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Category:

Metastatic Breast Cancer

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Question:  #571 7/24/2006		Q:	My mother is 70 yrs old. She had a growth in the shoulder which was excised and the tissue biopsy indicated ER/Pr +ve. However, follow up tests which included functional PET study,CAT scan, X-ray, ultrasound and mammogram all turned out to be negative for any cancer in breast or neck or lymph nodes. She was however prescribed Arimidex once a day and has been on it for the last 6 months. She still has no symptoms of any cancer. Given the adverse effect on bone density, we have decided to stop it soon. What is the best way to stop Arimidex - gradually weaning it off or simply stop? Your comments in this regard is highly appreciated.
		A:	her oncologist needs to let her know his preference-- either stopping all at once or a weaning process.
Question:  #572 7/24/2006		Q:	Had modified radical mastectomy 10/04. 4 A/C, 12 Taxol, 38 radiation treatments. Had local recurrence 02/06. Had 28 more radiation treatments. Was on Metheltrexate, 5FU, and Cytoxin for two rounds. Went to the doctor and had a rash on my chest above the mastectomy site. Was told it was breast cancer coming through the skin. Changed my chemo to 4 weekly treatments of Nevelbine. Can they do radiation on the rash? I have never heard of breast cancer coming through the skin. Is this uncommon? What else can be done for this? Will be having a CT and bone scan in a couple of days.
		A:	sounds like inflammatory breast cancer and yes, radiation is done of the skin of the breast for this.
Question:  #573 7/24/2006		Q:	Im 35 and I have Stage IV BC w/liver & bone mets. A lot of node involvement too. I have had, Adramyacin w/Taxotere - dose dense.. Abraxin with Avastin. Every three weeks I get Zometa & Avastin. And every three months I receive Zoledex. I have tried, Tamoxifen & Femara as well. The Adramyacin slowed down the progression by a couple months two years ago, but now nothing seems to be slowing down my disease. I was wondering if you at Johns Hopkins had any Phase I Studies that might be of interest to me. Currently, I feel great, have no symptoms of anything. I dont have pain from the spots down my spine, shoulder, hip, and no symptoms from the liver mets either. I look great and feel great. I start Xeloda next week. Id like to try and slow the progression down prior to it going to the lungs or brain and thought that a Phase I study might be appropriate. Any thoughts? Thanks!
		A:	not sure... call 410-955-8964 and ask to speak with clinical trials nurse there.
Question:  #574 7/24/2006		Q:	I wasn't sure where this question fit. I am 44, pre-menopausal and I scored a 36 on the oncotype DX test. Had a mastecomy, 6 months of chemo and am on tamoxifen. I started getting my period again 1 month after I stopped chemo. My oncologist now wants to put me on a drug that will suppress my ovaries (zoladex or lupadin (sp?) Is this common? Have people had bad side effects with these drugs?
		A:	get a formal second opinion to decipher if this is the best approach to take. tamoxifen is designed for premenopausal women like yourself and may very well cause your periods to stop anyway...
Question:  #575 7/21/2006		Q:	My mother n law is 55 years old and was diagnosed with metastatic breast cancer in 2005. In the past year she has been on 5 different chemos the last 2 navalbine and gemzar were given in conjunction with herceptin. The chemo has not held the cancer at bay and recently after undergoing a ct scan for confusion it was discovered that she had a 7mm tumor in her brain (which radiation took care of). However, last week she under went more scans and a mass measuring 2CM was located in the lower lobe of the right. lung. She has been selected for a clinical study of a new pill lapatinib which her doctor and staff are quite excited about. According to what I have read this could be possibly the medication of ther future. Have you heard of this medication? Is it worth trying? Generally what is the prognosis when breast cancer reaches the lungs?
		A:	yes, it is exciting news about this drug and information about it was presented recently at the ASCO conference. we hope it helps her.
Question:  #576 7/21/2006		Q:	Can you recommend a good source for additional information on metastatic breast cancer? I am very interested in finding more well-founded guidance on nutrition, treatments, prognosis and statistics adn other good resources for assistance. Thanks in advance!
		A:	check on www.breastcancer.org also on the NCCN website.
Question:  #577 7/21/2006		Q:	My 78 yr old Mom diag Stage IIb grade 3 ER/PR and HER2 negative in March 2005, lumpectomy, 1st sentinel node micrometastes the rest clear, chose CMF chemo thinking that A/C would have high toxicity, 6 wks radiation and she did very well with all of it! Routine chest xray in June 2006 shows 1.7cm spot on right upper lung. PET-CT scan showed activity with lesion. We held off on surgery because the surgeon thought he would have to do full thoracotomy not through a scope. We are waiting to re-do scan to see if other areas light up demonstrating likelihood that this is breast mets not a primary lung cancer. My questions are as follows: 1. The doctors all refer to waiting "6-8 weeks to redo scan" does this refer to a typical "doubling time" of the cancer cells? 2. Is it improbable that there would be no additional "hot spots" but still be breast cancer spread? 3. If this is breast cancer mets then isn't there still a benefit to removing this nodule even if she ends up having to go through other treatments? 4. What systemic treatments will be best choices and in which order for her particular profile? 5. Is it of benefit that this was discovered while there is only one small spot and she has absolutely no symptoms of disease? 6. With this type of cancer is there a reasonable possibility of still surviving for years or is it more likely that it will be too aggressive? Thanks so much for your guidance! I was so pleased to see you back on line!
		A:	1. it is a length of time to show tumor growth. not necessarily doubling. 2. if cancer, usually there are several 3.not usually. messing with these isn't helpful 4. requires formal consultation to figure that out 5. yes 6. unknown.... biopsy of the area is important to verify that it is mets.
Question:  #578 7/21/2006		Q:	thanks for responding to my questino #1 on July 20. the dr has ordered a cat scan and blood work, then maybe a biopsy. My real question is - can bone mets go into remission? thanks.
		A:	yes, that's possible.
Question:  #579 7/21/2006		Q:	Hello Lillie and thank you so very much for all the caring support you provide here. My sister has Stage IV BC with mets to bones, liver and brain. She has been on Xeloda for some time now but her tumor markers have been going up consistently over the past 4 to 6 months. She is now very weak, often has trouble walking and stays in bed much of the time. She refuses to discuss her final wishes and now plans to request her onc switch her a different chemo. I was under the impression that Xeloda is considered the final drug. Is there another chemo drug for her to try? We, her family, don't know how best to help her. Can you give us any idea of how much time she has left? And, please, can you discuss what we can expect to happen as she worsens? Thank you again.
		A:	oh my. what a difficult situation for all of you. he may try other drugs like avastin or other agents. one of the challenges with her brain mets is that chemo drugs don't cross the blood brain barrier in general... time to get a psychotherapist involved perhaps and hospice counseling to help everyone. its wise for all of us to have our affairs in order, so that these things aren't left to family to have to guess about later. (after all life is unpredictable. i could be hit by a truck going home, right?) she will probably lose appetite, become lethargic, and inactive as well as forgetful. her skin color may change due to liver involvement. her urine may darken. hang in dear.
Question:  #580 7/20/2006		Q:	my sister was diagnosed with pagest and DCIS 2 years ago. She had a dbl mastectomy and all nodes taken were clear so no chemo/radiation given. She recently had a bone scan - multiple hot spots showed up - mri is inconclusive but suspicious. Could this be another cancer in her bones, given the grade of her DCIS? Dr thinks it might be the breast cancer mets.... and as you know that is not very positive. if it is cancer mets can it go into remission with treatment? please help.
		A:	its extraordinarily rare to see mets with this type of original pathology. there are situations in which hidden in the breast tissue was an invasive cancer not seen or found by xray or pathologists. they will probably do additional imaging and possibly biopsy to figure it out.
Question:  #581 7/20/2006		Q:	My mother has battled bc since 2000 with mets to lung (had surgery) and brain (had surgery with chemo and radiation)she has negative receptors. pet scan picked up nodules in her lungs. Ct scan showed 4 cm tumor on kidney that has met to both lungs. We were told bc usually does not metstastize to kidney. Have you heard of this and what do you think her chances are? She is 69 and in pretty good health. She had 3 stents in 2004. Thank you for your honesty. This website is the best.
		A:	would be highly unusual to see it in kidney from breast. there are situations in which it goes to adrenal glands though, which sit on top of the kidney. ask if they plan to do a biopsy to confirm its pathology.
Question:  #582 7/20/2006		Q:	Lillie, you have been very helpful and right on in answering my previous questions, so thank-you. My girlfriend with stage 4 BC with mets to liver and brain, is now entering what I think is the terminal stages of her disease. They can no longer offer radiation, but have given her Temozolomide pills. In the last 4 weeks she has gone down hill. Very unsteady on her feet, weak, numb in some areas, vision worsening, left eye protruding, she has fallen twice, trouble with reg bowel movements, slurred speech and for the first time last night she lost bladder control. My question is, in your experience, how close do you think she is to the end of her journey? And what are some of the signs/symptoms of end stages. Will she be nauseous or have seizures?? Very scared of whats to come. Thank-you
		A:	sounds very close... these are signs her body is not able to live in harmony with the disease anymore. i hope her affairs are in order and her wishes known. she may lose appetite. hopefully won't have seizures... let's hope not. she needs to be in a safe environment so she doesn't injure herself trying to ambulate and have someone with her now.
Question:  #583 7/20/2006		Q:	Since March I have been on Gemzar after the first treatment my WBC dropped so low I couldnt do chemo that week, they gave me neupregen which didnt bring them up so they switched me to neulasta which helped. end of may cancer was progressing so they switch me to navelbine, but now I am having the same problems my blood counts will not come up, I am back on neupregen which brings up my counts to 2.0, my doctors are stumpt, they dont understand why my counts will not come back, they want to do a pet scan but that would mean laying off treatments and shots for 2 weeks. What could cause my counts to stay extremely low, unless the cancer has spread to my bone marrow? please help. I need to know what to do next. I would really like another pet scan but I'm scared to be off chemo for 2 weeks.
		A:	gee, don't know... they may want to talk with one of the hemolytic doctors about it.
Question:  #584 7/20/2006		Q:	I was diagnosed with breast cancer in 1989 at age 35. I had a modified-radical mastectomy followed by 6 treatments of CMF. I then began taking Tamoxifen and continued taking it for approximately 12 years. My original tumor was 2 cm. and I had 4 or 5 positive lymph nodes. I don't think some of the tests were available back then, but I do know that my tumor tested as hormone receptive. The cancer metastasised to my bones only, in 2005, 16 years later. I began my menstrual cycle at age 10 and went through menopause by age 50. During the two years prior to my reoccurence I lost both of my parents with 3 months in between the time of each of their deaths. I am currently taking Femara and monthly Aredia treatments and I am in complete remission once again. My question to you is, Is it possible that either menopause, stopping Tamoxifen or the death of my parents could have in any way contributed to my reoccurence? I understand that this a million dollar question, but I would really like to hear your opinion. I am currently doing great.
		A:	it is the million dollar question and there really isn't an known answer to it. some have wondered what role stress plays in these situations... also other medications, menstruation, etc. glad you are "back in business" again. sorry you have experienced so much loss and illness.
Question:  #585 7/6/2006		Q:	ER PR HER2/neu +++. Mets to spine. 36 years old. Dx'd stage IV straight away. Chemo: Taxotere, herceptin, zometa. Will have ovaries removed next week. Does this treatment seem aggressive enough? Other survivors suggested hormone therapy, but onc said would take up to 2 months to work and didn't want to waste time waiting. Is there anything else I should be asking about?
		A:	get second opinion and inquire about hormonal therapy and the timing of when they anticipate starting it.
Question:  #586 7/6/2006		Q:	I recently finished chemotherapy with Taxol and Herceptin. My doctor did a bone scan in March which showed an area around t-7 that was suspicious. She followed this with an MRI of the area which showed a focus of low signal intensity in the 7th rib with increased T2 signal in the marrow and perhaps mild enhancement. A small area of increased T2 signal abnormality was also noted in the T11 vertebral body. My oncologist thought that the area around T7 probably represented a fracture so we've been waiting to reevaluate after 3 months. She said if it shows healing then they would assume they were right about the fracture. She also said though that it could represent metastasis. The T11 area they thought might represent a hemangioma.How would the MRI have to change to show healing? and if it didn't change, would it have to be cancer or could it be something else? I'm a very active person and if it hasn't healed how would I know for sure its cancer? Perhaps it could be a sports injury? I would want to be 100% sure of the diagnosis before taking any more treatment.Thank you.
		A:	the challenge is once diagnosed we look at everything with a tainted eye and have to assume cancer or at least rule it out. there would be less uptake of the radioactive isotope to show healing.. we hope that is what the outcome is for you.
Question:  #587 6/29/2006		Q:	My mom has metazised breast cancer. They just did an ultrasound on my breast and found them normal but on the right breast they did find prominent axiullary node 18mm. They have recommend for me to see a surgeon. Should I be worry?
		A:	don't worry yet. too soon to assume it is something serious.
Question:  #588 6/29/2006		Q:	I have recently started chemo again. I was on adry, cytox and 5FU 4 yrs ago. But I have considerable progression in the bones. The chemo is Xeloda. I take 1800mg morning and 1800mg at nite. I also am on blood thinners. I go for regular blood work to keep an eye on my INR and PT with my PCP. My onco will not be checking my blood counts untily July 18 and I started this the 26th of this month. Doesn't this seem a long time to wait to check my blood counts? Also, I had scans (CT, bone, mri) in January, end of March and again in June, except a PET was added in June. Each month I see on the reports it shows progression in several areas although it does say slight. Until I had the PET and it shows considerable. It seems I should have been changed to chemo sooner than I was. Do you feel this may warrant a second opinion? I am real confused and do appreciate your time.
		A:	for peace of mind consider a second opinion. ask for rationale of waiting this long for blood work to be done.
Question:  #589 6/28/2006		Q:	Three yrs ago diagnosed with IIIB inflammatory breast cancer. The last few days both of my knees have been aching so badly when I sit and try to get up. I had surgery last week for a failed lat reconstruction but did some work at the house in the basement and went up and down the stairs numerous times. I am also about 40 lbs overweight. Does this sound like bone mets to you? Would they show up in both knees at the same exact time? Thanks for your help.
		A:	would be unusual to be in both knees at the same time and to be a sudden onset. report it to your oncologist though. hopefully it will be from your increased activity.
Question:  #590 6/27/2006		Q:	Any connection at all between a recurrent kidney infection (with UTI's as well) and metastatic breast cancer?I had bc diagnosis in 2002, mastectomy in 2003, chemo for 3 months (AC) in 2003, development of type 2 diabetes following chem, taking tamoxifen (about 2 1/2 years now), and have had recurrent UTI, now a kidney infection, and ongoing "troubling" test results on my liver and kidneys (including a benigh cyst on left kidney -- where current kidney infection is also located). Any connection? should I be concerned? Of course, my first thought always goes to cancer... Thanks for your reply.
		A:	hhhmm. not that i'm aware of .
Question:  #591 6/27/2006		Q:	I was dx with stage 3A invasive lobular cancer last year. sentinal node neg, ER/PR+ Her2-, 7cm tumor did 4 rounds AC, 4rounds Taxol, 33 radiation treatments, on Tamoxifin since febuary, what is my risk for reccurence and or mets? Thanks for a great site
		A:	have your doctor use www.adjuvantonline.com where he can enter in your pathology and the treatment you have had and it will actually calculate your survival chart for you.
Question:  #592 6/22/2006		Q:	I have stage IV bc to lungs and liver. I am currently doing well on gemzar. My last scan showed that my lungs were disease free and the liver had lots of tumors but had significant shrinkage. I know that there are vaccine trials out there and wondering if this is the time to start looking them. I hate to walk away from a treatment that is working... but to join a vaccine trial your disease has to be minimal. Do you have any input on the results of these vaccine trials...how effective they have been for those with stage 4? Thank you
		A:	we are doing a vaccine clinical trial here with women with stage 4 stable disease. call 410-502-7051 for more information.
Question:  #593 6/22/2006		Q:	I was diagnosed with 2 small lung mets (right lung) in December of this yea, I am HER2+. In April I was prounounced NED after 5 cycles of Taxotere, Xeloda, and Herceptin. I just finished 33 rads. I got the results of my latest CT scan yesterday, after 3 months on Herceptin alone. My Oncologist said all was clear. It did mention a "vague pleural density-6mm" in the left lung. My Oncologist said that he looked at the scans himself and it was nothing at all and not to worry about it. What exactly is a vague plueral density? I was so excited that my scans were clean that I forgot to question him more on it. Could it be caused by the radiations (which were to my right breast). And in your opinion, is it indeed nothing. You all have always been a great help..tks..
		A:	not really sure, and i suspect neither are they...its too vague a deion to guess.
Question:  #594 6/21/2006		Q:	How often does breast cancer spread to the ovaries or intestines?
		A:	less than 1%
Question:  #595 6/21/2006		Q:	What is the predictive value of the Nottingham grade for survival?
		A:	go to www.breastcancer.org and click on their pathology section to learn more about this.
Question:  #596 6/21/2006		Q:	My wife is 48 years old and has been battling metastatic breast cancer for 2 years. She is classified as a stage 4 cancer patient. In August of 2004, she was treated for a tumor in her right breast that was 6cm x 5cm x 4.5cm. She underwent 4 sessions of andrameyson to shrink the tumor size and then had a lumpectomy. The tumor was removed along with 20 lymph nods. There were clear margins. She is ER- and HER2-. There were 2 positive nods. She had one more session of andrameyson and then 36 sessions of radiation. She was classified in remission in May of 2005, but the disease came back in October of 2005, in her chest wall. A small tumor was removed and she went through more chemotherapy. The chemo was gemsar and braxin. This did nothing. In January the cancer had spread to her liver. They did 4 sessions of carbo-platin and taxetere. In March 2006, there was no visible evidence of the lesions in her liver. In April her cancer markers started to rise. At the end of May her CA125 marker went from 31 to 157. Two weeks later her CA125 went to 297. Her PET, MRI, and CT showed multiple lesions in her liver on 06-19-06. Now they are using CMF for the next 3 session, one every three weeks. Then they will scan again to check progress. Is there anything else that we should be looking into? Her onconologist does not recommend surgery at this time, because of the danger of cancer advancing during the healing process after surgery, where chemotherapy would not be administered. Please advise. Thanks
		A:	they are trying do all they can for her. her situation is a tough one. a second opinion may give you more peace of mind.
Question:  #597 6/21/2006		Q:	I am 4 yrs out of original bc dx. Within a year, had mets to spine. One of the chemos was adrimiacyn. I have been having shortness of breath and my onco ordered a muga scan. My LVEF was 53%. Can you tell me what this means and if the number is rather low? I will be starting chemo again in a couple weeks and wanted to know if this should be of concern. Thanks so much for your help!
		A:	it is lower than probably desired. see if they did a muga before and what the original numbers were for comparison. they will follow you closely from a cardiac perspective.
Question:  #598 6/21/2006		Q:	My 54 year old mother is battling metstatic breast cancer. In February she had surgery to remove a single brain met. Follow up MRI's showed no other lesions in or around her brain. This is the problem, for the past 3 weeks, she has been throwing up 2-3 times a day. She thinks about food and she gets sick. We have had bloodwork done everyweek, checking and making sure all her other organs are working properly. All came back perfect. She even had endoscopy performed and nothing! I am thinking that her constant nauseau and vomiting is stress related. Could I be right? Her oncologist is the head of the tumor board and he too can't find out what is wrong. Based on your experience, can stress be causing all this? Is there someone at JH that I can call and speak with? Thank you in advance.
		A:	oh my.. so sorry. her medical oncologist can contact one of ours to discuss her case. they do require though that it be doctor to doctor... stress can cause such things. sometimes brain mets can too though.
Question:  #599 6/21/2006		Q:	Lillie, are there any chemo drugs available that will cross the blood brain barrier? My girlfriend has been told that they cannot give her more raidation. The radiologist has upped her steriods to 16mg/daily, and has told her that her weakening leg muscle will worsen, but has recomended a Chemotherapy Specialist. What are the chances of him helping her and lengthening her time?? Thanks.
		A:	oh my.... sometimes they give the chemo through a tube directly into the brain called intrathecal injection but its fairly rare...it sounds like she is reaching the end of her journey. make sure her affairs are in order and her wishes known while she remains alert and functioning. your support is invaluable.
Question:  #600 6/20/2006		Q:	I am sure you have been asked this many times, but I need to ask this again. Is metstatic breast cancer an automatic death sentence? Have you ever come to know someone who is still alive with brain, bone, etc...mets? I am so scared that my days are numbered. I have passed the two year mark and I am finding nothing that is encouraging.
		A:	there are many women with metastatic breast cancer for which the disease is stable and they are living wonderful lives.