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Question:
#571
7/24/2006
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I was wondering what factors are considered when deciding about ovarian shutdown/removal. I had a large tumor with node involvement. The good news was that it was strongly ER and PR positive, so after chemo and radiation I will obviously take some form of hormonal therapy to maximize chances of long-terms survival. My onc. says tamoxifen is enough, but I'm pre-menopausal and wondered if risk could be reduced more by including ovarian shutdown too. Onc. says there is no evidence this helps above tamoxifen alone, but it also seems to be quite common in Europe to use both. Given that tumor is strongly ER/PR positive, wouldn't our best chance be to eliminate as much estrogen as possible? How is this handled at JHU? |
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sometimes it really is based on the oncologist's experience. young women with locally advanced disease usually do have a discussion though about doing ovarian ablation. request that your case be presented to their weekly tumor board for team discussion. |
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Question:
#572
7/21/2006
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If a patient elects to have bilateral mastectomy, is it necessary to be on Tamoxifen also? Does Tamoxifen just prevent the development of cancer in the opposite breast after mastectomy? Does it affect the recurrence or development of cancer in other parts of the Body? |
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its unusual to take hormonal therapy following bilateral mastectomy if disease was early stage and limited to just being in the breast. |
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Question:
#573
7/21/2006
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44 year old post mastectomy,radiation, and chemo. ER+, HER2+, 3 nodes +,IDC with extensive DCIS (original tumor 1.3 cm). On Tamoxifen 7 months. Oncologist wants me to have oophorectomy and switch to Arimedex.(am premenopausal) Have experienced alot of hair loss on Tamoxifen. When hair is wet, large area where hair growth is extremely thin. Feel like a old bald man having to comb my hair so carefully to cover it up. Is this common with Tamoxifen? Is this due to estrogen loss and thus would this side effect probably be worse with Arimedex since it removes all sources of estrogen? Sorry know my oncologist has my best interests at heart but wouldn't want to have to resort to a wig again. |
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not common but due to estrogen loss. |
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Question:
#574
7/20/2006
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Hi, Have been on Tamoxifen for 11 months, have not had a period for the last 3 months. Emailed oncologist and said this could happen, I am very worried about ovarian cancer, does tamoxifen increase the chances of ovarian cancer and if tamoxifen is stopping my periods can I still ovulate?
Thanks |
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no connection between ovarian cancer and tamoxifen. menstrual periods commonly do stop on tam too. menstruation stopping isn't a symptom of ovarian cancer either. |
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Question:
#575
7/20/2006
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I noticed that another patient had the same concerns as myself. I have been on tamox. since 10/05 and have recently in the last 3mo.experienced severe bruiseing on my upper legs and calves. The symptom before the bruise appears is, severe itiching followed by pin-point red dots which later turn into large dark bruises. I have been experiencing hot flashes nightly since on the tamox, lately I have been more tired than usual. Finding it difficult to get up in the morning and work out.(not usual for me). I have also lost about 5lbs., in the last month. Is there any link to tamox. for these kind of symtoms? Blood clots would be one of my concerns as well as any kind of blood disorder. |
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so contact your oncologist and get an appointment for evaluation. |
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Question:
#576
7/20/2006
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I am presently on Aromasin for met. breast CA and experiencing headaches and upper arm bone pain. As I have met. to the bone (no soft tissue yet) I was wondering if it could possibly be side effects rather than the disease. Thanks. |
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yes, that is quite possible. |
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Question:
#577
7/20/2006
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I am 62 yrs. old and was diagnosed w/ DCIS in my left breast, 2.1 cm, nuclear grade 3 with necrosis, no lymph node involvement, 100% estrogen receptor positive, 5% progesterone. I completed two surgeries (the second to clear 1 margin) and radiation. I am about to go on either Tamoxifen or Evista. 1st doc says Tamoxifen; 2nd doc says Evista because I have some osteopenia and osteoporosis. It's now my call. Which is the drug of choice at this point in time (post-STAR trial)? |
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keep in mind that the STAR trial was for risk reduction for women who have never had breast cancer. your situation is different. you have had the disease. so at this point in time the standard of care doesn't include Evista yet... it may down the road... not "today" though. Additionally, tamoxifen also helps protect the bones. |
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Question:
#578
7/6/2006
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Tamoxifen has been shown to reduce breast cancer risk in high risk individuals. In a 28 y.o female with 2 sisters who developed breast cancer in their 30's/40's and with a maternal aunt with breast cancer, and all women testing positive for breast cancer gene, would she be a candidate for Tamoxifen prophylaxis? If so, at what age should it be offered and for how long? |
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the true value of tamoxifen for someone with known BRCA mutation isn't clear. most women opt to be more aggressive with prevention and do prophylactic mastectomy with reconstruction along with oopherectomy. |
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Question:
#579
7/6/2006
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I have been put on arimedix by my oncologist and since being put on it my sugar level has gone from normal to the 200 range. Doea Arimedix have any affect on sugar levels. The other medicine that I am on is Lisinopril, Ultram (PRN only), Sanctura. Please let me know if any of these medicines could have raised my sugar levels. Thanking you in advance. |
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not that i'm aware of. call your oncologist about it though. |
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Question:
#580
7/6/2006
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I've been on Tamoxifen since last October, today I noticed very large bruises on the back of my calves so I called my Onc. and they said bruising isn't a side effect of Tamoxifen. I know blod clots are........and he wants me to come in tomorrow for some bloodwork and a blood time test just to make sure everything is OK.....would he be testing to see if I'm DEVELOPING blood clots in my legs due to a platelet problem? or is he testing to see if there is cancer again somewhere??
Thanks in advance....you helped me so much during chemo, I had a bazillion questions, lol, figured I'd come back for one more. :-) |
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not sure so ask him. |
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Question:
#581
7/6/2006
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I have read that estrogen loss at the time of menopause and the first few years following is believed to contribute to the development of dimentia. Shouldn't women at this stage of life consider this risk before taking AI's? |
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the rationale years ago for going on HRT was to improve cognitive functioning. studies more recently have proven that it doesn't effect it. |
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Question:
#582
7/6/2006
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Hi. I was wondering if my Oncologist can have my tumor tested for PAK1 expression? I am ER/PR + and about to start Tamoxifen after chemo. Thank you! |
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i don't think so.. it is being done as a clinical trial in only a few places. check on www.nih.gov site. |
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Question:
#583
6/29/2006
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My doctor prescribed tamoxifen, after one week, I started having stomach pains. After going to urgent care, emergency room, and doctor, I was put in hospital because elevated liver enzymes. Waiting for test results, but doctors see that I have a fatty liver and that tamoxifen caused the elevated liver enzymes.
Have you heard of this? What other drug can I take? |
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there is a potential side effect of liver problems, though unusual to happen after just a week of hormonal therapy. wait and see what the oncologist recommends doing regarding potentially switching to something else. your menopausal status needs to be figured into here. |
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Question:
#584
6/28/2006
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premenopause 44 with stage 1 bc year ago had lumptecomy & radition. no lymph node involved -snl; been on tamoxifen since prior to radiation last year. i did stop period for few months last year during radiation then started again for 4 monhts; well my last period was jan this year; i am to have bloodwork in nov for menopause status if haven't had period yet; question is if i am not in menopaus yet; should i take something or have surgery to remove ovaries? i was 90% estrogen/90% pogestrin positive; negative her2/nue? if i am in menopaus, should i switch to another med or stay with tmx? |
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to figure this out really requires a formal consultation with the medical oncologist. most women with good prognostic factors like yourself are on tamoxifen and if menopausal then switch to an AI at some point. |
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Question:
#585
6/28/2006
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What is the professional position on therapeutic dose adjustment to mitigate hormonal therapy side effects?
After ILC/er+ diagnosis, surgery and chemotherapy I have
finally started taking Arimidex, 1 mg/day, experiencing
tiredness and edema and memory interference. At 100lbs
I am wondering whether or not asking my oncologist to
halve the dose would make sense, and whether or not the same clinical benefits of taking Arimidex might be achieved in my particular case? Is this ever done? |
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one of the peculiar things about hormonal therapy is that it hasn't been based on body weight. so big,small get the same dosage. we don't know its effectiveness in lesser dosages. |
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Question:
#586
6/27/2006
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Hi. I was diagnosed 3/06 with 1.8 cm IDC, Grade 1, ER+ (90%)PR+, HER2 -, 4 Sentinel Nodes negative, Lumpectomy, Clean margins, BRCA negative. I am about to finish 4 rounds of AC and start radiation. I am 36. My Oncologist is having me start Tamoxifen while on radiation. Do you think I should be aggressive given my young age and shut down (Lupron) or remove the ovaries? I have 3 very young children and want to do everything possible to prevent recurrence! Thanks for your help! |
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gee, to figure this out requires a formal consultation with a medical oncologist. so consider doing so. get 2 opinions to help you decide. |
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Question:
#587
6/27/2006
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Does taking aspirin interfere with Femara? Tylenol and Motrin don't help. Thanks. |
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not aware of any studies that contraindicate them being taken together. |
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Question:
#588
6/22/2006
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is it true stage 1 invasive dutal carcinoma, 1 cm., grade 2 no node involvment never comes back? and if that is true why do i need to take arimidex for 5 yrs? i have read many reports that there is a 20-30% of recurrence in early stage bc evnen with er& pr positive, yet a few reports say the word cure after initial treatment, thanks |
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"never" isn't correct. it can return.... in some cases some women are even advised to take chemotherapy. Lumpectomy with radiation and hormonal therapy for stage 1, no neg, hormone receptor positive disease usually is around 10% for local recurrence. 5% for distant recurrence. |
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Question:
#589
6/22/2006
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Hi there! I was recently diagnosed with breast cancer and had a double mastectomy. The invasive tumor was 0.6 cm-grade III, there was a small DCIS, and no node involvement. Tests on the tumor showed "very focal weak positivity" for estrogen and progresterone receptivity. My original oncologist calls this ER/PR negative, while a second doctor told me he might consider this ER positive, even if less than 10% of the cells show estrogen receptivity. I'll be having chemo regardless, but the question remains whether or not to follow up with a regimen of Tamoxifen as well. Is there a standard for defining "ER Positive" or should I go for a third opinion? Thanks! |
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get a third opinion about both doing chemo and about the hormonal therapy. <10% is considered negative. tumor was tiny so inquire more about purpose of chemo. |
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Question:
#590
6/22/2006
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I am 56, having 6 periods a year until beginning tamoxifen in May 2005 (DCIS , ER+, PR+ & LCIS). I have not had a period since June 2005. I am one of the women who do not have hot flashes on tamoxifen. My doc dismissed my concerns when I asked if I could be one of the small percentage who does respond to tamox treatment. They have never checked my hormone levels.... is that the definative way to determine the effectiveness of the tamox? Are there other things to look at? |
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blood test and you can ask for a transvaginal ultrasound to see what the uterus and ovaries look like. (ie, are the ovaries tiny from no longer functioning.) |
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Question:
#591
6/21/2006
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What is the probability that Femara will not be effective in my case? ER+, PR-, Her2-, pleomorphic ILC. |
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don't know... hormonal therapy in general is effective for ER+, PR - disease. |
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Question:
#592
6/21/2006
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Hello folks,
I have been taking tamoxifen for five months and still have not experienced any side effects, such as the common hot flash. I am scared that the tamoxifen is not working, since I read that 10-14 percent of women carry a gene mutation that prevents tamoxifen from being effective.
I am, therefore, considering having my ovaries removed. I am 46 years old, diagnosed with stage 1 hormone receptive breast cancer, non-nodes, none-Brca carrier. I had a lumpectomy and radiation. But, I am wary of having my ovaries removed because I've read that they continue to be useful to women as they age. However, I'm willing to risk osteoparosis and dementia, etc, rather than a reoccurrance of b.c. I'd prefer to wait until I reach natural menopause when I can take another hormone cancer drug, such as an Armatize inhibitor, but only if my 5 year survival rate is high.
So my question is, what is the 5 year survival rate for someone like me if they are not taking tamoxifen, or rather it is not working?
Thank you for your time. Ann
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before taking a surgical step, as the doctor to do blood work to see what your hormone levels are. |
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Question:
#593
6/21/2006
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Thanx for the earlier response.My onco.suggested that my ovaries be shut down so that arimadex can be given to me.[Tumour is ER,PR+ve]He feels that because of history of TIA,TAMOXIFEN cant be given.Are there any side effects of removal of ovaries?Is this the only way to to give hormonal therapy to me? |
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TIA and tamoxifen are contraindicated. that is correct. ovaries can be removed or you can be given a shot to put them to sleep too. ask about that. removal of ovaries of course results in menopausal symptoms. |
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Question:
#594
6/20/2006
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I was diagnosed with osteoporosis just before IDC. I was started on Fosamax for osteoporosis. Have you heard if Raloxifene being given instead since I have cancer too? |
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raloxifene has been validated for breast cancer prevention for women who are at high risk and haven't yet had breast cancer. it isn't yet approved though for women who have had the disease. tamoxifen is though and it prevents bone loss too. |
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Question:
#595
6/20/2006
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My invasive ducatl ca was focally pos for estrogen, neg for progesterone. Then afterlumpectomy, it was negative for both. When repeated, estrogen was focally positive again? How do we now know if I should be on hormone therapy? Also, Her-2 neu was first 3 +, then negative, and lastly FISH shows positive. How do you treat if results are uncertain? |
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by having the pathologist tell the doctor what percentage of the whole tumor was positive vs negative... sometimes it requires sampling several areas and the tumor and testing it. |
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Question:
#596
6/19/2006
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Is it possible to have regular menses during treatment with tamoxifen but to stop menstruating when treatment is discontinued? |
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yes, it is possible... strange but does happen. |
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Question:
#597
6/19/2006
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I am 38 and have been on Tamoxifen for 2 years following breast cancer. I have what my gyne calls a bulky or enlarged uterus. There are no cysts visible through vaginal ultrasound. What does this mean? I also recently had a benin polyp removed from the cervical area. |
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don't know.. he needs to explain what he means by that. sometimes transvaginal ultrasounds are done to evaluate the thickness of the endometrial lining. |
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Question:
#598
6/19/2006
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Hi - I was surprised to see that you personally had not known anyone who was given Femara as first-line hormonal therapy, as this is true for me. I was diagnosed 1.2 cm IDC,no nodes in Oct. 2005. Following radiation, my onc put me on Femara as there were some issues concerning uterine hyperplasia (which turned out to be not there) that would affect my taking tamoxifen. But, should I have gone on Arimidex, as this is the only hormonal therapy directly tested against tamoxifen??? My onc seems to think all AIs are pretty much the same... thanks a lot, |
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it really requires a formal consultation to determine what would be best for you to do. |
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Question:
#599
6/19/2006
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have been told I could forego hormone therapy as it would reduce risk of recurrance very little as Im already at low risk being stage 0. Is this wise? and how soon would I need to start? |
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don't know. depends on age, type of surgery done, degree of margins achieved, and other factors. |
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Question:
#600
6/19/2006
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What would an oncologist recommend as standard of care treatment for 48 year old, pre-meno, bilateral mastectomy for ILC 4mm, snb clean, er+/pr+ in left, and small focal area of LCIS in right?? |
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a formal consultation is needed to determine this... in general, with a small invasive like this only being 4mm and all breast tissue virtually being surgically removed to the best of the surgeon's ability, then probably no other treatment. |
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