Understanding Cancer Diagnostic Info

HORMONE RECEPTOR-POSITIVE OR -NEGATIVE

Breast cancer cells may contain receptors, or binding sites, for the hormones estrogen and progesterone. Cells containing these binding sites are known as hormone receptor-positive cells. If cells lack these connectors, they are called hormone receptor-negative cells. About 75% of breast cancers are estrogen receptor-positive (ER-positive, or ER+). About 65% of ER-positive breast cancers are also progesterone receptor-positive (PR-positive, or PR+). Cells that have receptors for one of these hormones, or both of them, are considered hormone receptor-positive.

Hormone receptor-positive cancer is also called "hormone sensitive" because it responds to hormone therapy such as tamoxifen or aromatase inhibitors. Hormone receptor-negative tumors are referred to as "hormone insensitive" or "hormone resistant."

Women have a better prognosis if their tumors are hormone receptor-positive because these cells grow more slowly than receptor-negative cells. In addition, women with hormone receptor-positive cancer have more treatment options. (Hormone receptor-negative tumors can be treated only with chemotherapy.) Recent declines in breast cancer mortality rates have been most significant among women with estrogen receptor-positive tumors, due in part to the widespread use of post-surgical hormone drug therapy.

TUMOR MARKERS

Tumor markers are proteins found in blood or urine when cancer is present. Although they are not used to diagnose cancer, the presence of certain markers can help predict how aggressive a patient’s cancer may be and how well the cancer may respond to certain types of drugs.

Tumor markers relevant for breast cancer prognosis include:

HER2 . The American Cancer Society recommends that all women newly diagnosed with breast cancer get a biopsy test for a growth-promoting protein called HER2/neu. HER2-positive cancer usually occurs in younger women and is more quickly-growing and aggressive than other types of breast cancer. The HER2 marker is present in about 20% of cases of invasive breast cancer. Two types of tests are used to detect HER2:

• Immunohistochemistry (IHC)
• Fluorescence in-situ hybridization (FISH)

Either test may be used as long as it is performed by an accredited laboratory. Tests that are not clearly positive or negative should be repeated.

Treatment with trastuzumab (Herceptin) or lapatinib (Tykerb) may help women who test positive for HER2. In 2008, the FDA approved a new genetic test (Spot-Light) that can help determine which patients with HER2-positive breast cancer may be good candidates for trastuzumab treatment.

surgeon consultation

On Monday, January 18, mom had her surgery consultation. It went really well. Mom's surgeon was very knowledgeable, thorough with information, and only does breast cancer surgeries. We were all very impressed with her track record. We are also very happy with her staff. They are friendly and timely in scheduling the surgery.

I have summarized the takeaways from the meeting in the notes below.

Mom has infiltration ductal carcinoma. This is the garden variety breast cancer. 80% of women with breast cancer have this one. That is very encouraging. The lump is <= 2cm. Dr Nancy considers this small. Because the lump is small, the doctor has concluded the following:
1) mom is a perfect candidate for a lumpectomy with radiation after the fact. She would not need a mascectomy.
2) The doctor has put mom at a Stage 1 until the results of the surgery.
3) No additional scanning is needed. The doctor says it is rare for carcinogens to turn up else where in the body based on the size of the tumor. She also indicated that liver cancer in the family history is irrelevant.

Mom will be having a breast MRI performed on Thursday 1/21 at 6am. The doctor has ordered this test to identify if there are any additional tumors that might not have shown up on the mammogram. Results of the the MRI will come within 1-2 business days. I believe the MRI will also give the doctor a better indication of the size of the tumor.

The surgery will take place on Thursday 1/28. Mom will arrive at 8:30. She will receive a nuclear dye injection at 10am. The surgery will be at noon.

The surgery is an outpatient procedure with general anesthetic. A localization wire will be given prior to surgery. Then, she will be given total anesthesia. Dr. Nancy will perform the lumpectomy and then send it in for lab work. We will want to know if the margins are clear. (This means that we will want to make sure there are no cancer cells on the outer layer of what she has removed. If this is the case, we will know that Dr. Nancy has got the entire tumor. If this is not the case, mom will need to go in for another surgery in order to take out more.) Dr. Nancy indicated that less than 1% of her patients need to come back for additional surgery. She makes sure to take out a generous amount to ensure the margins will be clear.

The lymph nodes will need to be checked in order to ensure it is free of carcinogens. As a little background info, the lymph nodes filter fluid throughout the body. There are approximately 30 nodes under each arm. These nodes are grouped in 4 'levels.' For removal of the nodes, a separate incision is made in the armpit. Dr. Nancy will remove the sentinal lymph node prior to removal of the tumor.
The sentinal node is the first node that the breast drains to. If the sentinal node is free of carcinogens, the remaining nodes will also be free of carcinogens. Dr Nancy will be able to identify which of the nodes is the sentinal node with the help of a radioactive dye. This dye will be injected 2 hours prior to surgery. The dye flows in the breast fluid. The dye will go to the sentinal node first. Dr Nancy will remove this node and then send it to the lab during surgery. She will have the results before surgery is completed. That way, she can take out more nodes if it is necessary. If the sentinal node turns up positive, Dr. Nancy will need to take out Level 1 and 2 nodes.

The surgery will take approximately 1 1/2 hours. It will not be too painful of an operation.

A final pathology report will come after surgery. We will need to ask:
1) Is the sentinal node still negative?
2) Are the margins clear?
3) How big is the tumor?

Mom will meet with the surgeon 2 weeks after surgery.

Mom will also be meeting with a radiation oncologist and a medical oncologist on 2/3 at the Breast Cancer Clinic.

Mom's biopsy report showed a couple notable items. One, the progesterine receptor tested negative. Two, the estrogen receptor tested positive. This means that mom will be needing to take an antihormonal pill. Three, the HER-2 tested positive. This means the tumor is aggressive. The oncologist will most likely recommend chemo as a treatment. The great news is that there is a great drug that will take care of HER-2 from recurring. This drug is called Herceptin.

After surgery, mom will be able to walk around. she will be able to take long walks by the next day. She will be able to resume her exercise classes the following week. Exercise is encouraged.

Mom will be participating in "Reach to Recovery." This is a support group that will match mom up with a breast cancer survivor from the American Cancer Society. The selected woman will be contacting mom.

All in all, the prognosis is very encouraging. Keep praying that Dr. Nancy is able to remove all the cancer next thursday and, more importantly, that the cancer has not spread to the lymph nodes.

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Key Contacts

Currently Mom's initial surgical contact is Dr. Nancy Jean Kalinowski. Attached is a link with some info on this physician.

Age: 57 with approximately 24 years of experience.

Lists speciality as: General and Vascular Surgery.

Her office number is (269) 343-9133.

http://www.vitals.com/doctors/Dr_Nancy_Kalinowski.html

Note from Pam

I learned a few things today.

1. I have learned there are tests that can be run during the biopsy called Estrogen Receptor and Progestin Receptor that can give an indication of the prognosis.  Not sure if they did those tests for mom's biopsy.
2. During surgery, they can remove 1 or 2 front lymph nodes at the same time as the lumpectomy/mascectomy to test for carcinogens.  They can detect which lymph nodes to removed based on the results of a nuclear dye test performed the morning of the surgery.  In one case that I know of, they removed a front lymph node and performed the biopsy during surgery.  That way, the doctor knew during the process whether they would need to remove more.  I also know of another case where they removed a couple of the front lymph nodes during the lumpectomy and perfromed the biopsy after the fact.  If tested positive, an additional surgery would need to be performed.
3. Mom's surgery will very likely be a one night stay.  From what I understand, she will not be able to do heavy lifting for a while afterwards, but will be able to get around otherwise fairly normally.

As I learn more, I will pass it along.  My main concern is to get the surgery scheduled as quickly as possible.  I will look more closely at the Mayo and ACS sites as well.

I have all my friends praying for mom.  I also have her on the prayer tree at Queen of All Saints.  Please pass along the news to your friends so that they all can keep her in their prayers.

Pam

Patient resources

Found a suggested list of questions for breast cancer patients on the ACS site.

What should you ask your doctor about breast cancer?

Sharon also found information on the Mayo Clinic site, including good suggestions for preparing for doctor appointments and what questions to ask.

Preparing for your appointment

Introduction

Welcome family and friends to this blog.  I hope that this blog will provide an avenue for sharing and communicating information between our family members.  It is live 24/7 and and designed to have multiple authors, all of which can post and contribute anytime.  

On Monday, we learned that our mom was diagnosed with breast cancer.  Following a regular mammogram, the doctor identified a lump in one of her breasts that warrranted a biopsy be performed.  The lab results from the biopsy suggest that there are cancerous cells in the ducts and some area of the tissue of that breast (tumor sizing 1 1/2 to 2cm). 

The news is obvisously frightening news to all of us and we know that a challenging road lies ahead.  As there will be many questions, decisions, and challenges on her path to recovery, we, as a family, want to offer her all the support, wisdom and prayers we can. 

One of my ways of dealing with frightening situations is information gathering.  Much of the early information I have learned so far comes from the American Cancer Society (see link below).

http://www.cancer.org/docroot/lrn/lrn_0.asp