Expert: Claes-Gustaf Nordquist, M.D. - 12/18/2009

Question
QUESTION: Hello Mr. Gustaf Nordquist,

Greetings,

Histopathology Report-
-Multiple sections from the breast show a tumor composed of clear cells arranged in nests.
-The tumor has pushing margins with lymphocytic response at the advancing edges. In -situ component notes with comedo necrosis and micro calcification.
-PAS stain for glycogen is negative.
-Histology consistent with clear cell carcinoma-left breast
-The nipple, areola and deep resected margins are free of tumor. The adjacent breast shows feature of fibroadenomatoid hyperplasia.
-Reactive hyperplasia – Regional lymph nodes (12)

The tumor measures 3*2. 5*2 cms

Report(ER, PR, HER2:
ER---Results not detected.Favourable positive (> 20%)
PR---not detected positive (>20%)

Comments: The tumor cells do not express Estrogen (ER) and Progesterone (PR) receptors.

HER 2/Neu oncoprotein is negative.
Intensity 1+
percentage HER2/neu positive (<20%)
interpretation 0 1+ 2+ 3+

Question:
According to the reports above and our previous conversations, we came to a conclusion that there will be NO Hormonal Therapy and cancer is not aggressive because HER2 is negative.

Doctor, as there are no receptors at all, it becomes a triple negative cancer and I have heard that triple negative is considered to be an aggressive cancer as compared to normal cancers. Is it true or am I missing on something?

So my question is " Can Her2 negative considered to be a good sign along with other receptors (ER, PR) negative, and If there would be no hormonal therapy then is there any alternative for that. If NO, will chemotherapy be sufficient to cure this disease?

I look forward to your response.



ANSWER: Yes that it is negative for HER2 is a good sign since that makes the tumor less aggressive (it can still be aggressive for other reasons). That the hormonal receptors are negative can not be regarded as a good sign since that limits treatment. NO hormonal treatment is useful. Chemotherapy is the only remaining option - but offers no guarantees unfortunately.

I have some computer problems so unfortunately my reply is delayed.

You can also reach me on: http://www.lifestylerescue.com/expert/health-fitness-advice/dr-claes-gustaf/128




---------- FOLLOW-UP ----------

QUESTION: Hello Doctor,

Thank you for your response.

As you have mentioned that chemotherapy offers no guarantee. How much approx percentage of people (triple negative) have been cured (life long) so far only with chemotherapy. Can you suggest something according to your experience or the studies/surveys that have happened. I mean how much are the chances of one getting cured.

I look forward to your response.

Thanks.

ANSWER: Well her chances of a cure are related to stage (and grade) of her cancer. If a stage 4 no cure is possible at present but her cancer may still be controlled for a shorter or longer period of time with regularly repeated sessions of chemotherapy and perhaps also radiation therapy. If on the other hand this had been a cancer in situ (cancer stage 0) then no chemotherapy would be necessary only post surgical radiation therapy. And a cure would be more or less SURE! I do not know the stage of her cancer and without that information I can not answer your question fully. To do so I do need that information!


I have some computer problems so unfortunately my reply is delayed.

You can also reach me on: http://www.lifestylerescue.com/expert/health-fitness-advice/dr-claes-gustaf/128


---------- FOLLOW-UP ----------

QUESTION: Thank you for your response.

The stage of her cancer is said to be a second stage because tumor size is more than 2 cm (The tumor measures 3*2. 5*2 cms)and the grade is intermediate and there is no lymph node involvement.with this information, can you please tell the chances of her cure?

Also the necessary reports are at the top of this email.

Answer
In that case her chances of a cure should be good and the only real reason for her chemotherapy is the rather big size of her tumor.


I have some computer problems so unfortunately my reply is delayed.

You can also reach me on: http://www.lifestylerescue.com/expert/health-fitness-advice/dr-claes-gustaf/128