Breast Cancer Staging and HER-3: Key Questions Answered

Q: Breast Cancer Staging and HER-3: Key Questions Answered

Dr. Yuan： 1. The staging of breast cancer is also related to tumor size. Physicians determine the stage based on tumor size, lymph node involvement, and distant metastasis. 2. Her-2/neu is a specific receptor; in breast cancer patients, a score of 3+ indicates

Please provide the questions regarding breast cancer?

Dear Dr.
Wu,
My mother is 78 years old and underwent surgery for left breast cancer at the end of last month.
During the consultation of the pathology report, the doctor mentioned it was stage II, with no lymph node metastasis.
Given my mother's advanced age and the absence of lymph node involvement, there is some debate about whether chemotherapy is necessary, and further discussion is needed.
However, there is one index, Her-3+ (which I saw but forgot the exact details, only remembering it had the Her-3+ notation), which complicates matters.
I would like to ask Dr.
Wu:
1.
Shouldn't the absence of lymph node metastasis indicate stage I? I found this information in books, but I'm unsure if it's correct.
2.
What does Her-3+ signify? Is it truly a negative indicator?
3.
If Her-3+ is indeed a concerning index, does that mean the risk of recurrence is high if chemotherapy is not administered?
4.
Is chemotherapy suitable for a 78-year-old? Can she tolerate it?
I would greatly appreciate your response.
Sincerely,
Yuan Qingxi

YoYO, 50~59 year old female. Ask Date: 2007/03/12

Dr. Wu Jingtang reply Breast and Thyroid

Dr.
Yuan: 1.
The staging of breast cancer is also related to tumor size.
Physicians determine the stage based on tumor size, lymph node involvement, and distant metastasis.
2.
Her-2/neu is a specific receptor; in breast cancer patients, a score of 3+ indicates "positive," and these patients have a higher rate of recurrence and metastasis.
3.
Whether a 78-year-old patient should receive chemotherapy is still inconclusive and can be evaluated based on the patient's overall health status.
Wishing you safety, Dr.
Wu.

Reply Date: 2007/03/12

More Info

Dear Mr. Yuan,
Thank you for reaching out with your questions regarding your mother's recent breast cancer diagnosis and treatment options. Understanding the complexities of breast cancer staging and the implications of HER-2 (often referred to as HER-3 in some contexts) can be challenging, especially when considering the age and overall health of the patient. Let’s address your questions one by one.

1. Staging and Lymph Node Involvement: The staging of breast cancer is determined by several factors, including the size of the tumor, whether it has spread to lymph nodes, and if there are any distant metastases. In general, Stage I breast cancer is characterized by a small tumor (typically less than 2 cm) that has not spread to any lymph nodes. Stage II can include larger tumors (2-5 cm) or tumors that have spread to nearby lymph nodes but not to distant sites. If your mother’s cancer is classified as Stage II and there is no lymph node involvement, it is indeed possible for it to be classified as such due to the size of the tumor or other factors. It’s important to discuss the specifics of her case with her oncologist for clarification.

2. Understanding HER-2 Status: HER-2 is a protein that can promote the growth of cancer cells. In breast cancer, HER-2 positivity (often indicated as HER-2+) means that the cancer cells have a higher than normal level of HER-2 protein, which can lead to more aggressive disease and a higher likelihood of recurrence. However, it’s important to note that HER-2+ cancers can be treated with targeted therapies, such as trastuzumab (Herceptin), which have significantly improved outcomes for patients with HER-2 positive breast cancer. If your mother’s report indicates HER-2 positivity, it suggests that her cancer may be more aggressive, but it also opens up treatment options that can effectively target the HER-2 protein.

3. Recurrence Risk: If HER-2 positivity is present, it can indicate a higher risk of recurrence, particularly if the cancer is not treated adequately. However, the decision to proceed with chemotherapy or other treatments should be based on a comprehensive evaluation of her overall health, the specific characteristics of her cancer, and the potential benefits versus risks of treatment. It’s crucial to have a detailed discussion with her oncologist about these factors.

4. Chemotherapy in Older Patients: Chemotherapy can be challenging for older adults due to potential side effects and the impact on overall health. However, many older patients tolerate chemotherapy well, especially when it is tailored to their specific health status and cancer characteristics. The oncologist will consider her age, overall health, and any comorbidities when recommending treatment. In some cases, less aggressive chemotherapy regimens may be appropriate.

In conclusion, it is essential to have an open dialogue with your mother’s healthcare team. They can provide personalized recommendations based on her specific situation, including the potential benefits of chemotherapy, the implications of HER-2 positivity, and the overall treatment plan. It’s also important to consider her preferences and quality of life when making treatment decisions.

I hope this information helps clarify your concerns. Please feel free to reach out if you have further questions or need additional information.

Best wishes for your mother’s health and recovery.

Sincerely,
Doctor Q&A Teams

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