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All TopicsForum: Stage III Breast Cancer → Topic: ER+/PR+ /ADRENAL EXHAUSTION/ CORTISOL

Topic: ER+/PR+ /ADRENAL EXHAUSTION/ CORTISOL

Forum: Stage III Breast Cancer — You are not alone. Meet others who have Stage III breast cancer.

Posted on: Dec 4, 2012 03:37AM

Ikari wrote:

During the last eight years prior to diagnosis I have been under extreme and contant stress from multiple sources and knew that my body was responding adversely - mild depression, slow recovery from exercise, memory problems, extreme PMS, cramping, irregular periods etc.  During that time I had looked into adrenal exhaustion and cortisol levels and basically came to "some sort"" of conclusion that my cortisol levels were out of whack. I had repeatedly raised my concerns with several doctors and these concerns were basically brushed off.

Differing internet articles state adrenal exhaustion is estrogen promoting (therefore higher risk of breast cancer) but I do not understand the interplay between estrogen and progesterone. Ive read up on the levels during the menstrual cycle and understand that process.

If I have been estrogen dominant and this has been the precursor to getting breast cancer, how does progesterone + come into this?

Can anyone simply explain the PR+ component.

Thanks 

Dx 9/2012, IDC, 2cm, Stage IIIA, Grade 3, 8/19 nodes, ER+/PR+, HER2+ Surgery 10/3/2012 Lumpectomy: Right; Lymph node removal: Right, Underarm/Axillary Chemotherapy 10/30/2012 Adriamycin (doxorubicin), Cytoxan (cyclophosphamide), Taxotere (docetaxel) Targeted Therapy 1/2/2013 Herceptin (trastuzumab) Radiation Therapy 4/23/2013 Breast, Lymph nodes
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Dec 4, 2012 03:46AM Myleftboob wrote:

You raise excellent question and I'm looking forward to hearing more. I too for at least 3 years prior to DX was under tremendous stress from various sources. Financial, relationship, family and wondered about cortisol. I'm adding this to my fav's to follow.

T/C/H 2/17, 3/9, 3/30, 4/20 then H til 1/13 Surgery 12/13/2011 Lymph node removal: Left, Underarm/Axillary; Mastectomy: Left; Reconstruction (left): Tissue expander placement Targeted Therapy 5/10/2012 Herceptin (trastuzumab) Hormonal Therapy 5/10/2012 Arimidex (anastrozole), Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Dx 7/15/2016, IDC, 2cm, Stage IV, metastasized to liver/lungs/other, Grade 3, 0/4 nodes, ER+/PR-, HER2+ Chemotherapy 7/24/2016 Cytoxan (cyclophosphamide), Taxotere (docetaxel)
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Dec 4, 2012 12:50PM Momine wrote:

I don't know the answer, but had been wondering about that too.

Dx 6/1/2011, ILC, 5cm, Stage IIIB, Grade 2, 7/23 nodes, ER+/PR+, HER2- Chemotherapy 6/20/2011 Cytoxan (cyclophosphamide), Ellence (epirubicin), Fluorouracil (5-fluorouracil, 5-FU, Adrucil), Taxotere (docetaxel) Surgery 9/13/2011 Mastectomy: Left, Right Radiation Therapy 1/9/2012 Surgery 3/8/2012 Prophylactic ovary removal Hormonal Therapy 4/1/2012 Femara (letrozole)
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Dec 5, 2012 12:07PM Ikari wrote:

Anyone?

Im struggling to get my head around this. 

Dx 9/2012, IDC, 2cm, Stage IIIA, Grade 3, 8/19 nodes, ER+/PR+, HER2+ Surgery 10/3/2012 Lumpectomy: Right; Lymph node removal: Right, Underarm/Axillary Chemotherapy 10/30/2012 Adriamycin (doxorubicin), Cytoxan (cyclophosphamide), Taxotere (docetaxel) Targeted Therapy 1/2/2013 Herceptin (trastuzumab) Radiation Therapy 4/23/2013 Breast, Lymph nodes
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Dec 5, 2012 06:23PM hopefour wrote:

I had hoped by now someone with understand of this topic would have responded...still hoping as I was ER+ 95% as well as PR+ 95%. Seems so many address the ER, but not the PR. I also was in exteremely stressful situations for 7 years prior to BC ( my daughter was in a car accident caused by a 80 year old man running a stop sign...years of medical care and brain surgery, as well as other stresses)! Thanks for posting this question.

Dx 5/2011, IDC, 1cm, Stage IIIA, Grade 1, 4/22 nodes, ER+/PR+, HER2-
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Dec 5, 2012 06:36PM TectonicShift wrote:

My understanding is that they really don't know very much at all about the PR component. People who are PR+ seem to do a bit better than people who are PR- in terms of prognosis.



I do know that some oncs say that there is no such thing as ER+ and PR-, that the test is in error if it comes out like that, that ER+ always comes with PR+. But that's controversial.

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Dec 5, 2012 08:55PM Shanagirl wrote:

Hi Shikari,

I  am aware that huge amounts of coritsol corsing tru your system for an extended period of time does cause chemistry changes in your brain which result in major depressive disorder and PTSD.  Cortisol is the fight or flight hormone triggered by the raised adrenaline from what I understand.  I went thru a terribly stressful few years that extended from 1989 thru 2000 of constantly having this body reaction which resulted in hospitalization in a center for PTSD.  Many years of therapies resulted after my hospitalization.  After going thru all of this stress I had a sudden brain Hemorrhagic stroke in 2005, more hospitaliztion and more new stresses, then 2009 I was diagnosed with breast cancer.  I do believe large amounts of unnatual stress causes much inflamation and weakening of our bodiy and it's immunity to disease.

I'm sorry you had to go thru what you went thru. I do believe that just as a person can become diabetic, or have cancer, or other diseases and must be treated by a doctor to treat with appropriate medication, we also need to be treated by a doctor who is knowledgable about mental diseases that result from chemical changes in brain.  I was treated with medications prescribed by a pharmachological Psychiatrist, to treat the chemical reactions by cortisol in my brain that caused the depression and PTSD.  I also had cognitive therapy to help me learn how to manage the stressors that triggered the stress cortisol reaction.  It was a process in my journey in life and I survived it all, just as I survived the coma from the brain hemorrage and the breast cancer.  I haven't been here on this forum in awhile, but was just stopping in to say hi and saw your post. Stay well and God Bless You.

image Barb
Shanagirl Dx 1/13/2009, IDC, 5cm, Stage IIIA, Grade 1, 2/18 nodes, ER+/PR+, HER2- Hormonal Therapy Aromasin (exemestane) Chemotherapy AC + T (Taxol)
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Dec 5, 2012 11:12PM cmdczc wrote:

Hi, just caught this thread...

Progesterone is, like estrogen, a steroid hormone (all produced from cholesterol) in a pathway that includes the production of other steroid hormones, including cortisol.  Progesterone is produced in the pathway before (as a precursor) to estrogen, therefore, if you are estrogen +, you should be also progesterone +.  This also explains the correlation with stress and cortisol production with breast cancer.  Progesterone is also stored in adipose tissue, so obesity promotes both estrogen and progesterone production and release, thereby feeding our ER+/PR+ receptor tumors. A vicious cycle...

Hope that helps!

Cindy (stage IIIa)

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Dec 5, 2012 11:20PM Myleftboob wrote:

Cindy

Thank you for that explanation!   Makes a ton of sense to me.

T/C/H 2/17, 3/9, 3/30, 4/20 then H til 1/13 Surgery 12/13/2011 Lymph node removal: Left, Underarm/Axillary; Mastectomy: Left; Reconstruction (left): Tissue expander placement Targeted Therapy 5/10/2012 Herceptin (trastuzumab) Hormonal Therapy 5/10/2012 Arimidex (anastrozole), Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Dx 7/15/2016, IDC, 2cm, Stage IV, metastasized to liver/lungs/other, Grade 3, 0/4 nodes, ER+/PR-, HER2+ Chemotherapy 7/24/2016 Cytoxan (cyclophosphamide), Taxotere (docetaxel)
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Dec 6, 2012 12:24AM pebee wrote:

Except.... I was diagnosed with adrenal failure (stress) and took cortisol for a year.  I am ER+ PR-.  And, that is not a typo - they double checked.....

Dx 2/2011, IDC, 2cm, Stage IIB, Grade 2, 2/33 nodes, ER+/PR-, HER2-
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Dec 6, 2012 12:59AM weety wrote:

If ER+ and PR- is impossible, than why do so many women on here have that diagnosis, including me?

Dx 7/17/2009, IDC, <1cm, Stage IB, Grade 3, 0/1 nodes, ER+/PR-, HER2+ Surgery 4/19/2010 Prophylactic ovary removal Surgery 4/10/2013 Prophylactic mastectomy: Right Hormonal Therapy Femara (letrozole) Targeted Therapy Herceptin (trastuzumab) Surgery Mastectomy: Left Radiation Therapy Chemotherapy Carboplatin (Paraplatin), Taxotere (docetaxel)
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Dec 6, 2012 05:17AM Sue2690 wrote:

I'm also Er+ Pr-.

I thought it was Er- and Pr+ that was rarely seen and thought to be a mistake.

Dx 3/20/2012, IDC, Right, 4cm, Stage IIIB, Grade 3, ER+/PR-, HER2+ Chemotherapy 4/10/2012 Adriamycin (doxorubicin), Cytoxan (cyclophosphamide), Taxotere (docetaxel) Targeted Therapy 7/3/2012 Herceptin (trastuzumab) Surgery 10/5/2012 Lymph node removal: Right, Underarm/Axillary; Mastectomy: Right Radiation Therapy 11/21/2012 Breast, Lymph nodes
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Dec 6, 2012 01:26PM - edited Dec 6, 2012 01:27PM by TectonicShift

That's why I say it is controversial. From what I could tell from conversations with my onc, there is a lot that is not understood - or agreed upon by scientists and oncologists - when it comes to PR receptors. He says that many in his profession believe you are either ER/PR+ or ER/PR-. That's one reason emphasis is placed on ER. (PR goes hand in hand.)

I don't mean to stress anyone. Obviously I have no idea if he is correct or not. There certainly seems to be a high number of patients who get a dx of ER+/PR- or ER-/PR+.

And I never knew anything about cortisol until I started reading this thread. I've researched a bit over the last day. Very interesting! Thanks, Shikari!

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Dec 6, 2012 01:47PM cmdczc wrote:

These ER/PR receptors are done by immunohistochemical stains.  Many times you will see that PR is generally weaker than ER, although still considered positive (anything over 1%), and some of those may essentially be interpreted as negative.  Yes, so there are cases that stain as ER+/PR-, however, what it means clinically, is controversial. The cases that stain ER-/PR+ are felt to be aberrant and might warrant repeating.

Thanks for the discussion,

Cindy  (stage IIIa)

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Dec 6, 2012 07:35PM Myleftboob wrote:

Actually in thinking back to my first discussion with MO about the path results.  He said that I was PR+ but it was such a small percentage that he considered it neutral.

T/C/H 2/17, 3/9, 3/30, 4/20 then H til 1/13 Surgery 12/13/2011 Lymph node removal: Left, Underarm/Axillary; Mastectomy: Left; Reconstruction (left): Tissue expander placement Targeted Therapy 5/10/2012 Herceptin (trastuzumab) Hormonal Therapy 5/10/2012 Arimidex (anastrozole), Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Dx 7/15/2016, IDC, 2cm, Stage IV, metastasized to liver/lungs/other, Grade 3, 0/4 nodes, ER+/PR-, HER2+ Chemotherapy 7/24/2016 Cytoxan (cyclophosphamide), Taxotere (docetaxel)
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Dec 7, 2012 11:13PM 1Athena1 wrote:

Interesting topic - I found this little abstract:

http://www.psychosomaticmedicine.org/content/67/2/277.short

Objective: Fatigue is one of the most common and distressing symptoms experienced by cancer patients and survivors. However, the etiology of cancer-related fatigue has not been determined. In previous studies, we have shown alterations in morning serum cortisol levels and diurnal cortisol rhythms in fatigued breast cancer survivors compared with nonfatigued control subjects. The purpose of the current study was to evaluate cortisol responses to an experimental psychologic stressor in fatigued and nonfatigued survivors.

Methods: Participants included 27 breast cancer survivors (11 fatigued, 16 nonfatigued). All had completed cancer treatment at least 3 years previously and were currently healthy with no evidence of recurrence. A standardized laboratory stressor, the Trier Social Stress Test (TSST), was administered during a 90-minute afternoon session. Saliva samples and autonomic measures (heart rate, blood pressure) were collected at 15-minute intervals throughout the session.

Results: Fatigued survivors showed a significantly blunted cortisol response to the stressor compared with nonfatigued survivors, controlling for depression and other potential confounds (p <.05). No differences in autonomic measures were observed.

Conclusions: These results, together with our earlier findings, suggest a dysregulation in hypothalamic–pituitary–adrenal (HPA) axis responsiveness among breast cancer survivors with enduring fatigue. Although the sample size was small, results suggest that attention to the HPA axis may be important for understanding cancer-related fatigue.

Anyone diagnosed with cancer should learn to have a healthy disrespect for statistics. Statistics are maths. It's the science which still eludes us. Dx 3/2009, IDC, 3cm, Stage IIB, Grade 3, 3/8 nodes, mets, ER+/PR+, HER2-
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Dec 8, 2012 07:41AM Momine wrote:

Athena, thanks for posting that. Interesting.

Dx 6/1/2011, ILC, 5cm, Stage IIIB, Grade 2, 7/23 nodes, ER+/PR+, HER2- Chemotherapy 6/20/2011 Cytoxan (cyclophosphamide), Ellence (epirubicin), Fluorouracil (5-fluorouracil, 5-FU, Adrucil), Taxotere (docetaxel) Surgery 9/13/2011 Mastectomy: Left, Right Radiation Therapy 1/9/2012 Surgery 3/8/2012 Prophylactic ovary removal Hormonal Therapy 4/1/2012 Femara (letrozole)
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Dec 13, 2012 03:36AM Rdrunner wrote:

interesting but it depends on what the inclusion and exclusion criteria were, there are lots of other disorders that one could have in addition to BC that can interfer with the HPA axis  such as ptsd which by the way is now being recognised amongst cancer survivors or cancer patients and their families even.

Dx 10/23/2012, ILC, 6cm+, Stage IIB, Grade 2, 0/4 nodes, ER+/PR+ Surgery 11/22/2012 Lymph node removal: Left, Underarm/Axillary; Mastectomy: Left Dx 11/23/2012, DCIS, <1cm, Stage II, Grade 2, 0/4 nodes, ER+/PR+ Dx 11/23/2012, ILC, <1cm, Stage IIB, Grade 2, 0/4 nodes, ER+/PR+ Dx 11/23/2012, IDC, <1cm, Stage IIB, Grade 1, 0/4 nodes, ER+/PR+ Chemotherapy 2/5/2013 AC + T (Taxol) Hormonal Therapy 4/30/2013 Surgery 9/11/2013 Prophylactic mastectomy: Right
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Jul 21, 2014 08:47PM ScubaGerl wrote:

Shikari

Many factors contribute to breast cancer - there is no one determining precursor. As for Progesterone; it is the great balancer of estrogen, and if you are indeed estrogen dominant as many are, you are probably not making enough on your own, so your estrogen is raging around your body unopposed feeding your cancer! May I suggest a natural bio-identical progesterone cream, It has helped me be human again.

I think what you are referring to is that when your adrenals are compromised your immune system also is not fighting disease with the force it would under normal circumstances, making you more vulnerable for cancer cells to proliferate and grow. Interestingly, when the adrenals are not working it means the body's immune cells are attacking the body, and if they are attacking the body they are NOT fighting the cancer cells! I hope this makes sense to you. This article may also help:

http://www.project-aware.org/Resource/articlearchi...

As for Adrenal Exhaustion; I think this is sadly overlooked in breast cancer treatment. Just 6 days ago I learned I was dangerously low in ALL steroid hormones including Cortisol via saliva testing. A study I just read states that low cortisol levels are correlative to a poorer outcome than women with healthier adrenals: 

www.adrenalfatigue.co.nz/adren...

Do your own due diligence research and NEVER accept when a doctor brushes off your concerns or discounts what you are experiencing, clearly adrenal health is important to any women who is fighting or is a breast cancer survivor! 

My Best,

ScubaGerl 

IDC 1a 

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