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Topic: Understanding HER2+ and 28 out of 30 tumor Impacted Lymph nodes

Forum: Caring for Someone with Breast cancer —

A place to share your struggles and concerns about supporting and caring for a person you love diagnosed with breast cancer with others who understand.

Posted on: May 18, 2018 11:28AM

Miza_73 wrote:

Hi everyone,

I have been reading many posts from this forum and found it to be one of the most supportive and helpful place.

I am currently a husband and the key caregiver for my wife who is diagnosed with Stage 2 or 3 HER2+ Breast cancer. It is a unique situation where there are no tumors on her breast but the cancer was discovered only at her anxillary lymph nodes.

She had done a 6 cycles of neo-adjuvant chemo therapy with Herceptin and Perjeta and recently undergone a surgery to remove the impacted lymph nodes. Post surgery, we were informed by the doctor that the lymph node impacted were more than what was seen from the PET scan. The PET scan only indicated 6 or 8 but during the surgery 30 nodes were removed for lab test and 27 came back to be cancer positive. The surgeon said that its good that she had removed all the lymph nodes and that there is nothing much to worry about. I asked if this means that the cancer is aggressive, she responded "no", but need to talk to oncologist for further treatment.

I am really taken aback by this recent update and unsure if things have suddenly become extremely critical. We are scheduled to meet the oncologist next week and it was mentioned that my wife may need to have another round of chemotheraphy after her scheduled 30 sessions of radiotheraphy.

I am trying to make sense of all this.

a) why was the tumor not detected during the PET scan?

b) What does 27 out of 30 nodes impacted with cancer mean?

c) If the full lymph node is removed, is she considered safe from the cancer spreading?

d) Does this mean that treatment has progressed to palliative?

e) what is my wife's chance of survival given all these new outcome.

I am trying to prepare myself before meeting with the oncologist next week so that I can have more proper answers.

If anyone have any experience similar to what I am going through, appreciate your kind feedback and advise.

Thank you

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May 18, 2018 01:00PM Moderators wrote:

Hi Miza-

We're so sorry to hear about your wife. We know what a difficult time this is for your whole family, but we hope it helps to know none of you are alone! We have a HER2+ forum where you might find some helpful info, and hear from members who're dealing with similar diagnoses:

Please keep us posted on what happens when you see her oncologist, we hope we can help you all through this!

The Mods

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May 18, 2018 11:14PM xxyzed wrote:

I also had a large number of cancerous lymph nodes. In my pet scan they could see approx 4 to 6. I had an axillary clearance and all 20 of my removed lymph nodes were cancerous.

In response to some of your questions: a) sometimes no tumour can be seen on imaging. It is known as occult which means they couldn’t find the primary tumour. b) 27/30 cancerous lymph nodes means that they removed the lymph nodes from the axilla region and when they analysed them and separated them they counted 30 in total and of those 27 tested positive for cancer. There are 3 levels of lymph nodes. The axilla clearance is normally of levels 1 and 2. In my case they also cleared level 3 as the surgeon thought they looked suspicious for cancer. Your surgeon should tell you how many levels were taken. 27/30 means the cancer had spread throughout the axilla region. My surgeon advised that breast cancer normally spreads in a predictable path. c) There is no such thing as safe in cancer. There is always a risk of recurrence. With so many cancerous nodes they will recommend aggressive treatment to minimise the risk of recurrence. d) The information you have been given so far does not indicate it has progressed to palliative. Mine was considered curable but locally advanced which means they recommend aggressive treatment. Palliative is when it has spread outside the breast / armpit area. They will take full body scans to see if it has spread outside the local area like the spine, lungs, liver or brain which are the common locations for breast cancer spread. If the scans indicate wider spread it would then be considered metatisis and be called stage 4 which is considered palliative, ie treatable but not curable. e) Your surgeon would be able to tell you her recurrence risk as it would depend on her specific factors. Realistically her chance of survival depends on how well her cancer responds to the treatments provided. Some people have cancer that doesn’t seem to respond as expected to the treatments whereas the majority undergo the recommended treatment and have no recurrence.

Mine was considered aggressive as I had very small multi focal tumours but extensive lymph node involvement. I had surgery first which was then followed by chemo, then radiation and now extended her 2 treatment.

Dx 5/17/2016, DCIS/IDC, Left, 1cm, Grade 3, HER2+ (IHC) Surgery 5/31/2016 Lymph node removal: Left, Underarm/Axillary; Mastectomy: Left, Right Dx 6/9/2016, DCIS/IDC, Left, 4cm, Stage IIIC, Grade 2, 20/20 nodes, ER-/PR-, HER2+ (DUAL) Chemotherapy 7/7/2016 AC + T (Taxol) Radiation Therapy 11/20/2016 Whole-breast: Breast, Lymph nodes, Chest wall Surgery 9/26/2017 Targeted Therapy Herceptin (trastuzumab) Targeted Therapy Nerlynx
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May 21, 2018 12:10PM Miza_73 wrote:

Hi xxyzed,

Thank you so much for sharing the information, they are very very helpful and I am now understanding the overview much better and these information are very helpful for my next session with the Onco in the next few days.

Really appreciate it.

Praying for the best outcome for both my wife and you.

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Jun 12, 2018 05:34PM - edited Jun 12, 2018 05:39PM by beauz

Hi miza, I just ran into your posts. You may have known this information already. But I post here for what I know, just in case. There is a discussion board in this site where people have similar type of BC to your wife. It is called

Topic: Occult Primary with Lymph Node Metastases Forum: Less Common Types of Breast Cancer
Dx 01/Dec/2017, invasive carcinoma of mixed type. Mixed no special type(60%) and micropapillary type(40%). High grade DCIS present within and beyond invasive carcinoma. Right, 5cm, Stage IIIB, Grade 2, 3/15 nodes, ER+/PR-,Her2- Dx 5/2017, IDC, Right, 5cm, Stage IIIB, Grade 2, ER+/PR-, HER2- Chemotherapy 6/27/2017 AC + T (Taxol) Surgery 11/28/2017 Lumpectomy: Right; Lymph node removal: Right, Underarm/Axillary Chemotherapy 1/10/2018 Xeloda (capecitabine) Radiation Therapy 4/17/2018 Whole-breast: Breast Hormonal Therapy 9/18/2018 Femara (letrozole)

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