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Topic: How did they confirm your Stage IV diagnosis? Biopsy questions.

Forum: Stage IV/Metastatic Breast Cancer, Open to All To Contribute —

Topics here are started by members with a Stage IV/Metastatic Breast Cancer diagnosis, but open to all members to contribute to discussions. Please note that there is a separate forum, Stage IV/Metastatic Breast Cancer ONLY, where topics are open only to those members.

Posted on: Apr 7, 2020 03:59PM - edited Apr 8, 2020 06:10AM by laastra

laastra wrote:

I have just had a CT scan and bone scan that came back with multiple areas in the lining of the lungs/pleura that have nodules and are suspicious for metastasis. There is also a spot that is suspicious in my right hip and another spot in my L2 vertebra.

I am going in for a CT-guided biopsy of the bone soon, so they can see if it is from my original breast cancer or if it changed characteristics or anything.. What kind of biopsies did you have to confirm your diagnosis?

My other question is if they confirm exactly what it is from the bone biopsy, can they know for sure that what is in the lungs is the same exact thing? Will they need to look at both?

Thank you for your input :)

IDC-L multifocal. age 33. Dx 11/3/2016, IDC, Left, 1cm, Stage IA, Grade 2, 0/3 nodes, ER+/PR+, HER2- Surgery 1/14/2017 Lymph node removal: Sentinel; Mastectomy: Left; Reconstruction (left): Silicone implant Hormonal Therapy 3/17/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Dx 4/15/2020, IDC, Stage IV, metastasized to bone/lungs, Grade 2, ER+/PR+, HER2- Hormonal Therapy 4/16/2020 Faslodex (fulvestrant), Zoladex (goserelin) Targeted Therapy 4/23/2020 Ibrance (palbociclib)
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Apr 7, 2020 04:46PM moth wrote:

First off - sorry you find yourself here Hug


I have heard some people have more than 1 biopsy so it's possible. I did read someone on this board swore by it as she discovered that some of her mets had different profiles and so she had differing treatment approaches & she also recommended biopsying any progressions as they did not always have the same markers.

Mine they tried to biopsy the lung met but that tissue turned out to be all necrotic. They decided against biopsying the liver mets for a bunch of reasons which are just peculiar to my situation but I think usually they would want a biopsy. Mine was a bit different because I was trying to get into a trial and also I presented as pretty classic triple neg mbc so I think my MO was really 100% sure this is what we'd find. I was essentially diagnosed on the basis of CT scans & blood tumor markers.

hugs

I take weekends off

Initial dx at 50. Seriously?? “Sometimes the future changes quickly and completely and we’re left with only the choice of what to do next." blog: Never Tell Me the Odds

Dx 12/2017, IDC, Left, 1cm, Stage IA, Grade 3, 0/5 nodes, ER-/PR-, HER2- (IHC) Surgery 12/12/2017 Lumpectomy: Left; Lymph node removal: Sentinel Chemotherapy 2/14/2018 AC + T (Taxol) Radiation Therapy 8/13/2018 Whole-breast: Breast Dx 2/2020, IDC, Stage IV, metastasized to liver/lungs, Grade 3, ER-/PR-, HER2- Chemotherapy 3/18/2020 Taxol (paclitaxel) Immunotherapy 3/19/2020 Tecentriq (atezolizumab) Chemotherapy 11/26/2020 Abraxane (albumin-bound or nab-paclitaxel) Dx 12/9/2020, IDC, Right, Stage IV, metastasized to lungs, Grade 3, ER+/PR-, HER2- (IHC) Radiation Therapy 12/9/2020 External Hormonal Therapy 12/16/2020 Femara (letrozole) Dx 1/28/2021, IDC, Left, Stage IV, metastasized to bone Radiation Therapy 3/3/2021 External: Bone
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Apr 8, 2020 06:07AM laastra wrote:

moth - Thank you for your reply and thank you for your kind words. I am reeling from it as I've found all this out pretty recently. I am kind of just doing a lot of reading because I find the more I understand about this the more I feel just a tiny bit more in control. But it's also just plain terrifying. Everything is definitely so unique to each situation. I would think I would maybe get more than one biopsy but maybe if what they learn from the bone is conclusive enough they can predict that the lung is the same thing. I imagine I am doing the bone biopsy right now because it is easiest to access. I also have some internal mammary lymph nodes and lymph nodes near the lungs that are suspicious so I wonder if that just adds evidence for a particular thing.


JavaJana - Thank you for your reply and words of hope also! I hope they can get multiple areas or just explain well why they are confident that the bone biopsy was enough. I see where in your case they could not be sure! I am suspicious for myself because even though I know there are no guarantees it is weird to me that my scenario was somewhat standard and treatable at the beginning with stage 1 but and now it seems like so much evidence for mets after 3 years. I guess it could have changed type also. I am just anxious to find out more!

IDC-L multifocal. age 33. Dx 11/3/2016, IDC, Left, 1cm, Stage IA, Grade 2, 0/3 nodes, ER+/PR+, HER2- Surgery 1/14/2017 Lymph node removal: Sentinel; Mastectomy: Left; Reconstruction (left): Silicone implant Hormonal Therapy 3/17/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Dx 4/15/2020, IDC, Stage IV, metastasized to bone/lungs, Grade 2, ER+/PR+, HER2- Hormonal Therapy 4/16/2020 Faslodex (fulvestrant), Zoladex (goserelin) Targeted Therapy 4/23/2020 Ibrance (palbociclib)
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Apr 8, 2020 07:57AM illimae wrote:

I was pretty much told I was stage IV after a spot lit up on the CT scan but a bone biopsy (iliac/hip) confirmed it. There have been a few other suspicious spots on other bones since then but they are minimal and stable, so MO doesn’t biopsy those. Good luck 🙂

Diagnosed at 41 Stage IV De Novo Dx 11/16/2016, IDC, Left, 5cm, Stage IV, metastasized to bone, Grade 3, 3/13 nodes, ER+/PR-, HER2+ (IHC) Chemotherapy 1/1/2017 Abraxane (albumin-bound or nab-paclitaxel) Targeted Therapy 1/1/2017 Herceptin (trastuzumab) Targeted Therapy 1/1/2017 Perjeta (pertuzumab) Surgery 6/26/2017 Lumpectomy: Left; Lymph node removal: Underarm/Axillary Radiation Therapy 8/10/2017 Breast, Lymph nodes Dx 10/5/2017, IDC, Left, 5cm, Stage IV, metastasized to brain, Grade 3, 3/13 nodes, ER+, HER2+ (IHC) Radiation Therapy 10/19/2017 External: Brain Radiation Therapy 4/18/2018 External: Brain Radiation Therapy 5/22/2019 External: Brain Surgery 1/21/2020 Radiation Therapy 2/16/2020 External: Brain Radiation Therapy 7/20/2020 External: Bone Radiation Therapy 12/4/2020 External: Brain Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Targeted Therapy Tukysa (tucatinib) Chemotherapy Xeloda (capecitabine)
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Apr 8, 2020 09:15AM laastra wrote:

illiemae Thank you! I think the one they are going to biopsy is in the hip for me also. Did the biopsy go pretty smooth for you? I think they're doing some kind of partial anesthesia and it's going to be CT-guided. Never had one like this..have only had the breast biopsy.

IDC-L multifocal. age 33. Dx 11/3/2016, IDC, Left, 1cm, Stage IA, Grade 2, 0/3 nodes, ER+/PR+, HER2- Surgery 1/14/2017 Lymph node removal: Sentinel; Mastectomy: Left; Reconstruction (left): Silicone implant Hormonal Therapy 3/17/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Dx 4/15/2020, IDC, Stage IV, metastasized to bone/lungs, Grade 2, ER+/PR+, HER2- Hormonal Therapy 4/16/2020 Faslodex (fulvestrant), Zoladex (goserelin) Targeted Therapy 4/23/2020 Ibrance (palbociclib)
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Apr 8, 2020 09:41AM SondraF wrote:

Sorry, just a question for Mae but - if you were de novo why did they do a biopsy?

"The closer we come to the negative, to death, the more we blossom" - Montgomery Clift Dx 9/27/2019, IDC, Right, 5cm, Stage IV, metastasized to bone, Grade 3, ER+/PR+, HER2- Targeted Therapy 11/29/2019 Ibrance (palbociclib) Hormonal Therapy 11/29/2019 Femara (letrozole) Surgery Prophylactic ovary removal
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Apr 9, 2020 08:16AM - edited Apr 9, 2020 08:16AM by illimae

laastra, the bone biopsy was fine, a little pressure but no pain and it was twilight sedation. Just don't look up bone biopsy before the procedure, it will freak you out for no reason.

Sondra, I had a positive supraclavicular node but they biopsied the hip bone to confirm that what they saw was indeed MBC. Also, it was a single met, perhaps if it was more widespread an assumption would have been enough. The single met meant that MDA would treat me as oligometastic with curative intent.

The MBC did eventually go to my brain too but that's been manageable so far.

Diagnosed at 41 Stage IV De Novo Dx 11/16/2016, IDC, Left, 5cm, Stage IV, metastasized to bone, Grade 3, 3/13 nodes, ER+/PR-, HER2+ (IHC) Chemotherapy 1/1/2017 Abraxane (albumin-bound or nab-paclitaxel) Targeted Therapy 1/1/2017 Herceptin (trastuzumab) Targeted Therapy 1/1/2017 Perjeta (pertuzumab) Surgery 6/26/2017 Lumpectomy: Left; Lymph node removal: Underarm/Axillary Radiation Therapy 8/10/2017 Breast, Lymph nodes Dx 10/5/2017, IDC, Left, 5cm, Stage IV, metastasized to brain, Grade 3, 3/13 nodes, ER+, HER2+ (IHC) Radiation Therapy 10/19/2017 External: Brain Radiation Therapy 4/18/2018 External: Brain Radiation Therapy 5/22/2019 External: Brain Surgery 1/21/2020 Radiation Therapy 2/16/2020 External: Brain Radiation Therapy 7/20/2020 External: Bone Radiation Therapy 12/4/2020 External: Brain Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Targeted Therapy Tukysa (tucatinib) Chemotherapy Xeloda (capecitabine)
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Apr 9, 2020 11:34AM laastra wrote:

illimae - thank you! I tried not to look at anything beforehand and I just had the biopsy done today and it went really smoothly. The hospital is mostly empty right now - it's a risk to be going in right now but also they call me up really quickly and get it over with so that's a small benefit in a crazy situation. The whole thing went by quickly. I am glad they are managing the brain mets well for you and everything else.

JavaJana - yes my mind keeps going to frustration about how this has turned out after my original treatment. I feel like it is on the more unusual side of things even though I know there is no guarantee and cancer is tricky and seems to find ways around everything! I found out mostly because I was having symptoms with my breathing and the CA 15-3 blood test numbers rose up sharply, so then they ordered the scans. I'm anxious to get started on treatment to get that relief that it's not just growing unchecked. I'm worried about more lung symptoms. I'm glad they found yours and got you started on the right treatment even though it was all a roundabout path to it. :)

IDC-L multifocal. age 33. Dx 11/3/2016, IDC, Left, 1cm, Stage IA, Grade 2, 0/3 nodes, ER+/PR+, HER2- Surgery 1/14/2017 Lymph node removal: Sentinel; Mastectomy: Left; Reconstruction (left): Silicone implant Hormonal Therapy 3/17/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Dx 4/15/2020, IDC, Stage IV, metastasized to bone/lungs, Grade 2, ER+/PR+, HER2- Hormonal Therapy 4/16/2020 Faslodex (fulvestrant), Zoladex (goserelin) Targeted Therapy 4/23/2020 Ibrance (palbociclib)
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Sep 2, 2020 03:22PM - edited Sep 2, 2020 03:42PM by beep7bop

how are you doing? I hope things are looking up. I am thinking I may be heading to the IV Metastatic side. My serum calcium is 10.8 and PTH, intact 29 is normal, Vitamin D, 25-hydroxy 32.9, my calcium last year in July was 9.9., January 2020 10.0 and august 2020 10.8. I have PET next week. So a little scared. when I found out I had cancer back in 2019 I thought well no problem it's caught early take them off I'll be fine. I think the joke might be on me.. I just found out about my serum calcium but I am already have appt for another spot they found on my reconstructive breast. Now I also am having PET.

Dx 3/11/2019, ILC/IDC, Both breasts, 1cm, Stage IA, Grade 2, ER+/PR+, HER2- Surgery Lymph node removal: Sentinel; Mastectomy: Left, Right

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