Originally posted October 23rd, 2014 on Facebook

Today, I had a second ultrasound guided biopsy. The first determined that I have cancer, what the cells looked like, how they behaved. This biopsy was done to determine what type of cancer.

Breast cancer has a few different factors to consider. First is whether the cancer is estrogen or progesterone positive, and also whether it is HER2 positive.

Breast cancer that is ER (estrogen) positive basically means that estrogen makes it grow. PR (progesterone) positive basically means that progesterone makes it grow. HER2 positive means that the cancer makes too much of the protein HER2. This type of cancer is more aggressive.

My initial biopsy showed weak ER, PR negative, but the HER2 results weren’t clear. So today’s biopsy is really to make sure they definitively know the cancer’s HER2 status.

After chemo, surgery, and radiation (or whatever combination is deemed best for the specific case) ER and PR positive cancers are treated with a type of hormone therapy. Not the type you think of with menopause, actually pretty close to the opposite. Drugs are given to stop the body from making estrogen and/or progesterone. Sometimes surgery is done to remove the ovaries and/or uterus as well. Cancer that is ‘weak’ly positive for the hormones are often treated the same as fully positive post chemo.

HER2 positive cancers need to be treated with slightly different chemotherapy drugs, and they do not respond as well to the hormone therapy.

The above cancer markers, ER, PR, and HER2, can occur in any combination. They can also all be negative, that’s referred to as triple negative. Some people with ‘weak’ hormone status are also called triple negative b/c the long term outcome of the cancer follows the path of triple negative more so than the path of the positive hormone receptor. However, they are still treated as though positive because it does help.

Currently there is no specific treatment for triple negative cancers. Though some research is showing promise with new therapies that may increase the 5 year survival by a significant margin.

As far as which is ‘better’ to have it’s tough to say. When checking online throughout the various cancer information sites, I’ve found some that say triple negative is bad, some that say HER2 is bad, some that say the hormone ones are bad. And strangely enough, they all have 5 year survival rates that support their conclusion. So I don’t know which is actually most aggressive, more likely to recur. But it does sound like ER/PR positive and HER2 negative would be a ‘better’ combination to have.

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