How serious is my ER/PR-positive HER2 breast cancer?

Question

Hello doctor,

I found a lump in my breast five months ago. Initially, it was thought to be a cyst. I followed up after four weeks, and the cyst was unchanged. My PCP recommended a needle biopsy to be safe. My surgeon felt more comfortable with a lumpectomy because I have a family history of thyroid tumors, and I have a pituitary tumor.

After the lumpectomy, I was diagnosed with ER/PR-positive, HER2 breast cancer. I am confused about my pathology report. It states DCIS, but also states a test was performed to confirm the lesion was invasive. It also calls it an infiltrating carcinoma. From what I have researched, this is contradictory.

Currently, I am taking the following medications: Paxil 40 mg daily, Nexium OTC daily, Trulicity 1.5 mg SQ once weekly, Lisinopril 2.5 mg daily, Cabergoline 0.5 mg daily, and Amaryl 4 mg twice daily.

Kindly guide.

Answer 1

Hi,

Welcome to icliniq.com.

I have seen your reports (attachment removed to protect the patient's identity). It looks like early breast cancer, and it is predominantly a cystic lesion. It is staged as pT1c Nx hormone receptor-positive and HER2/neu negative. Histopathology is showing low-risk breast cancer as it is predominantly a cystic lesion with a predominance of intracystic papillary components, but there are areas of infiltrating mammary carcinoma and areas of DCIS (ductal carcinoma-in-situ). So, it is an early-stage low-risk breast cancer. Have they done a sentinel lymph node biopsy to check the lymph node status?

You have a family history of thyroid tumors and a previous personal history of a benign pituitary tumor. That may be part of some genetic syndrome. For that, you may need to go for genetic counseling.

Your breast lesion is showing ER+, PR+, and HER2/neu negative. These are also good prognostic factors in breast cancer. Discuss with your primary oncologist about a few points as follows:

Why was the sentinel lymph node biopsy not done?
Hormonal therapy (Tamoxifen) is needed.
To do an X-ray chest and an ultrasound of the abdomen, or a CT (computed tomography) scan to look for any distant lesions.
Genetic counseling is recommended because of your young age and thyroid, pituitary, and breast lesions.

Overall prognosis is very good in early and low-risk breast cancers.

I hope I have answered your question.

Let me know if I can assist you further.

Regards.