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Category:

Metastatic Breast Cancer

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Question:  #1 11/15/2009		Q:	dearest lillie my mother was dignosed with MBC mainly to bone ,er-,pr-,her-2 +3 2 years ago.her last pet -ct done last june showed stabilized disease.recently she complained of left flank pain,the pain moves up and down ,mild to moderate, generally tolerable ,the pain is not continuous,mainly when standing after a along rest,then after standing the pain decreases in intensity.the pain is generally better in the morning ,worse later in the day. her tumor marker CA15-3 IS NORMAL,ALP NORMAL,CALCIUM 9,6. her next pet is sceduled next month.should she worry and reschedule her pet,or she could wait till next month unless the pain worsens or something?? thank you
		A:	talk with her doctor soon rather than waiting. he/she might want to actually get a bone scan.
Question:  #2 11/15/2009		Q:	Hello Lillie, I searched your achives and couldn''t find a similar question. Have you ever heard of breast cancer changing in regard to receptors? I was triple negative. My onc called me last week and told me I am now Her2+ and she wants to start me on herceptin. I have had two local recurrances. Will I likely get a chemo with the herceptin? It''s like doing adjuvant treatment all over again. Thank you.
		A:	YES. about 25% of the time the hormone receptor and HER2neu receptors have been found to be the opposite in the metastatic organ site from what they were originally in the breast tumor. strange but true. so glad he double checked this for you. now you have more options.
Question:  #3 11/7/2009		Q:	My mom is 65. Stage IV invasive lobular cancer with bone mets, liver and carcinoma in right pleural lung. She is on life support. She is given 2 mg. of Dilaudid every 4 hours. She is very bloated. She needs dialysis. She a chest tube for 1 month. They removed it, but she has water in her lungs again. The doctor doesn''t want to put the tube back in - but based on our experience, she got a lot of relief when they put the tube last month. They were able to wean her a few hours a day - now she can''t even be weaned for 5 minutes. She is spacing out. Her heart rate goes down to 35 a few times a day and she wakes up and stares at the ceiling. They don''t know the cause of this - is it because of the Dilauded? Will the chest tube help her. What about Trazadone? Will this be good for. HELP! I am at a lost. I feel absolutely helpless to see my mom who in this condition. Thanks for your help.
		A:	By what you have described, your mom is nearing end of life. The focus now needs to be keeping her comfortable and making sure that her wishes are known and carried out. you are describing some with very advanced disease and her organs are trying to shut down. spending time with her and making sure she is not in pain is the priority. it would not be at all unusual for her to become unresponsive soon. let her know how much you love her, even when she isn't able to respond to you. the last sense we lose is our hearing... take care. wish i had better news but i am a believer in being very honest. please speak to here doctor tomorrow about hospice. L
Question:  #4 11/7/2009		Q:	my moms doctor refers to a tumor marker and it is now in the low 50''s and it went down to the 20''s which is where they like to see it, but now is back in the 50''s. she is stage IV cancer diagnosed for 2 years now. what is the range and what does it tell us. Does going up a few just say treatment is not holding. I am confused with this tumor marker. Not sure if it is ca 15.3 but i find no ranges online.
		A:	its sort of like a barameter of what the cancer cells may be doing. this is a slight elevation. I've seen these numbers in the tens of thousands so the range is VERY wide. sounds like she is being monitored closely and that is good. the mission is for her body to live in harmony with the cancer and to treat it as a chronic disease. L
Question:  #5 11/1/2009		Q:	I am in a trial for a PARP inhibitor and will be receiving Gemzar and Carboplatin without the PARP inhibitor. Would this PARP inhibitor always be paired with these particular drugs? My concern is that it would be unavailable to me in the future. Assuming it gets FDA approved, would it be paired with other chemo drugs? I don''t know how this works. I am Triple Negative. Thank you for all the information I obtain from this site!
		A:	We don't know the answers to your questions because PARP inhibitors are so new and in fact this is the reason for the trials. For right now, there seems to be a preference to use those two drugs with a PARP inhibitor, but we don't honestly know for sure if this is the right thing to do or is necessary. The trial you're on sounds like the big BiPAR sponsored trial, and I believe you would have the option for taking the PARP inhibitor later. Please ask your doctors about this and thanks for participating in these important trials to help us find the answers!
Question:  #6 10/17/2009		Q:	My IDC was diagnosed and DBL Mast was done last spring. T1C, MO, NO, ER+, PR+, Her2-, 1.7 cm tumor, clear margins Grade 2, HYSTY/Ooph in July. Postmenopausal for 10 years. I have had no follow-up tests so far and don''t have an appt with my oncologist for a few weeks yet. What tests are customary to monitor me for recurrence and/or mets? I would like to know what I should expect so that If the onco practice here does not do those tests, I can either ask for them or travel to a larger city with more to offer. I keep reading different reports on different sites of what follow-up tests different women with my same criteria are having. Some have lots of follow-up tests and some say their oncs just wait and check based on symptoms or complaints. So, I have no idea what follow-up tests I should want. I am willing to pay out of pocket for whatever tests will detect recurrence or mets as early as possible.
		A:	in keeping with the NCCN treatment guidelines, there are NO tests to be done. your nodes were negative. stage 1 breast cancer. routine scans are no longer considered of any value or purpose. no need for them. we rely on symptoms instead.
Question:  #7 9/5/2009		Q:	Hi- I wast first diagnosed in 1988 and two years ago, broke a rib and discovered liver involvement also. I have been on Femara, Zometa for 9 months and finished the Taxol, Sutent clinical trial in May (6 months). Now on Falsodex and Zometa since end of May. My latest scan showed increase in liver mets from 1.6 x 1.2 cm to 1.9 x 1.6 cm. Bones are stable. I feel good and had good results from chemo. My question, is it time to switch treatments or should I give the falsodex more time? thanks
		A:	Gee what you are really requesting is a formal consultation to determine a continued treatment plan and in order to do that we of course need to see you, review all your records, past treatments, scans, even look at the pathology slides. so if you want to come for a second opinion for medical oncology management call 410-955-8964 and an appt can be arranged. that said, sounds like your doctors have been doing a good job of taking care of you and trying to keep this disease in control. i wish for you continued success in having the disease be such so that your body can live in harmony with it for a long long time.
Question:  #8 9/5/2009		Q:	I have metastatic breast cancer that is limited to cervical lymph nodes. (CT and bone scans show no signs of disease elsewhere.) My question is about the very limited pathology report that was done on the biopsied lymph node. It simply says ER+, PR- (the original tumor was strongly ER+ and PR+), but does not indicate percentages, a mitotic index, or grade. Wouldn''t that information be useful when prescribing treatment? The plan now is to remove ovaries and start Femara, but what if the cancer is now only weakly ER+ and we should be doing something else? I''ve asked two doctors and don''t understand the answers from either one. The gist of what I heard is "if we''re wrong and it starts to grow again, we''ll try something else." I''d rather not wait and see how things go. What would you recommend?
		A:	they may not have had enough tissue to do anything more than that for the prognostic factors. so pressing on with hormonal treatment makes sense. glad the disease is limited to where it has spread too. should make it easier to get into control I hope for you. the grade has no bearing on hormonal therapy. only on chemo.
Question:  #9 8/16/2009		Q:	I am 48 years old and was diagnosed in 2/08 with lobular invasive carcinoma. The size of the tumor was .3cm. with 15 lymph nodes positive. I was ER+, PR+ and Her/neu.+ the surgeon was able to get to clear margins. I have undergone 8 weeks of chemo, including herception, and 36 weeks of radiation and currently on Femara and will take for 10 years. I have not had reaccurance and my body responded very well to all the treatments. I had a P.E.T./C.T. scan that showed "No cancer." Do you have any research as to the reaccurance rate on this. I had heard that if you go 3 years with no reaccurance you would be considered in the 10% survival rate. Thank you
		A:	risk of recurrence for stage III breast cancer (and with 15 positive nodes this is stage III) is about 70%. the highest period of time for recurrence is the first two years after completion of treatment, excluding hormonal therapy. I think you meant to write that you had 36 days of radiation and not 36 weeks! you may start on femara for now and then be switched to something else. a little odd to use femara first though. consider a second opinion formally about your hormonal therapy regimen. once you get to the 6 year mark then risk goes down around 10%.
Question:  #10 8/9/2009		Q:	I was diagnosed with breast cancer (IDC) 3.5 years ago - stage 1, grade 3, triple negative, BRCA1+. Had bilateral mastectomies (no nodes involved) and 6 treatments of FAC (previously had complete hysterectomy). Now I''ve had severe pain in my hip/leg area for almost 4 months and pain in my shoulder for about 2 months. The pain in my hip/leg wakes me up every night at about 3am and I can''t lay down. It''s better during the day when I''m busy, but I''m still aware of it. Last week my oncologist did x-rays of both areas (both fine) and my usual blood tests showed nothing wrong. He''s sending me to a back doctor next week. Can I rule out bone mets if the x-ray and blood tests are both fine?
		A:	I'm assuming a bone scan and tumor markers were done and came back fine which would imply that this is something other than bone mets. remember that though you have had cancer you are not immuned to other disorders that you might have gotten anyway. like arthritis, a pinched nerve in your spine causing sciatica or other ailments sounds like you next consultation is with neuro or ortho doc.
Question:  #11 8/3/2009		Q:	Dx 10/07 Stage2/Grade2 2/7nodes+, ER+PR-,HER2+,Carbo/Toxatr x4,LeftBrst, could not hv rad, (BMT for AML 1981) Last Chemo Feb 5,2008. BiLat Mast/Expnd-Silc 7/08.Numb/Tingling in both feet started Feb 09. Onc ref me to Negst said it is Neuropothy. It has been getting worse, Negst said spinal tap. Is this normal to have neuropothy develope 1 year after tx?
		A:	Not typical to have it 1 year post therapy, though certainly anything is possible. I would continue to have your neurology doctors work this up including imaging studies (such as an MRI of the spine and brain) as well as the spinal tap). Best wishes.
Question:  #12 8/3/2009		Q:	Dear Lillie, My sister was dx''d with bc 11 yrs ago and that she has the BRCA1 mutation. She did chemo/radiation and later had her ovaries out. They found some malignancy in one ovary, but after the slides being sent to numerous places, they could not definitively determine whether it was bc mets or early oc. The former was thought most likely. She had more chemo and was in remission for 10 yrs. Five months ago she had lower back pain. They found a large tumor on her pelvic wall. Biopsy showed inconclusive pathology. Sent to numerous top cancer centers. Her onc treated it with both taxol and carbo platin to cover as many bases. In four months the pet scan showed no evidence of the tumor - or anything else - we are elated! She has another month of her taxol/carbo and the doctor is proprosing maintenance chemo. It is more likely this is breast mets, since her CA125 never went up, but her BC tumor marker did.... it is difficult to find much info on bc maintenance chemo, it mostly seems ovarian.. He has mentioned taxotere as a possible maintenance chemo. It is hard to know whether the benefits will outweigh the costs. Do you have any thoughts on this? She lives in the DC area. Many thanks, Sally
		A:	THere are no good studies regarding maintenance chemo for breast cancer and in general it isn't done. Given your sister's ambiguity about breast vs. ovarian cancer, this probably merits second opinions at various academic hospitals (including here if you'd like). You should know however, that there are new exciting emerging data and trials regarding PARP inhibitors for BRCA1 and BRCA2 patients that your sister may be eligible for. Here in the US, a company called BiPar Sciences is leading the trials. She may want to check that out, and if you haven't been BRCA tested you should be. Best wishes.
Question:  #13 8/3/2009		Q:	dearest lillie i have another question please you have advised me before to go to a NCI comprehensive cancer center to get a second opinion or have an idea about ongoing clinical trials for her-2 MBC THE THING IS i live in the middle east ,AND i wonder if there is a NCI comprehensive cancer center in THE AREA?? THANK YOU
		A:	You would want a center that treats MBC frequetntly and participates in clinical trials if possible. NCI centers are in the US. ds
Question:  #14 8/3/2009		Q:	DEAR LILLIE WHAT IS RECENT EVIDENCE ABOUT THE DIFFERENCE IN SURVIVAL BETWEEN CHEMOTHERAPY MAINTENACE AFTER DISEASE STABILITY ,AND *drug holiday patients) thank you
		A:	THere is no great evidence to support or refute its use, but certainly everything needs to be weighed between toxicity and benefit. Hormonal therapy, however, is generally given in ER/PR positive disease even with disease stability in the metastatic setting. Hope that helped.
Question:  #15 7/26/2009		Q:	Hi Lillie- You are an amazing woman and have given so many, so much help. My Aunt who is 44 yrs old was dx Feb with what they believed to be Stg III BC. Surgeon wanted tumor shrunk via chemo first as tumor was +10 cm (baseball size). My aunt has undergone 4 AC and 12 Taxol/Herceptin. Surgery is being scheduled this week. There was a questionable spot on her liver that has responded to the chemo (went from 2 cm to .7 cm). The onc now says that the liver is a distant met. Does this mean she is actually Stage IV? Her markers are er/pr neg and her pos. My aunt is a single mom to a 12 and 10 yr old. My sister and I are her only support and we both want to respect her wishes but we need to help make plans for our cousins as one of us will likely be their guardian should something happen. My aunt does not want to know what her ''odds'' are. I just want to help her through this but my heart is telling me I need to know more so that I can be prepared for the future. She is the most amazing person in the world and lives for her kids. My grandma (Aunt''s mother) lived with cancer that started in her throat area for over 20 years and my Aunt is assuming the same will happen for her. Is this a realistic outcome? I have never missed a doctor appt or a chemo session and will do anything to help my family through this. Any thoughts or advice. We meet with the surgeon tomorrow and I need to know what to ask as my Aunt has told me I am in charge and she would like me to help her through this appt. as she doesn''t think her ''head'' is in the game right now. Thank you so much for everything you do. I have taken a ton of notes from your website and my aunt''s oncologist said I am one of the best patient advocates she has seen. I mentioned your website as my main source of information. Thank you for your brutal honesty.
		A:	While Lillie is away, I will try to answer your questions. Your aunt has cancer in the liver which would be metastatic breast cancer -- stage IV. It is responding well to chemo which is a good sign. Now her breast cancer will be treated like a chronic illness, she will be on medication to control the disease. We see women who are on medications for years as long as the meds are effective, changing to different drugs when needed. Don't give up hope. There are better chemotherapies and targeted drugs like Herceptin today. Your aunt is blessed to have you as her advocate. ds
Question:  #16 7/27/2009		Q:	Hi, I am 10.5 year out, first diagnosed age 39 in 1998 w 11/12 positive nodes IDC & ILC. 4 X CAF, High Dose chemo, rads, TN-Muc-1 vaccine at MSKCC, plunged into chemopause, Tamo, Femara,. 6/2009 diagnosed with met to same side ovary, both ovaries and uterus removed laporotomy. Normal PET/CT scan results following the surgery, no symptoms. Was on Femara Holiday during diagnoses (joint pain relieves during these breaks as does constipation), opted to have the ovaries removed because the "cyst" slightly grew over 2 month period. Ovarian tumor stained positive for breast markers and is ER+PR+ same as diagnoses. Was HER-2 negative in 1998, that staining still needs to be done. Going for first opinion, what is experience and knowledge with a case like this? May consider coming there, any oncs you would reccomend for this case experience. I am in VA, but going to neighboring states for opinions. thanks, NatAda
		A:	Hi there, This is Ben Park and Lillie forwarded your email:) Let me know if you still want to come up for a 2nd opinion. Best, Ben
Question:  #17 7/27/2009		Q:	My mother, 70, was stage 2A, 7 mm with only sentinel node containing a miniscule amount of cancer in February 2006. Treated with lumpectomy and radiation. She was on tamoxifen for the first 2 years and is now on arimidex. She had a clear mammogram in Jan. and a clear bone scan and head CT in March 2008. She recently has complained of right hip and leg pain (3-4 weeks) and mentioned it at her regular 6 month appointment with her oncologist last week. The doctor didn''t think it was cancer, but ordered an x ray just to be on the safe side. Her pain has gotten better and just comes and goes now. She feels it more when she has been walking for a long period of time. The x ray came back and showed some ''faint spots'' and the radiologists cannot say for certain what these are. The oncologist is sending her for a bone scan but we need to wait about 3 weeks. I am so worried that this is bone metastases. I can''t stop thinking about this. Is there anything else that could account for these spots on hip and her hip/leg pain? If it is cancer how much will it advance in the next 3 weeks or so while waiting for the bone scan and then follow up with the oncologist. We were told back in 2006 that chances of metastasis were less than 10% and that the risks of chemo outweighed the benefits. Thank you for your response.
		A:	Not getting chemo would also have likely been recommending here so hopefully that puts your mind at ease. The bone pain could be from many things including arimidex as AIs can cause bone and joint pain. I know it's hard, but hang in there. Hopefully the bone scan will reveal nothing. Best.
Question:  #18 7/27/2009		Q:	My sister was diagnosed with triple neg, 3 pos. nodes ( 9 removed). This was an "occult" BC and did not show up in 2 previous mammograms nor breast MRI''s, over 2 years until a radiologist noted a very tiny "suspicious" spot. They told her it had probably been there all along. She has finished dense dose ACT chemo and 40 radiation treatments. Her immediate post treatment scans and blood work were negative. With the triple neg and pos. nodes can someone give me an idea of her chance of reoccurance? Her next scans are in 3 months. I am not able to discuss this with her.
		A:	Depends on the size of her primary (which sounds very small) as well as her age, and other things like grade of the tumor, but in general, this is an aggressive form of breast cancer and it sounds like she got excellent treatment. Let's keep our fingers crossed and hope everything is okay!
Question:  #19 7/27/2009		Q:	My question is about my treatment. I was dx 7/1/2008 (age 40) with Stage IV breast cancer (hip, sternum, low back, mid-back, and liver). I am triple positive. My primary tumor was plus 6 cm. I have not had surgery. I am being treated with zometa and herceptin once every 3 weeks and lupron and faslodex injections once a month. (I was also on avastin but it was discontinued in March due to side effects (High blood pressure). Subsequent scans every 3 months since dx show no evidence of disease. I do have some minor side effects from the medications. My questions are: (1) what are the benefits/drawbacks of postponing surgery at this time and (2) are there any studies that show how long the treatment I am on will be effective? I read your ask the expert entries regularly and would very much appreciate a response.
		A:	YOur question is a tough one as we do not know if there is any value of getting surgery for stage IV disease. But since you have responded so wonderfully, some surgeons would consider it. I would advise you to talk to your doctors about this. Also be sure to ask about BRCA1/2 testing since you were diagnosed at such a young age. Best.
Question:  #20 7/19/2009		Q:	dear lillie what are chemo drugs with knwn activity in bone -only mets beside taxanes,thank you
		A:	In theory, any chemodrug that has activity in any organ will also have activity in the bone. Bone also has a blood supply which is the way chemotherapy gets into the tumor cells. Currently there are many chemodrugs approved for the treatment of metastatic breast cancer, which includes bone only disease. Usually for ER positive disease, oncologists like to treat bone only disease with hormone therapy because ER positive disease tends to grow slower, and having disease in the bone is usually not of iminent danger. So that gives the doctors time for the hormone therapy to work without worrying about disease growing rapidly in visceral organs which tend to be more worrisome.
Question:  #21 7/18/2009		Q:	Dear Lillie: In October 2006 I was diagnosed with Triple Negative Breast Cancer, stage IIB. I had a bi-lateral mastectomy, AC chemotherapy and 36 sessions of radiotion. May 2009 I found out that it has metastasized to my liver. I am currently undergoing chemotherapy of Abraxane along with Avastin. I am seeking additional therapies (meditation, yoga, diet, etc) to go along with what the oncolgist is suggesting. Another patient has reported marked improvement in liver count blood test numbers after using a Castor Oil Pack which she applies with a heating pad. My question is, would the application of a heating pad cause cancer tumors to grow?
		A:	i'm so sorry to hear that this has returned as stage IV breast cancer. there is very little known about complementary medicine therapies. i've not heard of heat being an issue however it frankly hasn't been studied so when it doubt leave it out has always been my motto. hang in... L
Question:  #22 7/13/2009		Q:	My dear friend who is only 43 is now dealing with mets to brain, bones, and lung. She is on oxygen and still taking chemo to try to slow the progression but she spends her days vomiting. She also recently fell I am worried her family does not know the severity or the prognosis. Im surprised the drs have not mention hospice. Does this sound like someone who is coming to the end of their journey? And if so how long can someone live with all that fluid in their luns??
		A:	Yes this sounds very bad and potentially appropriate for hospice. One cannot live very long with increased fluid build up in the lungs. I am very sorry to hear of this situation.
Question:  #23 7/12/2009		Q:	I have been following the advice you have been giving others for about 2 years...thanks for all you do. My father is 67 years old and has stage 4 breast cancer. Original diagnosis 1998 including mastectomy, radiation and chemo, and Tamoxifin. Stage 4 diagnosis September 2006. He currently has mets in his right hip, spine, ribs, all confined to the bones at the moment. He has been through several rounds of chemo, Zometa, etc. and two courses of radiation to help with pain in different areas. We just found out that he has mets in his left hip, and is currently going through round 3 of radiation to try to reduce the pain in his left hip. However, my dad''s quality of life is terrible right now, mostly because of the pain he is in, throughout various areas of his body...it seems to float around from place to place at diffenent times of each week. He was on various narcotics over the last two years, but recently the doc prescribed liquid morphine to help with the pain. but even that is not always helpful. We tried to get hospice involved with pain control but he wanted nothing to do with it at the moment. I guess my main question is: How can my father enjoy his last days (however many there may be) with a better quality of life than he is experiencing? The bi-weekly chemo treatments beat him up, this third course of radiation is taking its toll on him, and in general he is simply in so much pain that he doesn''t want to eat much, drink much, or do anything because of the effort involved in doing it. His head is foggy from the meds, but of course he needs them to help reduce the pain. If you have suggestions for finding a balance for my father to find a quality of life in the midst of trying to keep him alive, I certainly would appreciate it. Thank you very much. Terri
		A:	My own father went into hospice months before he died. It was a blessing to have them control the pain and monitor his other needs. It helped the family too. There is also palliative care that your oncology center might be able to connect you with. They deal with treating symptoms and pain. I wish you all the best. ds
Question:  #24 7/13/2009		Q:	DEAR DOCTOR IS IT TRUE THAT THERE ARE SOME STUDIES ,MAY BE IN EUROPE,RECOMMENDING THAT EVERY POSTMENOPAUSAL BREAST CANCER PATIENT SHOULD CONSIDER HORMONAL TREATMENT REGARDLESS OF HER HORMONAL STATUS ON IHC, BECAUSE SOME MAY ACTUALLY BENEFIT FROM SUCH TREATMENT?
		A:	No good studies that I am aware of. THat said, hormonal therapies for preventing breast cancer in women at high risk do sometimes include women with a previous history of breast cancer regardless of hormone receptor status, though this is in the PREVENTATIVE setting, not treatment setting ie to try an prevent a new breast cancer from occurring.
Question:  #25 7/5/2009		Q:	Very recently having shortness of breath when going upstairs, pain in my upper right back with really dry itchy skin issues. Have an appointment with oncologist this week. Had a clear chest exray and labwork late February. Is it possible that cancer has spread to lungs in this period of time. If so, will draining help ease pain and can draining be done more than once? currently take femara what else would be available?
		A:	there are many factors here to consider. originally stage of the breast cancer, what treatment was done, other health issues, your age and such. IF the oncologist has been concerned about the possible development of stage IV breast cancer, it is true that shortness of breath can be a signal. it also can be a signal for heart disease too however. and there are times that due to humidity or other factors (like being overweight) shortness of breath will naturally happen when climbing stairs or walking fast. dry itchy skin isn't related to metastatic breast cancer. sounds like you will have answers soon by seeing your doctor this week.
Question:  #26 7/6/2009		Q:	dearest lillie in feb 2003 my mother was diagnosed withIDC T(2,5CM),N(2\21),M0 SHE RECEIVED ACX4,TX4 AND POSTMASTECTOMY RADIOTHERAPY.HER THERAPY ENDED ON OCT 2003 IN FEB 2005,SHE SUFFERED FROM BACK PAIN ,ONE SPOT ON L4 WAS NOTED ON BONE SCAN,HER SYMPTOMS DISAPPEARED SPONTANEOUSLY,HER MRI was inconclusive ,PET WAS NEG SO was HER NEXT FOLLOW-UP BX,SHE RECEIVED NO TREATMENT IN SEP 2007 WAS DIAGNOSED WITH MBC TO BONES AND LUNG,AND A SUSPICIUOS SMALL HEPATIC DEPOSIT SHE RECEIVED NAV,CARB,HERCEPTIN AND ZOMETA WITH REMARKABLE IMPROVEMENT ,AFTER 12 CYCCLES SHE REMAINED ON HERCEPTIN ALONE FOR 4MONTHS.THEN HER PET SHOWED INCREASE IN BONE LESIONS INTENSITIES WITH NEW HYPERMETABOLIC BONE LESIONS .I HAD DIFFERENT OPINIONS WHETHER TO CONSIDER HER CURRENT SITUATION AS PROGRESSION OR NOT ,AND IF IT SHOULD BE CONSIDERED AS SUCH, SHOULD SHE SWITCH TO TYKERB OR SHE MIGHT STAY ON HERCEPTIN WITH OTHER COMBINATION,AND IS ANY OF THESE OPTIONS MORE *right* THAN THE OTHER/ im sure sound very confused,i appreciate any help thank you
		A:	Not confusing at all, but very good question. There is evidence that tykerb could be appropriate now as it is approved for HER2 resistant metastatic disease, but there is also evidence recently from Germany that keeping on Herceptin but switching the chemo can have equal effects in this regard, though there are some caveats to the German study. I would advise getting a 2nd opinion at your nearest NCI comprehensive cancer center to not only garner another opinion but see if there are any trials she may be eligible for as this is still an unanswered question in our field.
Question:  #27 7/4/2009		Q:	Hello Lillie - I was diagnosed with stage IV with bone mets 4 weeks age(couple of spots one on the rib and one the spine area)As you can imagine I am still in shock and having a hard time digesting this roller coaster cancer ride. I am currently on Femara after my lumpectomy and was not given an option for radiation therapy. I am also starting Zomata IV next week. I am Estrogen (3+), Progestrone (1+) with HER-2 no over expression (1+) i guess this means I am amplified but not over expressed....my question is I have heard about a vaccine trial both at your hospital and also at UAE - would this be something for me? Also I feel just taking a pill everyday is not enough and need to do some other additional therapy. Thanks for your help.
		A:	Hormonal therapy is highly effective in controlling stage IV breast cancer that is hormone receptor positive. one thing to ask about is a biopsy of where the disease has spread. we have seen cases where the prognostic factors end up changing when the disease migrates to another organ. we will hope and pray it is ER positive as the breast tumor was. currently the vaccine trial is for HER2neu positive patients but there are plans to begin onf ro HER2neu negative patients. on monday call 410-955-5000 and ask for Stacie Jeter who can tell you more details about this. We have a relationship at Tawam hospital in the UAE who may start doing some trials there as well in the future.
Question:  #28 6/14/2009		Q:	In 2004 I had a masectomy for DCIS noninvasive. No radiation or hormone treatments. I had a total hysterectomy over 20 years ago due to recurring endometriosis & ledged fallopian tubes (tubal pregnancy). This May a CT/PET scan showed an enlarged middle media stinal lymph node. I will have a consultation with a pulmonologist this Monday re the scan & results of A PFT test done also. I thought DCIS was a stage 0 cancer & by having a masectomy my risk of recurrence was close to 0%- especially because I had a total hysterectomy also. What are the chances this is a spread of my breast cancer? The minutes are passing like hours until I understand better what is going on. Thanks so much for your help if you choose to answer,
		A:	you are technically right- stage 0 is noninvasive breast cancer that cannot travel beyond the breast ducts. however there are odd cases in which a tiny invasive ductal cancer was lurking inside the breast and missed by pathology. it could make its way through the body via blood stream. so the answer to your question isn't 0% but instead 1%. hopefully the findings will end up being something benign we hope for you.
Question:  #29 6/14/2009		Q:	dear lillie i appologize in advance for my long question. my mother was diagnosed in 2007 with metastatic breast cancer to bones ,lung and focal suspicuous liver lesion,her tumor is er,pr negative,her-2 +3,after taking herceptin ,navelbine ,carboplatin and zometa,there was a considerable response with regression of bone lesions ,almost disappearance of lung lesions(a mild hilar focus remained)mnoother abnormalities noted she remained on navelbine ,zometa and herceptin ,then on herceptin alone .then her pet scan showed mild increase in bone lesions intensity with new uptake of axillary lymph nodes,there is also reappearance of the suspicuous liver focus,her clinical status remaind stable.this situation was considered as progression by her oncologist .he switched to gemzar and tykerb,after 4x 3 weeks cycle she remained on tykerb alone for 6weeks,her last pet-scan showed stable bone lesions ,disappearance of axillary lymph nodes activity also the liver focus ,no new lesions noted.she is to remain on tykerb alone for 6 months unless clinical progreesion shows up , my question is why stopping gemzar and remaining on tykerb ,not the other way around,and is tykerb alone studied in such situation? thank you for your patience
		A:	i think the oncologist is trying to reserve drug use so that when tykerb period of use stops he has something to fall back on to continue her treatment with. ask him though. glad to hear meds are stabilizing her disease too. L
Question:  #30 6/1/2009		Q:	My question isn''t necessarily about breast cancer. But I have very little time to live and I am desperately trying to get answers. I have been diagnosed with peritoneal carcinomatosis from an unknown primary source. I''d like to know who is doing the most current treatment for this specific type of cancer. Please e-mail any info asap. I''m trying to save my life. Any info you could povide would be appreciated.
		A:	There are many centers across the country that treat cancers of unknown primary, but I honestly don't know who is doing the most current treatments for your type of cancer. I would encourage you to make an appointment as a new patient here at Hopkins, or other major academic cancer center close to you, to seek this out. This may be related to gynecologic malignancies, and therefore it may be helpful to ask for the gynecologic cancer experts here or elsewhere for help. Best wishes for you.