9-28-09 Loading dose of Herceptin & started Zometa
9-29-09 Power Port Placement
10-24-09 Mass 6.4 x 4.7 cm on Rt. femur head.
11-19-09 RT. Femur surgery - Rod placed
12-7-09 Navelbine added to Herceptin/Zometa.
3-23-10 Ten days of rads to RT femur. Completed.
4-05-10 Quit Navelbine--Herceptin/Zometa alone.
5-4-10 Appt. with Dr. Slamon to see what is next? Waiting on FISH results from femur biopsy.
Results to FISH was unsuccessful--this happens less then 2% of the time.
7-7-10 Recurrence to RT axilla again. Back to UCLA for options.
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Old 06-17-2011, 09:03 AM   #5
Kim in CA
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Re: Her2 Serum ?

Thanks for your replies ladies. Can you believe, I have still not heard back from my Dr. I just called again and left another message. I think my Dr. will eventually go along with my wishes, but I hate it that it's so hard to get to talk with him unless I have an appt. I know that they are short staffed, and he has other patients who are very sick, but I just get so frustrated with this.

I know I'm just getting myself all worked up, but being in this uncharted territory is really nerve wracking sometimes. I just keep remembering how fast my cancer grew when I had my first recurrence in 2001, and don't want to make the same mistakes I made back then.

Thanks for listening, and I'll keep ya posted.

Kim
__________________
Diag. Feb 1997 4.5cm IDC <10%ER+, PR-. 5 out of 36 nodes +. Mastectomy followed by 3 rounds Adriamycin/Cytoxin.


5/1997 Hi Dose Chemo w/ Stem cell rescue. Spent 4 weeks in isolation ward. Then 6 weeks radiation.

9/2001 widespread mets to liver. 8 mos Taxotere/Herceptin brought me almost to NED. Stop Taxotere & add Femara .

11/2002 liver resection to remove spot that turned out to be necrosis. Officially NED!

7/2003 Tumor markers rising add Xeloda Disastrous reaction, 8 days hospital, but tumor markers came back to normal!

June -Dec 2004 UW Vaccine Trial.

7/2005 MRI single 11mm brain met
8/2005 Gamma Knife.

Brain MRI @3 months NED!

2006-2011 brain/body still NED

8/04/11 Taking Herceptin break, will monitor with tumor markers.

6/20/12 Tumor markers begin to rise. CA15-3 is 31.3 and Her2 Serum is at 17.1 Decide to repeat in one month.

7/23/12 CA15-3 now 49.3
Her2 Serum 26.8

8/6/12 Back on Herceptin
CA15-3 now 76
Her2 Serum now 49

11/7/12 Add weekly Taxotere for 4 cycles

2/2013 Stopped Taxotere added Perjeta. MRI shows approx. 50% reduction liver mets. CA15-3 still elevated @ 55. Will continue on just Herceptin & Perjeta.

November 2014 Continuing on Herceptin, Perjeta, and
Femara indefinitely. Guess I'm NED again, but watching those tumor markers carefully!

Dec. 2015 PET scan reveals mass in perirectal area of abdomen.biopsy confirms. Still Her2+, but no longer ER+. Bye bye Femara

Jan 2016 Begin Kadcyla

March 2016 PET scan shows tumor now barely visible, still NED everywhere else.
2016/2017 continue Kadcyla

November 2017 brain MRI reveals small focus of T2 hyperintensity with possible 4mm enhancing nodule. Short term follow up MRI suggested. Stay tuned...
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Old 06-17-2011, 10:33 AM   #6
StephN
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Re: Her2 Serum ?

Dear Kim -
I think 6 weeks is a time frame the docs must have learned in med school because I have heard that before. Maybe that is the "normal" time for changes to show, but I am with you in that we are talking aggressive HER2 bc.

So, I feel your nerves chattering. Are you doing anything in the alternative treatment realm? Taking curcumin or any other things that have shown effectiveness against HER2?

So far my HER2 serum has stayed in the 6 to 8 range over the years I have had that lab.

Take comfort in a nice long ride with your horse.
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Live in the moment.

MY STORY SO FAR ~~~~
Found suspicious lump 9/2000
Lumpectomy, then node dissection and port placement
Stage IIB, 8 pos nodes of 18, Grade 3, ER & PR -
Adriamycin 12 weekly, taxotere 4 rounds
36 rads - very little burning
3 mos after rads liver full of tumors, Stage IV Jan 2002, one spot on sternum
Weekly Taxol, Navelbine, Herceptin for 27 rounds to NED!
2003 & 2004 no active disease - 3 weekly Herceptin + Zometa
Jan 2005 two mets to brain - Gamma Knife on Jan 18
All clear until treated cerebellum spot showing activity on Jan 2006 brain MRI & brain PET
Brain surgery on Feb 9, 2006 - no cancer, 100% radiation necrosis - tumor was still dying
Continue as NED while on Herceptin & quarterly Zometa
Fall-2006 - off Zometa - watching one small brain spot (scar?)
2007 - spot/scar in brain stable - finished anticoagulation therapy for clot along my port-a-catheter - 3 angioplasties to unblock vena cava
2008 - Brain and body still NED! Port removed and scans in Dec.
Dec 2008 - stop Herceptin - Vaccine Trial at U of W begun in Oct. of 2011
STILL NED everywhere in Feb 2014 - on wing & prayer
7/14 - Started twice yearly Zometa for my bones
Jan. 2015 checkup still shows NED
2015 Neuropathy in feet - otherwise all OK - still NED.
Same news for 2016 and all of 2017.
Nov of 2017 - had small skin cancer removed from my face. Will have Zometa end of Jan. 2018.
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Old 06-19-2011, 08:24 PM   #7
Joan M
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Re: Her2 Serum ?

Kim,

Hopefully the slight elevation is just a reaction to your stopping Herceptin and nothing more than that.

Joan
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Diagnosed stage 2b in July 2003 (2.3 cm, HER2+, ER-/PR-, 7+ nodes). Treated with mastectomy (with immediate DIEP flap reconstruction), AC + T/Herceptin (off label). Cancer advanced to lung in Jan. 2007 (1 cm nodule). Started Herceptin every 3 weeks. Lung wedge resection April 2007. Cancer recurred in lung April 2008. RFA of lung in August 2008. 2nd annual brain MRI in Oct. 2008 discovered 2.6 cm cystic tumor in left frontal lobe. Craniotomy Oct. 2008 (ER-/PR-/HER2-) followed by targeted radiation (IMRT). Coughing up blood Feb. 2009. Thoractomy July 2009 to cut out fungal ball of common soil fungus (aspergillus) that grew in the RFA cavity (most likely inhaled while gardening). No cancer, only fungus. Removal of tiny melanoma from upper left arm, plus sentinel lymph node biopsy in Feb. 2016. Guardant Health liquid biopsy in Feb. 2016 showed mutations in 4 subtypes of TP53. Repeat of Guardant Health biopsy in Jana. 2021 showed 3 TP53 mutations, BRCA1 mutation and CHEK2 mutation. Invitae genetic testing showed negative for all of these. Living with MBC since 2007. Stopped Herceptin Hylecta (injection) treatment in March 2020. Recent 2021 annual CT of chest, abdomen and pelvis and annual brain MRI showed NED. Praying for NED forever!!
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Old 06-20-2011, 04:36 PM   #8
Kim in CA
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Re: Her2 Serum ?

Well, I finally had a message from one of the advice nurses, saying that we could re do the Her2 serum in 3-4 weeks. I know they think I'm over reacting, but "tough noogies".

I made a promise to myself that I'd keep a close watch on my markers, since they are the only tests we are using at this time. I try not to do scans anymore, so as not to add to my cumulative radiation exposure.

Steph, I've tried taking the curcumin, but unfortunately it does not agree with me (major stomach/intestinal upset)but I do try to eat more foods with anti cancer properties, and of course try to stay active.

I'll let you know my results when I get them. Thank you all for your feedback.

Kim
__________________
Diag. Feb 1997 4.5cm IDC <10%ER+, PR-. 5 out of 36 nodes +. Mastectomy followed by 3 rounds Adriamycin/Cytoxin.


5/1997 Hi Dose Chemo w/ Stem cell rescue. Spent 4 weeks in isolation ward. Then 6 weeks radiation.

9/2001 widespread mets to liver. 8 mos Taxotere/Herceptin brought me almost to NED. Stop Taxotere & add Femara .

11/2002 liver resection to remove spot that turned out to be necrosis. Officially NED!

7/2003 Tumor markers rising add Xeloda Disastrous reaction, 8 days hospital, but tumor markers came back to normal!

June -Dec 2004 UW Vaccine Trial.

7/2005 MRI single 11mm brain met
8/2005 Gamma Knife.

Brain MRI @3 months NED!

2006-2011 brain/body still NED

8/04/11 Taking Herceptin break, will monitor with tumor markers.

6/20/12 Tumor markers begin to rise. CA15-3 is 31.3 and Her2 Serum is at 17.1 Decide to repeat in one month.

7/23/12 CA15-3 now 49.3
Her2 Serum 26.8

8/6/12 Back on Herceptin
CA15-3 now 76
Her2 Serum now 49

11/7/12 Add weekly Taxotere for 4 cycles

2/2013 Stopped Taxotere added Perjeta. MRI shows approx. 50% reduction liver mets. CA15-3 still elevated @ 55. Will continue on just Herceptin & Perjeta.

November 2014 Continuing on Herceptin, Perjeta, and
Femara indefinitely. Guess I'm NED again, but watching those tumor markers carefully!

Dec. 2015 PET scan reveals mass in perirectal area of abdomen.biopsy confirms. Still Her2+, but no longer ER+. Bye bye Femara

Jan 2016 Begin Kadcyla

March 2016 PET scan shows tumor now barely visible, still NED everywhere else.
2016/2017 continue Kadcyla

November 2017 brain MRI reveals small focus of T2 hyperintensity with possible 4mm enhancing nodule. Short term follow up MRI suggested. Stay tuned...
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Old 06-20-2011, 05:57 PM   #9
Elizabethtx
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Re: Her2 Serum ?

I'm with you, don't give them a chance to say no! It is your choice, get the new blood work whenever you feel it is right. I would feel the same way until a little more time has passed. Stay strong and we are rooting for you!
__________________
Diagnosed: Feb 2010 @ 46 yrs old
Invasive Ductual Carcinoma, left
2/28/10 Bilateral Mastectomy (tissue saving for future reconstruction)
3.2 cm 2/18 +lymph nodes
Stage 2b; E+/P+/Her2 +++
Nottingham score grade 2
Ki67 30%
3/2010 A/C 4 DD/2wks
5/2010 Herceptin/Taxotere 4D/3wks
8/2010 Herceptin until May 2011
Tamoxifin 20mg
9/2010 RAD 34 treatments
Pet scan Aug 2010 clear
Port removed July 2011
Bone scan, chest MRI 12/11 clear
Vaccine trial began Oct 2011








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Old 06-29-2011, 04:38 AM   #10
mamacze
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Re: Her2 Serum ?


Hi Kim,
I just got back from vacation with the kids (my LAST trip to Disney World!) and I am glad I stumbled on this post. I stopped Herceptin last month4 years. Before I stopped, I got a 2nd from an oncologist at Sloan. She said in her experience; her ladies who respond to Herceptin then take a holiday; typically recur (and need to go back on Herceptin) within 8 weeks to 4 years. My oncologist decided to monitor me with the CellSearch Circulating Tumor Cell Test. I am expecting results from my first test this week. I am wondering if it would be helpful for you to have this as a back up test ... it would be interesting to see if it too shows an elevation. Keep us posted. Fingers and Toes are crossed for you!
Love Kim from CT
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2001 - Stage 0, lumpectomy, radiation, tamoxifen

2004 - Stage 4, mets to 4 lobes of lungs and liver, lumpectomy, er/pr -, her2 neu+++, Herceptin and Navelbine then Herceptin only.

2005 - Breast Ca vaccinations with the Tumor Vaccine Group in Seattle

2011 - Still Herceptin only and NED


2011, June - STOPPED Herceptin and kicked up my heels!

2012, February - 1 small tumor came back to haunt me in my lungs - back on Herceptin only, tumor stable.


2015, November - tumor on lungs removed (Segmentectomy), back on Herceptin only
Received U of W vaccine clinical "booster" Vaccine


2022 On Herceptin and NED continues - WOOT WOOT!
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Old 07-01-2011, 11:07 PM   #11
Kim in CA
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Angry Re: Her2 Serum ?

Hello Everyone,

My Oncologist called me tonight to report that my Her2 Serum test that I just had redone on Weds. was up again, to 16.9. He asked me what I wanted to do. Wait, and retest in another month, or go back on Herceptin. I must admit I'm not willing to gamble on this one. It's back on the Herceptin for me.

We don't think doing scans would show anything at this time. My CA15-3 four weeks ago was still normal, and that has always been a pretty good indicator for me. I just have a feeling that the Her2 Serum may be a little more sensitive, and I don't want to give those cancer cells a chance to really get going, if indeed they are getting active.

I mean it's just too much of a coincidence that my Her2 Serum has always been in the normal range since we started testing 5 yrs ago, and within 5 weeks of stopping Herceptin it starts climbing.

I feel so incredibly lucky to have had such a long run with NED, and I'm just not much of a gambler, even though the idea of stopping Herceptin was so alluring.

On a very sad note, my sister was just diagnosed with a malignant brain tumor. She has a glioblastoma, and has one heck of a fight ahead of her.

I HATE CANCER!!
__________________
Diag. Feb 1997 4.5cm IDC <10%ER+, PR-. 5 out of 36 nodes +. Mastectomy followed by 3 rounds Adriamycin/Cytoxin.


5/1997 Hi Dose Chemo w/ Stem cell rescue. Spent 4 weeks in isolation ward. Then 6 weeks radiation.

9/2001 widespread mets to liver. 8 mos Taxotere/Herceptin brought me almost to NED. Stop Taxotere & add Femara .

11/2002 liver resection to remove spot that turned out to be necrosis. Officially NED!

7/2003 Tumor markers rising add Xeloda Disastrous reaction, 8 days hospital, but tumor markers came back to normal!

June -Dec 2004 UW Vaccine Trial.

7/2005 MRI single 11mm brain met
8/2005 Gamma Knife.

Brain MRI @3 months NED!

2006-2011 brain/body still NED

8/04/11 Taking Herceptin break, will monitor with tumor markers.

6/20/12 Tumor markers begin to rise. CA15-3 is 31.3 and Her2 Serum is at 17.1 Decide to repeat in one month.

7/23/12 CA15-3 now 49.3
Her2 Serum 26.8

8/6/12 Back on Herceptin
CA15-3 now 76
Her2 Serum now 49

11/7/12 Add weekly Taxotere for 4 cycles

2/2013 Stopped Taxotere added Perjeta. MRI shows approx. 50% reduction liver mets. CA15-3 still elevated @ 55. Will continue on just Herceptin & Perjeta.

November 2014 Continuing on Herceptin, Perjeta, and
Femara indefinitely. Guess I'm NED again, but watching those tumor markers carefully!

Dec. 2015 PET scan reveals mass in perirectal area of abdomen.biopsy confirms. Still Her2+, but no longer ER+. Bye bye Femara

Jan 2016 Begin Kadcyla

March 2016 PET scan shows tumor now barely visible, still NED everywhere else.
2016/2017 continue Kadcyla

November 2017 brain MRI reveals small focus of T2 hyperintensity with possible 4mm enhancing nodule. Short term follow up MRI suggested. Stay tuned...
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Old 07-02-2011, 01:54 AM   #12
Lien
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Re: Her2 Serum ?

Hi Kim, I'm glad your doc included you in this decision. I think this is the right course of action for you. You wouldn't feel safe any other way. May you get a lot more mileage out of Vit H. I know several people who have been dancing with NED for over a decade.

I am so sorry about your sister. That is a scary diagnosis. Hope she pulls through ok.

Hugs

Jacqueline
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Diagnosed age 44, January 2004, 0.7 cm IDC & DCIS. Stage 1, grade 3, ER/PR pos. HER2 pos. clear margins, no nodes. SNB. 35 rads. On Zoladex and Armidex since Dec. 2004. Stopped Zoladex/Arimidex sept 2009 Still taking mistletoe shots (CAM therapy) Doing fine.
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Old 07-02-2011, 09:24 AM   #13
Mary L
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Re: Her2 Serum ?

Hi Kim, I too am a her2+++ and was on Herceptin for over 4 years. My onc decided almost 4 years ago to stop the Herceptin. He and Dr Slamon felt that it was a good time to stop. I was very afraid and begged to stay on it but it was stopped. I have been so fortunate & blessed to be coming up on 8 years this Oct 2011. I love Herceptin, it saved my life. I sometimes wish I could just have a round of it as a precaution, however my onc says that is not done. I wish you the very best and I agree with you on starting Herceptin asap. It works! Mary L
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Mary L from PA Diag: Oct 2003 w/6mm mass, IDC grade III ductal carcinoma in-situ, IBC stage IIIB. tx A/C followed by Taxotere(only able to have 2 tx, allergic), mastectomy, 3 0ut of 7 positive nodes. 35 rads. Recurrence 9 months later, skin mets to mastectomy site. Tx Carboplatin/Herceptin. Stayed on Herceptin almost 5 years, had 3 more recurrences when I had to stop Herceptin due to my ejection fraction getting too low. Herceptin stopped and ned 3 years in Oct. 2010.
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Old 07-02-2011, 11:15 AM   #14
Jackie07
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Re: Her2 Serum ?

Kim,

I'm sorry about your sister's diagnosis of GBM. Please contact ABTA (American Brain Tumor Association http://www.abta.org/) and NBTS (National Brain Tumor Society http://www.braintumor.org/patients-f...-brain-tumors/) for current research info and support.

GBM is extremely difficult to treat. But there are quite a few long-term survivors out there. NBTS is currently providing funding on 'translational' research.

Your family might fit the profile of HNPCC or other familial cancer cluster. Please request for genetic testing for both you and your sister, and possibly other family members.

Sending both of you good vibes.
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Old 07-02-2011, 04:04 PM   #15
Chelee
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Re: Her2 Serum ?

Hi Kim,
I think that is a very wise decision to go back on Herceptin. Like you, here is no way I could risk it. If you were to wait again to retest it might be hard to close that barn door and be NED again. I'm glad you have decided to stay on the NED horse again...you will rest easy now.

What was your normal range for the Her2 serum test before stopping Herceptin? As to your sister I am so sorry to hear the news. My heart just goes out to you both. She does have a fight ahead of her...but as you know from 1st hand experience...there are those that make it through these things. Jackie is very knowledable in this area and she knows of surviviors. I'll keep her in my thoughts and prayers.

Chelee
__________________
DX: 12-20-05 - Stage IIIA, Her2/Neu, 3+++,Er & Pr weakly positive, 5 of 16 pos nodes.
Rt. MRM on 1-3-06 -- No Rads due to compromised lungs.
Chemo started 2-7-06 -- TCH - - Finished 6-12-06
Finished yr of wkly herceptin 3-19-07
3-15-07 Lt side prophylactic simple mastectomy. -- Ooph 4-05-07
9-21-09 PET/CT "Recurrence" to Rt. axllia, Rt. femur, ilium. Possible Sacrum & liver? Now stage IV.
9-28-09 Loading dose of Herceptin & started Zometa
9-29-09 Power Port Placement
10-24-09 Mass 6.4 x 4.7 cm on Rt. femur head.
11-19-09 RT. Femur surgery - Rod placed
12-7-09 Navelbine added to Herceptin/Zometa.
3-23-10 Ten days of rads to RT femur. Completed.
4-05-10 Quit Navelbine--Herceptin/Zometa alone.
5-4-10 Appt. with Dr. Slamon to see what is next? Waiting on FISH results from femur biopsy.
Results to FISH was unsuccessful--this happens less then 2% of the time.
7-7-10 Recurrence to RT axilla again. Back to UCLA for options.
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