ER+, PR+, Her2 Neg, Haven't had lumpectomy/node surgery yet...

11/08/08

Cruzer

Hi, and thank you for the help and re-assurance I have received in my - so far - one week adventure with this diagnosis. Information seems to come slowly, especially when you are waiting for anything to help define the sudden center-point of your existence...

Yesterday, I found out that my ER/PR status is strongly positive and that the HER2 is negative. That seemed to make my new oncologist happy when he called the lab for the "breaking news", and if he's happy, I guess I am, too.

I do understand the significance of this, and - interestingly - my younger sister who had breast cancer 10 years ago had the exact same diagnosis, which is grade one ductal infiltrating with multiple margins, ER/PR +, Her2 negative. People have often asked if we are twins (we are 7 years apart), but I've never aspired to match her cell-by-cell.

Here is my question...as far as hormone suppression with a hormone positive cancer, one of the choices is surgical removal of the ovaries (or in my case, ovary) and uterus. This is the choice I prefer. What I wondered is WHEN do you have this surgery? As soon as possible? Before my lumpectomy? As soon as I heal from my lumpectomy?

Does anyone have any experience with this?

It seems I have to wait a month to have surgery (lumpectomy and lymph node biopsy) with the surgeon I want at the facility I want. I am really bummed about that, but given that I have a month, can I squeeze a quick hysterctomy in there? (I am only half kidding).

Thanks for any feedback. I thrive on information!!

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Answers (7)

Saturday, November 08, 2008

PJ Hamel

WHOA, Cruzer - slow down, girl! I understand you're anxious to get treatment started, but breast cancer is VERY slow. A month isn't going to make the difference between successful treatment, and recurrence. Yes, ER/PR positive is good news; it means you can have hormone therapy. If you're pre-menopausal, that would usually be tamoxifen, which has proven very effective for over 30 years. If post-menopausal, you'd probably have an aromatase inhibitor, which has a shorter (but very successful) track record. Both deal with estrogen: an AI by suppressing its manufacture, tamoxifen by preventing it latching onto cancer cells.

If you're post-menopausal, then a hysterectomy isn't really going to accomplish much. Your ovaries have already stopped pumping out most of the estrogen they used to manufacture. Pre-menopausal, then yeah, a hysterectomy would remove a lot of estrogen. But that comes at a cost: bone loss (risk of fractures, esp. hip and spine); menopause, with all its associated side effects; a slower metabolism/weight gain... lots of side effects. With tamoxifen such a proven drug, do you really want to trade the good that estrogen does for the bad that accompanies its absence?

So anyway, I doubt there's a surgeon that would recommend having a prophylactic hysterectomy before the lumpectomy and lymph node work. You don't yet know the details of your cancer. And the most important thing is to get rid of the tumor first, THEN worry about preventing recurrence. Once you have the complete pathology, and know exactly the stage, whether you need chemo, and all the other info. you'll get after surgery, then you can make a really informed decision on treatment. Till then, I'd just hang tough and cool it. Waiting is awful, but it's unavoidable. Be careful about cruising the Internet for info., too; you'll quickly get information overload, much of it conflicting, and you won't know what to believe. Talk to your doctor; ask if your hospital has a shared decision-making facility and, if so, access their expertise.

And take deeeeeep breaths. We're with you. You can do this. Just don't jump too quickly, because you may regret it down the road. OK? Take care- PJH