Topic: How large does Tumor gets chemo and herceptin

Forum: HER2+ (Positive) Breast Cancer — Testing, treatment, side effects, and more.

Posted on: Jan 21, 2012 05:05PM

Posted on: Jan 21, 2012 05:05PM

ccjj wrote:

Curious... my step mom had BMX due to high grade DCIS in left and suspicious area of concern in right.  After surgery, pathology came back with invasive ILC Her2+ in right breast. Very small, less than 1/2 cm. Sentinel nodes were clear.  Surgeon thought no chemo would be needed.  I thought all Her2+ invasive tumors were treated with chemo and herceptin.  What size warrants chemo and herceptin?

Dx 7/7/2011, ILC, 2cm, Stage IIA, Grade 2, 1/9 nodes, ER+/PR+, HER2+
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Jan 22, 2012 09:17AM lago wrote:

I'll agree this is not  the BS's call. Seek the advice of a MO or 2.

DONE!! goo.gl/IoaN6U • Tattoos 2.7.2012 • Nipples 10.6.2011 • Exchange 6.24.2011 • Chemo 1.18. 2011 • BMX 8.31.2010 Dx 7/13/2010, IDC, 5cm, Stage IIB, Grade 3, 0/14 nodes, ER+/PR+, HER2-
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Jan 22, 2012 09:21AM ccjj wrote:

Thanks for the replies.  Right now the BS is going in on Monday to clean up some unclear margins on the DCIS side.  After all that gets resolved, I will make sure that she sees an MO. I am sure the BS will refer her.  I was just surprised that she told her with such confidence that she would not need any chemo. She said she would only have to take the pills for 5 years, the AI for post menopausal. 

Dx 7/7/2011, ILC, 2cm, Stage IIA, Grade 2, 1/9 nodes, ER+/PR+, HER2+
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Jan 22, 2012 09:48PM - edited Jan 22, 2012 10:04PM by Minnshark

I just had a BMX on 12/14/11 due to IDC with a .4 cm tumor; grade 3, stage 1a, 0/2 nodes, er-/pr- and HER2+.  The chief of MO at my hospital told me protocols said no chemo (if the tumor had been .6 cm the protocols supported chemo).  Generally tumors of my size that are HER2 + aren't caught this early or have gone into the lymph nodes; since mine didn't it was gray.  This was too iffy for me so I got a second opinion from the MO at the Mayo Clinic.  The Mayo Clinic confirmed what my MO said and recommended no chemo; which is my course of action.  If I insisted on treatment they both would have used Taxol/Herceptin.   Family history, cancer caught just as I turned 50 and I had the BMX, which means that my chance for reoccurance is only if cells became blood born.  I have a 10-15% of re-occurrence. Chemo lessens that historically by 1/3 and for me, the side effects weren't worth that small of a gain.     While I am at peace with my decision to wait and see; my friends and extended family members are split; but utimately it is mine and my husbands decision.  I see some have seen reoccurance within a year, but I am curious if there was any node involvement originally.     
Diagnosis: 11/29/2011, IDC, .4cm, Stage 1a, Grade 3, 0/2 nodes, ER-/PR-, HER2+
BMX: 12/14/2011
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Jan 23, 2012 02:32PM sassa wrote:

Minnshark,

Her2+ tumors are aggressive and can spread without any lymph node involvement.  For a stage one HER2+ cancer, there is a 25% chance of it spreading with no lymph node involvement.

Dx 11/6/2006, IDC, 1cm, Stage IA, Grade 3, 0/9 nodes, ER-/PR-, HER2+
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Jan 23, 2012 03:06PM lago wrote:

Sassa I know that HER2+ can spread when there is no lymph node involvement but 25% chance? That high for stage I? Did your onc tell you that? I never got into that much detail with my onc because I knew chemo/herceptin was something I needed.
DONE!! goo.gl/IoaN6U • Tattoos 2.7.2012 • Nipples 10.6.2011 • Exchange 6.24.2011 • Chemo 1.18. 2011 • BMX 8.31.2010 Dx 7/13/2010, IDC, 5cm, Stage IIB, Grade 3, 0/14 nodes, ER+/PR+, HER2-
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Jan 23, 2012 04:07PM Minnshark wrote:

Sassa do you know if there some research that I should be reading that supports the 25% reoccurrence and if that number grows with the increased size of tumor. I went before the tumor board and the second opinion at Mayo and while they agree that it was close to treatment protocols, the reoccurrence percentage I received was much lower. I'd appreciate any help you can give me.

Diagnosis: 11/29/2011, IDC, .4cm, Stage 1a, Grade 3, 0/2 nodes, ER-/PR-, HER2+
BMX: 12/14/2011
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Jan 23, 2012 04:32PM voraciousreader wrote:

Minnshark. According to cancermath.net your risk of recurrence is 8.1% without further treatment. It asked for age and I just plugged in 45. As I mentioned earlier, NCCN breast cancer treatment guidelines do not recommend Herceptin and chemo for tumors less than .5 cm. However, some women ARE receiving it for tumors that are smaller.

Doctor told me regarding my prognosis that I WASN'T on the Titanic! Hmmm...Really?....Okay! 02/2010 Pure Mucinous Breast Cancer, Oncotype DX 15, Stage 1, Grade 1, 1.8 cm, 0/2 nodes, ER+ 90% /PR+ 70% HER2- (+1)
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Jan 23, 2012 04:40PM - edited Jan 23, 2012 04:40PM by suzieq60

Lago - I was told a 23% chance of recurrence for an 11mm tumour with clear nodes

2nd diagnosis October 2010 - IDC 5.8mm node negative - missed on mammogram in October 2009 Dx 10/13/2009, ILC, 1cm, Stage I, Grade 3, 0/5 nodes, ER+/PR+, HER2+
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Jan 23, 2012 04:49PM voraciousreader wrote:

There is a ER- PR - HER 2 + thread. Check it Out.

Doctor told me regarding my prognosis that I WASN'T on the Titanic! Hmmm...Really?....Okay! 02/2010 Pure Mucinous Breast Cancer, Oncotype DX 15, Stage 1, Grade 1, 1.8 cm, 0/2 nodes, ER+ 90% /PR+ 70% HER2- (+1)
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Jan 23, 2012 04:54PM - edited Jan 23, 2012 04:59PM by beesie.is.out-of-office

Stage I tumors can range in size from 0.1mm to 1.9cm in size, and they can be grade 1, grade 2 or grade 3.  So there is no single answer on what the recurrence risk is for an HER2+ Stage I tumor.

Using CancerMath, if we start with someone who is 45 years old and node negative, and who has an ER+, PR+ and HER2+ tumor:

- if the tumor is 0.3mm and grade 1, the 15 year recurrence risk is 1.8%.

- if the tumor is 1.9cm and grade 3, the 15 year recurrence risk is 26.4%.

Both those figures are prior to treatment.  CancerMath suggests that chemo followed by Tamox/AI will bring the recurrence risk in the second case down to 8.1%, and that's before adding in the very positive impact of Herceptin.  

Edited to Add:  By the way, I just did the CancerMath numbers on the same two situations, but if the cancer is ER- and PR-.  The 0.3mm grade 1 tumor presents a 2.3% 15 year recurrence risk and the 1.9cm grade 3 tumor presents a 32.8% 15 year recurrence risk.  So that's quite a wide range of risk within Stage I.

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