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Category:

Hormonal Therapy

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Question:  #1171 6/22/2005		Q:	In Oct I will have been on tamoxifen for 2 yrs. Had a bone density since they want to change me to Aramidex. I am 48 yrs old, test shows lumbar spine -2.58, neck -1.99, hip -2.27. Since I have osteoporosis dr. wants to leave me on tamoxifen for another yr. Also, doesn't want to put me on med's for osteoporosis, then do another bone density in a yr. I am now taking calcium w/vitamin D. My cancer was limited to the breast. Also, BMD spine 0.763, neck 0.628, hop 0.0665. I am very confused as to why I shouldn't be on med's now, must admit, made sense at the time he talked to me. Thought another opinion would help. Thanks
		A:	doctor do take into consideration a variety of things, including your bone health, when deciding if they should switch you to an aromatase inhibitor or leave you on tamoxifen. tamoxifen is bone friendly; arimidex is not. both are effective in preventing breast cancer recurrence.
Question:  #1172 6/22/2005		Q:	i had a mastectomy last july for two cancers in one breast, ductal carc. in situ and lobular carc. in situ with three positive lymph nodes. i underwent chemo and radiation. i have been given a preion for tamoxophen and i am hesitant to take it. reading the side effects have scared me into thinking it isnt going to benefit me as much as it may hurt me. i have fibrous tumors in my uterus and can this be a start to the medication turning these into cancer? i dont want to have a hysterectomy. what is the best scenario for person on this drug? have studies been done to determine what percentage of women end up with cervical cancer and if so whhat is the percentage? what is the positive side to not taking it if there is one?
		A:	cervical cancer and tamoxifen aren't related. there is an issue of a small risk of uterine cancer however. one of the tests that is sometimes done by doctors is called a transvaginal ultrasound annually to evaluate the lining of the uterus to head off any concerns related to this developing. tamoxifen has proven quite effective in preventing recurrence of breast cancer.
Question:  #1173 6/22/2005		Q:	My sister is currently on tomoxifen and has been told she should not exercise while on this drug. She has gained a considerable amount of weight which seems unhealthy, is this true that she should avoid exercise.
		A:	don't exercise?? strange recommendation. watching her weight is something usually that is encouraged, as well as exercise.
Question:  #1174 6/22/2005		Q:	My wife had breast cancer in '02, had lumpectomy, chemo and radiation. She could not tolerate Tamxafin or the other hormone due to terrible mood swings and extreme pain. She could not walk. In 1/05 she was diagnosed with bone cancer. She is on Aromasin and having infusions of Zemata. She has a history of Clinical depression. The Aromasin is making her moody, hot flashes, etc. but until recently they were bearable. Now a severe depression has been going on for weeks. Wellbutrin is not cutting it (she has been on that drug for YEARS). Is there ANYTHING that has been proven to help severe depression while on Aromasin. We know she can't stop the hormone...but I am afraid I will lose her to depression in the process. HELP!
		A:	Talk with her doctor including her family doctor about her depression so she can have a proper evaluation. sometimes oncologists consider using other anti-depressants like Effexor to control hot flashes and it has the added benefit(as it is was designed for) helping with depression symptoms.
Question:  #1175 6/21/2005		Q:	I am 57 years old, recently diagnosed with DCIS - Stage 0 -'intermediate grade' (found on annual mammo, followed by stereotactic biopsy and subsecquent lumpectomy). I am 25 years post TAH-BSO and am now coming off of estrogen therapy. My interest proposed Tomoxifen alone, surgeon proposed radiation plus Taomoxifen, medical oncologist gave me all options including doing nothing but 6 month mammos. I'm leaning to doing only radiation. All my internet searches show only a 2% improvement with Tomoxifen ... your thoughts?
		A:	ask the oncologist to show you the statistics on each of the options to decide. some women will take meds for a 0.005% benefit and others want to see some "real difference." it truly is your choice.
Question:  #1176 6/19/2005		Q:	i am 60 years old I have been on the esterderm patch 0.05 for 10 years, and my dr. has told me I need to change to a lower dose? I have had my uterues out,, What is the danger to staying on this?
		A:	he may be concerned about increased risk of breast cancer. ask him.
Question:  #1177 6/19/2005		Q:	I am 46 and recently finished chemo/rads. My periods have not returned yet. My onc is dead set against ovarian suppression/AI because technically I am still premenopausal. Am I misunderstanding something here? I thought if my ovaries were suppressed or removed I was considered postmenopausal and a candidate for an AI.
		A:	blood tests can determine if you are officially in menopause or not. ask about having that done to solve the discrepancy.
Question:  #1178 6/16/2005		Q:	Resubmit with corrections: I have a 1.2cm IDC lump in left breast which is ER/PR and Her2neu NEGATIVE & DCIS in situ in the right breast which tested to have variable 1-2+/3+ for estrogen and trace positivity for progesterone. Should the DCIS be tested separately for Her2neu also? I had neo chemo 4 AC and 4 Taxol dense dose. In 2 weeks will have bilateral mastectomies. My onc has indicated that after surgery we will be on watch for the left breast but that she will be putting me on tamoxifen to keep and right breast residual DCIS cells from becoming invasive. Says this is standard care for DCIS even though I am post memopausal by age and surgery having had a hystrectomy in 1976 leaving only 1 ovary. My surgeon on the other hand wrinkled her face and said WHY??? The DCIS is in situ and BOTH breasts will be gone,I don't see the purpose; but it is not my area of speciality so ask her again. I did ask the onc again today w/o mentioning what the surgeon said, and she again states I will need to be on the tamoxifen. Can you enlighten me further. Both the surgeon and I seems confused. Thanks so much.
		A:	used to be standard for DCIS but was changed 2-3 years ago and now DCIS is tested for hormone receptors to decide if hormonal therapy is appropriate or not. her2neu is not done on DCIS cells.
Question:  #1179 6/15/2005		Q:	I have a 1.2cm IDC lump in left breast and DCIS in situ in the right breast. Because I am ER/PR and Her2neu NEGATIVE, I had neo chemo 4 AC and 4 Taxol dense dose. In 2 weeks will have bilateral mastectomies. My onc has indicated that after surgery she will be putting me on tamoxifen to keep residual DCIS cells from becoming invasive. Says this is standard care for hormone negative. My surgeon on the other hand wrinkled her face and said WHY??? The DCIS is in situ and BOTH breasts will be gone,I don't see the purpose; but it is not my area of speciality so ask her again. I did ask the onc again today w/o mentioning what the surgeon said, and she again states I will need to be on the tamoxifen. Can you enlighten me further. Both the surgeon and I seems confused. Thanks so much.
		A:	hhhmmm.time for a second opinion with another medical oncologist. DCIS is also to be tested for hormone receptors-- not just the invasive disease. the surgeon brings up valuable points worth pursuing.
Question:  #1180 6/14/2005		Q:	Is it ok to take Ibuprofen or Aspirin at the same time with Tamoxifen
		A:	i'm not aware of any contraindications for doing so. verify with your oncologist as he should be made aware of all medicines you are on anyway.
Question:  #1181 6/14/2005		Q:	What is the new drug called that is ?? better than tamoxofen? Thanks
		A:	"better than tamoxifen." I'm sure that this is an accurate statement??? there are SERMs which is one family of hormonal therapy and there are AIs-- aromatase inhibitors. both beneficial in preventing recurrence.
Question:  #1182 6/14/2005		Q:	A couple of weeks ago I had a core biopsy done the calcification was benign. However my doctor said they found Atypical Ductal Hyperplaysia, so I need a Excisional Biopsy. My question is will I have to take hormone therapy no matter what? Also what are common side effects of the hormone therapy?
		A:	the doctor may discuss with you the pros and cons of these meds for prevention of breast cancer. cross one bridge at a time... get the open excisional biopsy first and then take it from there. if you wish to come to us for this just call 443-287-2778.
Question:  #1183 6/14/2005		Q:	why would someone with er+ BC start their period after 2 years of being on arimedex(sp?)Could it be ovarian cancer? does it mean the arimedex is not working?
		A:	not sure.... ovarian cancer usually doesn't present that way however, additionally hormonal therapy isn't linked to ovarian is that is the concern. time to see your gyn doctor though for a pelvic exam and ask him to call your oncologist to discuss it.
Question:  #1184 6/13/2005		Q:	I'm 50 years old and just recently went off estrogen because of DCIS cancer. My doctor has given me Effexor for hot flashes and it seems to be really helping. Would you say it is a good idea to be on an anti-depressant like Effexor long term, since the hot flashes would most likely return if I went off of it? Is there a better alternative than using anti-depressants for curing hot flashes?
		A:	effexor is a relatively common drug choice for controlling hot flashes. your oncologist needs to decide the length of time to take it and the dosage for you, in coordination with your family doctor.
Question:  #1185 6/12/2005		Q:	I had a lumpectomy for DCIS and a 3mm IDC was found by the pathologist along with the DCIS. He tested the DCIS tissue for hormone receptor status and it was ER/PR negative. However, he never tested the IDC tissue. My oncologist has requested hormone receptor testing of the invasive cancer (along with HER2/neu testing) because he said that it's possible for the DCIS to test ER/PR- and the IDC to test ER/PR+. Isn't it unusual to get different results likw that?
		A:	it would be unusual but not impossible so he wants to be sure. also, hope you had a sentinel node biopsy done as well.
Question:  #1186 6/12/2005		Q:	How worrisome is lymphovascular space invasion on the final report? Does this really mean that even though the nodes are negative, cells could have spread via the bloodstream. How much consideration should this be given in regards to deciding about chemo? I am 44 years old with a small primary tumor that is estrogen positive. I am torn between tamoxifen alone or using chemo with tamoxifen. Thank you.
		A:	it is worrisome in that even though nodes are negative it still may have traveled to other nodes or used the blood stream to travel.
Question:  #1187 6/12/2005		Q:	I have been on arimidex for four years following removal of pre-cancerous tissu in left breast. I had cancer removed from the same breast in 1984. I am 62 and I am concerned about hair quality, not able to take a perm, gone thin and silky. (It has always been thick and strong). Arthritis pain seems ro be intensified and am suffering huge temperature swings (hot flushes). I have weaned myself off the medication over the last month. I see my specialist again on 4th July. I am hoping that the flushes will eventually disappear and my hair will get stronger. Is this likely. I really do not want to continue with hormone treatment any more. I was on Tamoxican for ten years and had a horrendous menstrual flood days later. That is one reason I have weaned myself off Arimidex. Thanks foer your help.
		A:	the cause may be hormonal therapy but don't be surprised if you still have some of these symptoms after stopping because you are well passed menopausal age and your estrogen levels are low and will remain low.
Question:  #1188 6/12/2005		Q:	I am 10% oestrogen pos 70% prog pos...I'm 54 went from taking the Pill straight on to taking HRT. I've tried Tamoxifen for 6 weeks but found I was a bit dizzy hot flushes, cervix pain so Dr stopped me for 7 weeks and said come back and think about Arimidex. Is it ok to stop for 7 weeks? I had ductal carcinoma her neg sentinel node neg chemo 12 weeks radiation 6 weeks. I have ankle leg pain feel 10 yrs older....low libido....depressed
		A:	he wants your body to be free of the one drug before starting the replacement option. makes sense.
Question:  #1189 6/10/2005		Q:	I just had my bone scan and it showed stable except for a small flare-up on my sacrum. What does flareup mean. I am on faslodex. Thankyou
		A:	the radiologist reading the images needs to explain what he means by this term. it is too subject to being interpreted in multiple ways to guess without seeing the images.
Question:  #1190 6/9/2005		Q:	I have been on all the hormonal(now on faslodex) except arimidex. I was dx at stage IV in 1998 with bone mets. I have been on homonals for 4 years now and am stable at the present time. Is it possible to go back on a hormonal that you took once before and had good results on for a long time until changing?
		A:	when dealing with stage 4 breast cancer it is not unusual to deviate from the usual protocols and try "whatever works."
Question:  #1191 6/9/2005		Q:	I am a 41yr old diagnosed with a 4cm, mostly DCIS but also intermediate grade, ER+ (85%), HER-2 negative, LN positive (1 node) invasive ductal carcinoma. I have undergone 3 rounds of FEC with 1 more to go and then scheduled for 4 rounds of taxotere. I just found out today via u/s that the tumor has shrunk tremendously and LN appear normal. I am scheduled to undergo a mastectomy and either SN or axillary node dissection after my chemo. My oncologist has then recommended Tamoxifen and Zoladex injections. I am not really thrilled about going menopausal and really not looking forward to what I hear about the side effects of Tamoxifen. In addition, the risk of strokes is very high in my family (grandmother, mother, sister). Because I seem to be so sensitive to the side effects of most medications, I have wondered whether I can request a bilateral mastectomy to avoid having to go on Tamoxifen and the Zoladex injections. Why would it be necessary if no breast tissue remains? Any other recommendations? Thank you.
		A:	he may not be worrying as much about local recurrence in breast tissue as he is distance recurrence given the size of the tumor originally and that there was verification of positive nodal involvement.
Question:  #1192 6/9/2005		Q:	I am being switched from Tamoxifen to Arimidex. I did not gain any weight while of Tamoxifen (of which I have heard is a more "weight gaining" type drug than the AIs). However, I have heard that Arimidex causes 5% to 10% weight gain. Is this true? I cannot diet or exercise because I am already running 5 miles daily and eat a low fat diet (can't really do much better than I am doing). What can I expect and when does the gain start (over time, within the first 4-8 weeks?) I will take the drug no matter what but...
		A:	if you didn't gain with tamoxifen you probably won't with an AI. don't worry about that.
Question:  #1193 6/7/2005		Q:	Could you please comment on the benefits of having ovaries removed vs. just hormone therapy and tell me with ovaries removed which hormone therapy is optimum and when it should begin after removal? I am 45, estrogen receptor postive 75%, progesterone postive 4%, HER 2 neu +++, stage 1, grade 3.
		A:	it is really an important discussion to have with your medical oncologist. sometimes both is done. remember that when ovaries are removed that doesn't take away all of your estrogen. your adrenal glands still produce it and your body fat still stores it.
Question:  #1194 6/6/2005		Q:	I started taking arimidex after finishing my treat of lumpectomy with sentinelbiopsy, chemo, radiation 14 months ago. during my annual physical, it was discovered that my cholesterol had gone up from an average of 190 to 246. I am currently trying to lower it by diet and excercise. Do you have any recommendation? Is this a common occurance? I would prefer not to go on cholesterol medication. How often should I request a bone density test? Thank you
		A:	bone density usually done annually. sometimes doctors choose to place patients on cholesterol lowering medicine so talk with your family doctor about this. not a common side effect.
Question:  #1195 6/5/2005		Q:	I am two years past lumpectomy, chemotherapy and radiation. My tumor was ER +. I have been taking Arimidex since August 2003, and have been hearing that I possibly should not eat foods containing soy protein. Is there any definitive study on the interactions negative or positive between Arimidex and soy protein?
		A:	no there aren't. and actually there are studies underway related to having women take soy while on hormonal therapy to control hot flashes. stay tuned for more information in the future on that.
Question:  #1196 6/3/2005		Q:	Hi Lili I sent you a question on 4/27/05 regarding leg cramps and being on Tamoxifen. I just wanted to let you know that I was diagnosed on 4/29 with DVT in my leg. The reason I am writing you is just in case somebody else claims to have leg problems please have them see their Dr. immediately and be checked for DVT which is a known side effect of Tamoxifen. Thanks
		A:	glad you got diagnosed! no doubt you are off of tamoxifen now. take care of yourself.
Question:  #1197 6/3/2005		Q:	I'm hearing a lot about this new drug called Remidix (spelling?). What are the side effects of this drug and are there any long-term effect?
		A:	maybe you mean arimidex?? take a look at www.hopkinsbreastcenter.org/artemis and use the search feature to read more about it. it isn't really new but is getting advertised more.
Question:  #1198 6/2/2005		Q:	I have been taking Arimidex for a year and a half and my hair is fallig out.I no longer have any hair under my arms.I would appreciate any information as to why this drug is causing hair loss and if ther is anything I can do to prevent more hair loss? I had invasive ductal carcinoma and it was treated with a lumpectomy and radiation.
		A:	an uncommon symptom. so see your doctor to discuss it and ensure it actually is drug related to this drug and not being caused by something else.
Question:  #1199 6/1/2005		Q:	I was recently diagnosed with DCIS and had double mastectomy. Cancer was ER+. I am pre-menopausal. Have had a second opinion on my pathology reports and both say the cancer was non-invasive, DCIS, high grade, comedo-type. Is there any reason that I would need to take tamoxifen at this point? Is it correct to say my chances of getting a new breast cancer is less than 1% now?
		A:	some oncologists would encourage tam and others would say you've done enough. it is a matter of choice really. your risk of local recurrence should be 1% and given it was only dcis the risk of distant recurrence is technically that low too. some women feel they want to address that 1%. others are comfortable where they are.
Question:  #1200 5/31/2005		Q:	I'm a brac 1. My first tumer was at 31 years old ER-. I had a bi-lateral mastectomy and chemo. At 43 I had my overies removed then went in for a completion mastectomy to remove tissue that was left behind...a new tumor was found in the tissue,ER+ this time. More chemo.. The question is the use of Tamoxifen. Is this really needed due to the removal of both breasts as well as removal of my overies???
		A:	they want you to die of old age. your body only had a 1% risk of local recurrence and managed to fall into that 1%, which made it 100% for you. talk with them about hormonal therapy and also discuss if tamoxifen is best of another form of hormonal therapy like an aromatase inhibitor.