Understanding HR+/HER2- Early Stage Breast Cancer with Lymph Node Involvement

Early stage breast cancer is a general term that refers to stages 0,1,2 and, in some cases, stage 3 cancer. Your doctor will make treatment recommendations according to your cancer stage, the presence of hormone receptors (HR), and whether the cancer has spread to your lymph nodes.

If you’ve been diagnosed with breast cancer, you’ll undergo tests to determine the size of your tumor(s) and see if your cancer has spread.

Your doctor will also examine your cancer cells for certain characteristics, including the presence of hormone receptors (HR) or human epidermal growth factor type 2 receptor (HER2). This information is used to stage your cancer and help select the best treatments. 

This article discusses what this all means, focusing on HR+/HER2- early stage breast cancer that has spread to your lymph nodes. 

Breast cancer is usually given a stage from 0–4 to indicate the extent of cancer within your body. For example, stage 0 breast cancer is composed of cancer cells that haven’t spread outside of your milk ducts or lobules, while stage 4 breast cancer refers to cancer that has spread to distant parts of your body, such as your bones or your brain. 

Early stage breast cancer is a more general term. It includes stages 0,1,2, and some cases of stage 3 breast cancer. It refers to breast cancer that hasn’t spread beyond the breast or nearby lymph nodes, like your underarm. Early breast cancer that has spread to your lymph nodes is more likely to come back after treatment. 

Your body contains the hormones estrogen and progesterone. Some breast cancer cells have hormone receptors on their surface. These are special proteins that bind to your hormones. When estrogen or progesterone attach to these receptors, they trigger the cancer to grow. If your breast cancer cells are found to have these receptors, your cancer will be considered hormone-receptor positive, or commonly referred to as ER+ and PR+.

HER2 is a protein that plays a role in how cells grow. Some breast cancer cells produce too much HER2 protein, which can cause cancer to grow and spread rapidly. If your breast cancer has high levels of HER2 protein, it’s called HER2-positive (HER2+). Conversely, if you have normal levels of HER2, you have HER2-negative (HER2-) breast cancer. 

Your breast cancer’s hormone receptor and HER2 protein status influence your treatment options. Most people have HR+/HER2- breast cancer. 

The goal of early breast cancer treatment is to eliminate the cancer if possible and prevent it from returning. This can be accomplished in a few ways:

• Surgery: Early breast cancer treatment usually involves surgery to remove the tumor(s). Some people may have breast-conserving surgery, also called a lumpectomy. Others may have a mastectomy, removal of the whole breast.
• Radiation: Radiation often follows surgery, especially after breast-conserving surgery or when cancer is detected in the lymph nodes. It delivers high-energy beams to the affected area to destroy remaining cancer cells in the breast or lymph nodes. 
• Chemotherapy: Chemotherapy may be used before or after surgery or both depending on the size or location of the tumor. Chemotherapy uses drugs to kill off fast-growing cells in your body, including cancer cells. Your breast cancer cells can be tested to look for certain genes to determine whether your cancer is likely to return, making you a good candidate for chemotherapy. 
• Hormone therapy: Most people with HR+ breast cancer receive hormone therapy drugs after surgery to lower the levels of hormones in the body. Examples include tamoxifen (Nolvadex) and a class of medications called aromatase inhibitors. These drugs can help slow or stop the growth of breast cancer and may be taken for 5 or more years. 
• Targeted therapy: A targeted drug called abemaciclib (Verzenio) may be given to some people with HR+/HER2- early stage breast cancer that has spread to the lymph nodes. It targets specific proteins on cancer cells and interferes with their growth. It’s given as a pill, in addition to hormone therapy, to decrease the risk of breast cancer recurring. 

Receiving a breast cancer diagnosis can feel overwhelming. Learning more about your case and treatment options can help you make informed decisions and take an active role in your care. Reach out to your doctor or members of your healthcare team with any concerns or questions along the way.