Q:  

dear doctor shockney in metastatic breast cancer to brain could tykerb be administred with corticsteroids ,if yes how the dose would be scheduled, is prophylactic phynetoin recommended and how should the dose be monitored with tykerb and dexamethasone finally ,could xeloda be effective in brain mets a lot of questions ,thank you for your care

A:  

To deermine the answers to these questions truly requires a formal consultation. there is no simple answer to type out for you. if you want to come for a consultation call the oncology referral office at 410-955-8964 and they will arrange this for you. it is good that we have tykerb today sicne it does cross the blood brain barrier to reach such cancer mets. L

Q:  

After 7 months of back pain, groin numbness and some urination issues, I got an MRI (no bone scan). The spine specialist read the report and said I have a 2x1x1cm oval perineural cyst pressing on S3 and S4 nerve roots in my sacrum. (Everything else normal.)They are going to aspirate it to relieve pressure. He called it a benign cyst because it was fluid-filled, but added that they would biopsy it. I wish now I had asked more questions, but at the time I was just relieved it wasn''t a bone tumour. But can a MRI reliably differentiate between liquid-filled vs. solid tumours? I am a 4 year BC survivor (IDC, Stage 1, Er/Pr+, Her 2-) BC survivor... is that why he biopsying this "benign" cyst? Could metastatic breast cancer take this form?? Now I''m scared. Thank you for your time!

A:  

i've never seen metastatic breast cancer take this form. also, your stg 1 and very favorable prognostic factors and being 4 years out further reduces the possibility of you having mets. MRI can tell liqui from solid filled masses. L

Q:  

Are my risks higher for getting Mets based on my medical history. 1981 Leukemia, AML, w/BMT. 2002, tested + for HepC, from blood products I received in 81, tx and cleared. 10/07 Dx with BC, Stage2/Grade2, 1/7 nodes+, ER+,PR-,Her2+++, Chemo,(Carboplatin, Toxatere x 4), Mast, (both), Expanders/Silicone. Could not take Herceptin because of Chemo I had in 1981. Could not be radiated either, due to the Total Body Radiation I had in 1981 for the BMT. Thank you again.

A:  

risk is based just on the breast cancer prognostic factors and the issue of not being able to do the degree of treatment that would have been optimal for you-- radiation and herceptin. you are past the 2 year mark which is the period of time that risk of recurrence (local and distant mets) is at its highest. that's the good news. celebrate this milestone.

Q:  

Hi Lillie - I sent you a question about bumbs under my arm and I think I told you the wrong dx date. It was April 2007, not 2008. Don''t know if that makes a differance in your answer to my question, but thought I should let you know anyway. Thanks!

A:  

same answer

Q:  

Per my earlier e-mail regarding x-rays and mets - I will be going to my oncologist for my two year anniversary this week. I have always been concerned because they did find a 2mm micrometastasis in the sentinel lymph node but I had no treatment other than hormonal. I am not sure if this was partly because I also have MS. I am ER+PR+ HERC- - I was stage IIA. Should I be concerned about the back and chest pain because of the finding in the sentinel node.

A:  

even if sentinel node was totally negative, we have to give thought to possibly mets anyway. your prognostic factors though were really good-- ER/PR positive and HER2neu negative. hang in.

Q:  

I have grade 111/111 infiltrating ductal carcinoma, lymph nodes positive for high grade metastic carcinoma just had a lumpectomy waiting on results is my grade and stage considered the same.. do you think I made the right decision..

A:  

grade 3. Stage not clear as it is based on diameter of infiltrating component of tumor AND # of nodes positive. you posted this in the mestastatic section. doesn't mean you have metastatic disease. only classified as metastatis breast cancer IF and only if it has spread to other organs in your body like lung, bone liver or brain.

Q:  

H1, thanks for your time and kind advice. I had IDC in 2006 at age 39. 0.9 cm, Er/Pr positive, Her2 negative. Sentinal node biopsy negative. Had a mastectomy (plus radiation due to presence of invasive cells at deep margin), no chemo. On tamoxifen. Now- continuous mid back pain since July 2009. Being evaluated by an excellent family doc. I no longer see an oncologist- I''m in Canada, so seeing an oncologist is difficult. Varies from dull ache to occasional sharp nervy pains. So far, only needed Tylenol but the pain is always there. Stiffness has increased dramatically- my back feels rigid and cannot twist at all. Cannot get comfortable at night. Walking and standing for long periods difficult. Some tingling in groin/vulva area when I lean on a counter or something- weird! Significant tenderness at one specific spot on my spine. Doc says it seems to be centred right on a ligament. Feels like right on the bone to me. Physio, accupuncture unsucessful. XRay showed nothing. MRI just came back normal. Could they have missed mets? Do I need a bonescan or not? What is the best diagnostic tool? I am really nervous about it but I don''t really want unnecessary radiation of a bone scan if I''ve already been well evaluated. What''s your opinion? Are the symptoms consistent or not with mets? And should I get a bonescan? Thanks very much!

A:  

next step would be bone scan to rule out bone mets. if negative then time to see ortho/neuro doctor.

Q:  

Hi I love your site and was so please to see the forum was open again. In April of 2008 I was dx with dci at the age of 42. Multicentric, largest 1cm, 4 nodes positive, grade one, pr/er+. Had left mastectomy, chemo and radiation with in 6 mos of dx. I now have 3 "bumbs" in and around my armpit. All raised, pink in color. Noticed around Christmas. Seems like my upper arm has been swelling more the the usual too. What does skin mets look like and should I be alarmed? They do not hurt or itch and are about the size of a bebe.

A:  

would be unusual to be skin mets in that area. usually, if it happens it declares itself more along the chest wall area of that specific skin zone. that said, might you have shaved too closely?? if so, could actually be infected hair follicles. given arm as swelled implies that your body has turned on its lymphatic system in response to thinking this is a local infection possible. really hard guessing though without physically seeing you and that IS what you need to do- go see your doctor this week. not wise to delay as you have apparently waited a month so far.

Q:  

Can an x-ray show mets - I have been having back and chest pain for a month and went for an x-ray a couple of weeks ago- according to the doctor it showed normal degeneration for my age but the pain is still there.

A:  

a chest x-ray or spine films is not how bone metastasis is diagnosed. it is with a bone scan. requestion one if you are at risk of potentially developing mets and that these now chronic pain symptoms.

Q:  

Hi Lillie. I''ve written to you before and have another question. Thanks so much for this. I had a recurrence in my internal mammary node, some "suspicious nodules" in my lungs, and a tumour under my arm. While the first two areas have been stable for two years, the underarm tumour kept growing and growing and was finally removed this past September. Now the darn thing seems to be growing back. They say it''s not life-threatening but that it can cause lymphedema and also the tumour has a lot of sensation and is a constant reminder to me that I have cancer. Apparently they can''t radiate the area because it was radiated before. Do you know if there''s any other local treatment they could do? I so enjoyed those few months without a lump under my arm! I''m currently on hormonal therapy (aromasin).Thanks again for your help.

A:  

might be good to request your case be presented at the breast cancer tumor board meeting for a team discussion. that way the doctors taking care of you and also get input from the medical oncologist. if hormone receptor positive hormonal therapy may help to shrink it. important to retest the hormone receptors where mets has gone as sometimes the receptivity has changed.

Q:  

i wish first to say happy new year for all MBC who are still hanging on,and especially for you lillie my question is about recurrent urinary tract infection . my mother is taking tykerb and suffers of recurrent diarrhea,also of recurrent lower urinary tract infection, mainly after diarrhea,she suffers of low abdominal pain without fever or burning sensation,the WBC count in urine is usually 20-25 sometimes with traces of hemoglobin and protein. the infection reolves after short course of antibiotics. is the presence of protein traces acceptable in this situation,are other measures necessary such as cystoscopy thanks

A:  

Thanks.. not an unusual problem. acceptable values. she might be having trouble when wiping after diarrhea and it may be tracking "forward" instead of backward. know what i mean? this is an instant ticket to get a UTI. cranberry juice and cranberry pills need to become her new best friend. this helps slough off the inside lining of the bladder to keep it healthier and reduce UTIs like this. glad she has you there for support. L

Q:  

for monitoring bone metastases ,is there a difference between bone scan and pet-ct. thanks (merry christmas everyone and happy holidays)

A:  

there is. no one specific test or scan is perfect in identifying everything of concern. bone scans of course focus on skeletal structures. PET/CT scan correlates a PET scan with a CT scan to look at other organs such as liver, lung. hope you too have a joyous holiday.

Q:  

DEAREST LILLIE : YOU VE BEEN KIND TO ANSWER MY QUESTION BEFORE ABOUT CROSS RESISTANCE BETWEEN TAXANES. I TOOK TAXOL IN THE ADJUVANT SETTING ,NOW WITH METASTASES MY ONCOLOGIST IS NOT WILLING TO USE TAXOTERE BECAUSE HE CONSIDERED THE METASTASTIC CELLS HAVE MANAGED TO EVADE TAXOL AND ITS OUIT POSSIBLE IT COULD EVADE TAXOTERE AS THE TOW DRUGS WORK THE SAME WAY,SO HE WONT USE IT UNLESS HE HAVE TO. I KNOW TAXOTERE IS ONE OF THE MOST ACTIVE DRUGS IN MBC BUT ALSO WITH MANY SIDE EFFECTS, I M CONFUSED .THANK YOU

A:  

Your oncologist's thinking is very logical, but often times chance of responding, even to the same class of drugs, depends on the interval between treatments. If you were recently treated with taxol, then using taxotere would probably not be the best option. There are also many many drugs that are active against breast cancer in the metastatic setting, and the goal here is to treat the disease, but not have too many side effects. If you feel your oncologist's explanations are still leaving you confused, consider getting a 2nd opinion. Best regards.

Q:  

My wife was dx''d with Stage IV breast cancer with bone mets in the lower spine, pelvic region, and ribs in Aug 2006. She has done regiments of A/C, tamoxifin, Taxol, Arimidex, radiation to her pelvic region, and currently Aromisin. Last month she had a radiation treatment to her hip that was described as being pallative in nature. This week a CT scan showed two lesions in her liver. The current plan is to start a new therapy next week. She is very tired and fatigued, and complains of feeling bad ALL the time. My question is, "What can we realistically expect?"

A:  

Very sorry to hear this. Well, the breast cancer is apparently still growing despite treatment. she needs her liver to be functioning properly to metabolize drugs as well as re-create new red blood cells. if lesions are small then this is manageable but if they are large or get large then that changes things a lot. one thing we have learned is the importance of taking biopsies of the areas where the cancer has spread to double check the prognostic factors of hormone receptors and HER2neu. this is because they can become the opposite of what they were originally in the breast tumor within the breast when she was first diagnosed. we don't know why or how this happens but it does and can. that's important since she was hormone receptor positive and therefore hopefully the mets is also. but it may not be and thus a reason why she doesn't respond to hormonal therapy. see what i mean? Her fatigue and frustration may drive her to make personal decisions soon about her treatment too, like whether she wants to continue or not. it does sound like it is time to sit down and have a very open discussion about her wishes and expectations, including of you. quality of life is usually more important to most women than quantity of life. So time to talk with her and her doctor about maximizing her quality of life for her remaining time. i don't know her age but if young children are involved it is wise to get hallmark cards for their birthdays, holidays, signficant events like weddings, graduations, and have her write a note in them-- what does she want to say on that day when your child reaches that milestone in his/her life? date them when to be opened and put the child's name on them. store in a lock box in a bank vault (these cannot be replaced in the event of fire or flood). She will still be right there with you and your children as they reach these important times in their lives. The holidays are upon us. memories are to be made... I hope for you both a blessed holiday. let me know how else I can help you. Lillie

Q:  

My mother has her2 breast cancer and is currently being treated with xelota and tykirb. she is very difficult and I am having a hard time with getting to the facts with her. when someone is taking these drugs what is a common prognosis?

A:  

Since you posted this under the metastatic breast cancer category i assume that she has breast cancer that has spread to other organs. To be on Tykerb would imply that she was previously on Herceptin and perhaps it is no longer working. not sure. Technically speaking, eventually all women succumb to their metastatic disease, however today women are known to live many more years with their breast cancer in other organ sites that ever before. sounds like it is time for the two of you to have a heart to heart before she isn't here for you to reconnect with. If she thinks you are seeking information because you want to know when she is going to die, then forget about rebonding. If you are genuinely concerned about her, love her and want to help her then make that known to her.

Q:  

dearest lillie how effective is xeloda in bone metastases,and can it be compared to taxotere ? and is there reliable evidence of cross resistance between taxol and taxotere?

A:  

The short answer is that nobody knows for sure. Xeloda can work in metastatic disease as can other drugs, but every patient and therefore every cancer is different, and we don't have as of yet reliable predictors of response to different chemo agents in the metastatic setting with few exceptions. There is however a general thought that cross resistance between taxanes is common since their mechanism of action is thought to be the same.

Q:  

dear lillie: how is clodronate different of zometa in the treatment of MBC to bone? were they compared head to head? thanks

A:  

There has not been any definitive head to head trials of bisphophonates for MBC to bone that I am aware of, but there is currently a trial ongoing here in the states to address the question of comparing three different bisphosphonates but in the adjuvant (post surgical) metastatic setting. Hopefully that will give us more insight into any differences between these drugs.

Q:  

Lily--not sure if you can answer this, but does having had breast cancer make you more prone to other cancers? I am a 3 yr survivor of early stage breast cancer and having stomach symptoms lately. My doctor wants me to get an endoscopy--she suspects an ulcer. I have read the symptoms for stomach cancer and they sound very similar. Any insights?

A:  

Yes, it does. so having had one type of cancer (not just breast cancer but any type of cancer other than skin cancer) increases risk of developing another type of new primary cancer in the future. Types that statistically carry a higher incidence among breast cancer patients are ovarian cancer, colorectal cancer, melanoma and even pancreatic. However there is no type of cancer that is off limits. stomach cancer however is quite rare. more often what is found is what your doctor suspects-- an ulcer.

Q:  

My sister is 53. She has Metastatic Breast cancer in her bones (hips, spine and ribs) and in her liver. She has had rediation to her hips, spine and ribs. This helped reduce her pain in these areas. She is on her second cycle of Chemo (avastin and taxol). Her oncologist tells us that her cancer is in her blood. Is this Chemo what would be done at John Hopkins? Are you aware of any other treatment that could help her to put her cancer in remission, Thank you.

A:  

sorry to hear that she is battling metastatic disease. to determine what we would do here truly requires a formal consultation. we would need to review her scans, her pathology slides, ensure that biopsies of the bone were done and that the prognostic factors are the same as the original tumor. We'd review all the therapy she has had thus far and then make a recommendation for her. if you want her to come our way call 410-955-8964.

Q:  

Hi Lillie. Thanks for your help with the question I sent on the 23rd Nov. There is no real history of breast cancer on our family (but my onco is going to check for the BRAC gene), and the malignant cells in my ovaries were Breast cancer cells. I have another question if I may. As lobular breast cancer spreads to odd places, and acts in odd ways (second tumour im my breast did not show up on mamagram but was spotted while ultrasounding the first), would it be wise to get a MRI of Brain, Chest, Pelvis to monitor for further spread, or would CT scan be adequate. We dont have access to a PET scanner in NZ. Thanks again.

A:  

CT scan and bone scans are usually adequate. I think that there is a relatively good possibility too that you may carry a gene. remember,the genetic history has to start somewhere. it may start with you dear. L

Q:  

dearest lillie: my mother has been diagnosed with MBC TO BONES ,LUNG AND ONE FOCUS IN LIVER 2007 ,TWO YEARS LATER HER DISEASE REMAINED MAINLY IN BONE AND STABILIZED.SHE DID LATELY COMPLAIN OF HIP PAIN ,HER PET SCAN SHOWED :NEW SACROILIAC LESION SUV 3 ,AND AN OLD FEMORAL NECK LESION *RESOLVED ON PET :SUV MAX1,6 WITH CORRELATED SCLEROTIC LESION ON CT AND WAS INTERPRETED AS HEALING .HER OTHER BONE LESIONS SUV MAX 4 ,ARE MOSTLY OSTEOBLASTIC(WERE MOSTLY OSTEOLYTIC BEFORE),HER LAST BLOOD TESTS NO MORE THAN MONTH AGO WRE ca15-3 less than 15,ALP LESS THAN 150 MY QUESTIONS IS HER FEMORAL NECK LESION REALLY HEALING OR SHOULD PERHAPS BE INVESTIGATED WITH BONE SCAN? DOES SWITCHING FROM OSTEOLYTIC TO OSTEOBLASTIC HAVE ANY PROGNOSTIC ,THERAPEUTIC IMPLICATIONS AND WHAT DOES ALP VALUES TELL US IN BOTH CONDITIONS? THANK YOU

A:  

Impossible to say. Bone scans are very non-specific and blastic lesions do usually correlate with sclerosis on CT or plain films but one cannot differentiate between healing bone and blastic lesions with either bone scan or CT as they can look the same. Because breast cancer can have either lytic or blastic lesions, there is no real way to determine what is happening, though your tumor markers and other blood work suggests that healing may be occuring. I'd talk this over with your mother's doctors. They should be able to give you a sense if they think the disease is still stable or now progressing.

Q:  

Hi Lillie. I am now 45, and was diagnosed with mixed ductal/lobular breast cancer in Aug 2008. Had 2 tumours and a Left Mastectomy - grade 2 ER/PR +ve, HER2 neg, 0/6 nodes. Went onto the SOFT trial and was randomised to the arm of Ovarian suppressian with Triptorelin inj monthly and Exemestane orally daily. I opted to have my ovaries therapeutically removed end of last month, laproscopically everything looked NAD, but both have come back with pockets of metastatic breast cancer - 5-10% in each. Thank god I had been on ovarian suppression therapy for the past 12 months, and that I opted to have my ovaries removed. I realise I am extremely lucky, but am still gutted. I met with my oncologist last week after having staging CT of Chest/Abdo/Pelvis (all NAD), has started me on Temoxifen, and wants to leave chemo at this stage incase any other mets pop up elsewhere.I queried about change in HER2 status as stated previously in this forum HER2 can change in 25% of mestastic Breast tumours. He hadnt heard of this occuring but is going to research it, and discuss my case with the Gynaeoncology team. How common is metastatic spread to the ovary, and what would be the best treatment plan in your opinion. What other tests etc should I be requesting. Thank you for your advice as everyone seems a little baffled by this.

A:  

Hi there. This is Ben Park one of the breast medical oncologists and Lillie forwarded me your question. Have you been BRCA tested? Do you have a family history? You are very young to have breast cancer which is why I ask. I agree that checking HER2 status is wise, though usually the shorter the interval between the first primary breast cancer to the discovery of recurrent disease, the less likely it would have changed, though not impossible. Also, because you had a lobular component, it is possible that this is metastatic disease to your ovaries, as lobular breast cancers tend to metastasize to unusual organ sites. However, another reason to check with your BRCA status is whether or not this represents ovarian cancer. Did they repeat all the usual stains such as ER/PR and HER2? Your case is not so simple and I would recommend getting a 2nd opinion preferrably from a large academic medical cancer center if you have one nearby. Best regards, Ben Park MD PhD

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.

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.

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

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

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!

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.

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.

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.