Expert: Claes-Gustaf Nordquist, M.D. - 2/22/2008

Question
My best friend's wife was diagnosed last week with breast cancer. She has 2 kinds in one breast: (1) mammary carcinoma in situ and (2) Invasive ductal carcinoma.
She has "Amplified (2.5)" HER2 from FISH analysis. She is "Strongly Positive" for ER, PR, and E-Cadherin on the invasive portion, and "Strongly Positive" for ER and PR with "High Grade" for the in situ portion. The "in situ" portion is described as the "bulk of the lesion". This is from her biopsy report. The size of the "tumer" is 5cm x 7cm. The doctor tells her she is "Stage II". She did not specify "A" or "B".

My question is this: Is it more likely she is stage III or worse, but since we don't know the lymph node spread yet, they are just give the lowest stage possible based on tumor size?

Also, it is hard to tell if the "Strongly Positive" results are a good thing, or a bad thing for the HER2, ER, and PR. Can you clarify that?

Thank you so much. This website is amazing.

Answer
The strong HER2 positive indication does not matter clinically now (except that she carries a strong genetic risk of developing breast cancer and maybe ovarian cancer and can pass that risk on to any offspring) once these cancers are a fact. It is rather important to know the grade of her invasive cancer too. At the moment we know nothing with regards to lymph nodes and other sites. So her stage is mainly based on the size of her tumor - which is quite big. In spite of the fact that a lot of her tumor is said to be in sity I think that due to tumor size and grade a mastectomy is the only surgical approach possible followed by radiation therapy and probably chemo therapy. Since her tumor (all of it) is also very strong on hormonal receptors (that is what ER & PR are all about)hormonal therapy is also probably a good idea (so that may be a good thing). Due to her genetic situation prophylactic measures may need to be discussed as well as genetic counseling if she has children.