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Category:

Metastatic Breast Cancer

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Question:  #61 3/9/2009		Q:	I am on my 6th line of chemo - Ixempra. I have liver mets among others. My liver enyzme levels on the day I started Ixempra (before my infusion) were: AST-61, ALT-65, ALP-314. I just had my 3rd infusion. These are my levels up to then. AST-49, ALT-72, ALP-335 AST-39, ALT-56, ALP_322 AST_53, ALT-50, ALP_279 AST-44, ALT-57, ALP-287 AST-42, ALT-56, ALP-303 AST_61, ALT-55 ALP-255 Bilirubin stays around .2, .27, .28 Does this tell you anything about how treatment is working? My smaller lobe of liver is entirely cancer, with much throughout other lobe. Lymph nodes, portahepatus, etc Thanks for any information.
		A:	Doesn't tell anything about the treatment working or not unfortunately. Would continue to follow up with your oncologist.
Question:  #62 3/9/2009		Q:	Hello,I''m 50yrs old with BC liver mets diagnosed in May 2006.(Initial stage 1 cancer diagnosed in July 2001 - Her2 neg amd Estrogen positive. Liver mets appeared 2 months short of 5 year remission while on tamoxifen. In the past 3 years I''ve gone thru 8 different drugs including Femara, Taxotere, Gemzar, Xeloda, Carboplatin, Taxol and for past 6 months Abraxane and Avastin dosed weekly at 3 on/1 off. This last combo reduced 10 tumors to 5 but a recent CT showed mild increase in largest tumor (now size of a quarter)-but no other new growth. Next pet scan is scheduled late April.If results are not good at April''s petscan,my Oncologist recommends a switch back to Gemzar/Avastin and then possibly Ixempro next. Tumors are widely distributed across both lobes so I''ve been told surgery is not an option. Liver function is still normal per enzyme studies. Chemo embolization mentioned as a last resort if tumors get to large. I have no pain and still work full time so most times it is still hard to believe I have liver mets. Just starting to have gastrointestinal issues such as cramping, bloating and gas so I''m not sure if that is common or related. I know there are no cures but I wondered if there are any known clinical trials for liver mets (I haven''t found any) or other procedures or protocals I should investigate? I would appreciate any additional insights. Thank You
		A:	Sorry to hear about this, but glad you seem to be doing so well otherwise. I don't know of any clinical trials specifically dealing with liver mets, but certainly it is always an option to go for a 2nd opinion at a major academic medical center to see if you are eligible for any trials. I think the thing to focus on is that you are in remarkable good health which may allow you to participate in any trials that might be available.
Question:  #63 3/9/2009		Q:	Yesterday I had a PET/CT scan and the report reads: In the left liver there is a very tiny punctate focus of FDG uptake on both the attenuation and nonattenuation corrected images. No discrete lesion is demonstrated on the corresponding CT images. This focus is of questionable significance and may be artifactual. Also there is a small 4mm nodular density in the left lower lung, too small for accurate PET evaluation. Followup scan is recommended in 3 months.Also left adnexal cyst, 2.6 x 2.1cm. I have a history of endometriosis of the ovaries and ovarian cancer. Also I had breast cancer 1 1/2 years ago. What is the significance of all this? My onc says not to worry. I am planning to have a hysterectomy in the very near future because I am sick of abnormalities and I want less to worry about. Thank you very much.
		A:	Hi. 1) have you had genetic testing? You should consider this given your history of ovarian and breast cancer 2) PET scans are notorious for giving false positives or non-diagnostic information. Based on what you described, follow up at 3 months is reasonable. Many doctors here don't like to use PET scans because of results like this.
Question:  #64 3/8/2009		Q:	Hi Lillie Is it possible for breast cancer to spread to the thyroid? My friend and I went through this journey almost 5 years ago, and they saw something on her thyroid on an ultrasound, and now will biopsy it.I told her it is usually bone, liver, brain and lungs, but this thyroid has us worried
		A:	There are many reasons to have a thyroid nodule including benign disease of the thyroid. It is possible but rare to see a breast cancer spread to thyroid. You are correct it is usually bone, liver, lungs or brain. The best answer will come from the biopsy. DS
Question:  #65 3/1/2009		Q:	Hello Dr.Shockney, Thanks a lot for the valuable form and your knowledge. Could you comment on topic presented at the SABC 2008 conference which talked about using high dose estrogen therapy in metastatic breast cancer that stops responding to anti-hormonal therapies? I also read online that when the cancer grows back due to estrogen therapy, they switch the patients to anti-hormonals again. How effective is this in your experience? Thanks a lot!!
		A:	I haven't seen the entire study results but did hear a bit about this. It's not yet considered standard of care however and more research will take place before health care providers will be comfortable doing it. When metastatic disease does occur, for tumors that are hormone receptor positive, the first line of defense is hormonal therapy. this can work for quite some time for many--- as in years. then when it eventually stops working other medications like chemotherapy be considered. take a look on www.pubmed.com for more study results.
Question:  #66 3/1/2009		Q:	Hi again, I am referring to Dr. Ellis study of giving women with hormone dependent breast cancer after failing AI, an estrogen pill. My own oncologist has mentioned this possibility and stated we would talk more if I should fail my present AI. I have, there is progression, as I just pick up my own test results. I haven’t spoken with the oncologist yet. I am confused whether the estradiol therapy is the same thing as an estrogen pill mentioned by Dr. Ellis in his report at the San Antonio Breast Cancer Symposium. I would like your opinion in regards of failure of AI, going on an estrogen pill until failure, and then going back on AI. If you are against it, would you tell me why? I am trying to learn as much as possible about this new way of looking at women on AI for metastasis breast cancer. Thanks you again.
		A:	There are some laboratory data suggesting that estrogen, sometimes given at high doses, may actually inhibit the growth of breast cancers that are estrogen receptor positive. Further, "cycling" between different hormonal therapies is another area of active research. Thus, there is biological and scientific rationale for this trial. However, we don't know if it will work, and hence the need for a trial. There are other hormonal therapies as well including tamoxifen and faslodex; please do talk with your oncologist about your results and whether and when would be the right time to look into the estrogen trial.
Question:  #67 3/1/2009		Q:	Hi Lillie. I have written to you before. Thank you for always giving timely advice or information. I have a large pleural effusion with pockets of pus and fluid that can''t get drained. I also have multiple tumors on my liver. My scans and tm''s say I''m stable. I had two episodes of c-diff which landed me in the hospital. I just started back on avastin and abraxene. The thing is I have lost alot of weight these last few months. My urine is very dark in color and has a super bad smell to it. I eat as much as I can which isn''t alot. I try to drink as much fluid as possible. My family and I are beginning to wonder if I''m getting closer to end stage. I''m tired all the time. I sleep at least 16 hours a day. I can''t do much cause I''m so short of breath. Can you tell me what you think? Thank you so much!
		A:	Oh my... these are pretty classic symptoms of nearing the end of your journey dear. And with the inability to get the infection in control and fluid out of your lungs, things will probably slowly progress over the next few days/weeks. urine being dark is a sign that your kidneys are having trouble doing their job as well. time to make sure your wishes are known, affairs in order and the people you want to see and/or talk with come to you. I wish i had a magic bullet but i do not. you are the reason why we need to continue to do research so that others don't have to walk in your footsteps. my heart and prayers are with you and your family. Please request hospice to get you. they are a great organization and can assist you and your family as you move forward. LS
Question:  #68 2/28/2009		Q:	What do you believe about being given high dosage of estrogen after hormonal therapy?
		A:	if you mean taking HRT after having been on tamoxifen or an aromatase inhibitor, i am not in favor of it at all. LS
Question:  #69 2/28/2009		Q:	I recently had a lumpectomy to remove a 1.8 cm invasive tumor from my left breast. One of the two sentinel nodes taken at that time had a micrometastisis. A subsequent surgery removed nine additional nodes that were all clear. Initially I was told that the oncotypeDX test would not be useful because I was node positive and I''m premenopausal. My oncologist later ordered the test saying there was new information that in cases of estrogen receptor positive (score 10.9) and HR2 negative (score 8.4)patients with micrometastisis that the test would still apply. The test report gave me a recurrence score of 10 which is great, but a close read of the report indicated that the study group was all POST menopausal women and that "it is unknown whether the findings summarized in the Clinical Experience are applicable to patients with features different from those described". Did my oncologist jump the gun in ordering the test for a node positive (although it was a micrometastisis, PRE menopausal patient? How can these results be interpreted in my case?
		A:	I believe that what you might want to do is actually contact the company that does the test. genomic health. go to their website for contact info. they are accustomed and very good about helping patients with questions like this. the data was on post menopausal women. however that was some time ago. hopefully newer data is available to help you with this critical question. www.genomichealth.com
Question:  #70 2/22/2009		Q:	dearest lillie i ve read about a closed clinical trial about gemzar with genestein ,i wonder if there is more information available? thanks
		A:	I think you are referring to the trial that was headed by the Karmanos Institute in MI? The trial took awhile to accrue, but it is closed and I do not know if there are any interim data that have been reported. We'll have to wait and see.
Question:  #71 2/22/2009		Q:	dear dr.lillie my mother has been on tykerb with a starting dose of 3 tab a day,gemzar 2000mg every 3 weeks,before starting her 2 gemzar cycle and after a week of tykerb she developed a pruritic maculopapular rash on trunk and proximal extremities at first then extending to hands and feet,her cheek showed swelling with redness and burning what might be the cause and if it is tykerb ,could she restart tykerb after relief of rash? thank you
		A:	Could be any of the new medications that were started and it's not possible to tell which one is which given the timing of the drugs. I would discuss this with your mother's doctors as they may have to either discontinue the drugs and/or try premedicating her prior to taking the new drugs to try and abate the allergic reaction.
Question:  #72 2/22/2009		Q:	My sister aged 50 had a mastectomy 5.5 years ago. 3 years ago she underwent pleyral surgery with only tiny spots on her lung. In August 2008 she underent surgery to have a lkarge brain metastatic tumor removed. She''s currently on Herceptin/Xeloda/Zometa treatment with scans showing possible sternum metastasis and otherwise in good health and spirits. Some doctors are(neural surgeon) tell me it''s a matter of a short time while her oncologist is more optimistic. Are we having the best tratment, are there other options? After three surgeries and a positive attitude can my sister who''s a fighter still hope?
		A:	Perhaps they are both saying the same thing but in different ways. sounds like she has responded well to treatment which is good news. Eventually however the cancer will return and at some point won't respond anymore to treatment. that is wht i think they are saying. so enjoy now and the many days forward she has of quality of life realizing that cure isn't possible but more time with loved ones is. we are holding a special retreat for women with metastatic disease the beginning of june. if she wants to come have her contact us. go to www.hopkinsbreastcenter.org and click on "upcoming events."
Question:  #73 2/22/2009		Q:	Hi Lilly: I''ve written you before. Stage 4, subclavicular lymph node with pleural effusion 14 years after primary. Complete response to treatment with Aromasin for the last two years. I feel fine. My oncologist wants me to have neck, chest, abdomen and pelvic scans in April to compare to my 2007 scans. Do I have to have contrast? I didn''t like the way it felt and if I don''t need to have it I don''t want it.
		A:	He will probably prefer that you do it with contrast. images tell them more this way. congrats for the remission. somethng to truly celebrate. BTW, we are holding a special retreat for women with stage 4 breast cancer. it will be the beginning of June. if you'd like to come let us know go to www.hopkinsbreastcenter.org and click on "upcoming events."
Question:  #74 2/22/2009		Q:	Hello, I am writing concerning my mother-in-law. She has metastastic breast cancer with mets to the spine, pelvis, shoulder and just recently upper arm. Her first diagnosis of bc was 19 years ago with metastes to the spine after 5 years. I am unsure of the treatments she received early on but sha was on tamoxifen which changed to faslodex last summer. She also takes monthly pamidronate. She has been reasonably healthy up until the last 2 years. She now spends most of her time in bed and has alot of bone pain for which she takes oxycontin. Her mobility and quality of life have severely decreased and she cannot do much for herself. In the last year she has lost 40lbs and 3"in height. She has always told her onc that she doesn''t want to know any timelines, which we have always respected. The problem is that we are living overseas and find it hard to make plans not knowing what will happen. I have been trying to read as much as possible and it doesn''t appear that she has long left. We have tried to ask her doctor but she will not give us any details other than that she is in the advanced stage of her disaese. Sorry for being so long winded but we are very concerned that her denial is hindering her from having the best care possible, i.e. hospice. Thank you
		A:	Hi Brenda, This is Ben Park MD PhD and I was forwarded your question by Lillie. It does indeed sound like your mother's case is now very advanced, but it is impossible for anyone to really make this assessment without seeing her and reviewing her medical records. From what you say though, she appears quite ill and I would be inclined to agree with you that hospice care would be an option. However, as you said, ultimately this has to be a decision made with your mother and her doctors, and cannot be forced upon by loved ones no matter how good the intentions. It's a very tough position for you to be in and I feel for you. Hang in there.
Question:  #75 2/21/2009		Q:	I was diagnosed with Her2+, ER/PR- breast cancer January 2008. My brain MRI (first one ever done) showed an 8mm tumor. The radiation oncologist said it could be a meningioma but due to a history of BC they are treating it as a solitary brain met. I show no evidence of disease anywhere else in my body. I am to have cyber knife surgery next week on the tumor, but then the med onc wants me to continue herceptin, add tykerb and xeloda. Is that over kill or a good thing for me? Is it possible to remain disease free after the tumor is gone or is that just wishful thinking?
		A:	To really be able to address a question of this nature would require a formal consultation with us. it would be wise to make sure that multiple radiologists who specialize in neuroradiology look at those images and are in agreement that they believe this to be a mets tumor. All because someone has a history of breast cancer doesn't mean they can't get other disorders like a meningioma. and needless to say a benigh tumor in the brain is far different than one that is determined to be metastatic disease. LS
Question:  #76 2/16/2009		Q:	A patient previously diagnosed with a moderately diff. ER/PR negative, HER-2/neu 3+ tumor of the breast underwent modified radical mastectomy (neg nodes) followed by 4 cycles of Adriamycin and Cytoxan. 4 1/2 years later the patient is found to have mildly elevated liver transaminases on routine follow-up lab screening and a CT showing muliple liver mets. The patient is started on Herceptin, Taxotere and Navelbine then continued on Herceptin maintenence and over the next 30 months appears to have a complete remission with evidence of what appears to be complete resolution of her liver lesions by CT with all labs returning to normal. What information is available in the literature to estimate this patient''s future life expectancy? (Now 7 years out from initial diagnosis, 30 months since mets first discovered). Do we have any data regarding long-term survival in metastatic breast cancer following Herceptin?
		A:	Great question. Unfortunately there is currently no reliable data to help prognosticate this patient's future, but certainly it is a great sign that she had a complete response and is currently disease free. Keep hoping for the best.
Question:  #77 2/16/2009		Q:	My tumor level marker test has gradually been increasing by 10 or more points over the past 4-6 months. Just this last test, it spiked from 78 to 155. How concerned should I be? My Onc. is sending me for PET scan and MRI''s. She once told me if my tumor level marker went past 100 she would need to change my treatment, I am on a monthly shot of Faslodex and receive an I.V. of Zometa for mets to the bones. I am estrogen + and I have already been on Aromasin and it no longer was effective. Do you think I should begin chemo? and if I should, what kind? She mentioned Taxol before. I am really interested in the latest drugs and trials. Thank you!
		A:	It is a bit concerning to see these numbers climbing and that explains why she has ordered some scans for you to have. Taxol and avastin are common drugs given for mets. Consider a formal second opinion to weigh all your options and formulate a plan. something complex like this can't be addressed effectively via email.
Question:  #78 2/16/2009		Q:	dear lillie how is gemzar every two weeks different from every 3 weeks,thank you
		A:	one protocol (every 2 weeks) is sometimes referred to as dose dense. the theory behind both treatment cycles is that cancer cells have different proliferation cycles, so the drugs don't kill all the cancer cells at once. they kill them at different points in time depending in part on their proliferation rate. so that is why various time frames are used, as well as different ones being tested out in clinical trials. you may have lower blood counts doing the 2 week method since your body doesn't have the same length of time to bounce back before the next treatment is given.
Question:  #79 2/14/2009		Q:	Hello Dr.Shockney, Thanks a lot for your reply to my questions about my mother''s current condition, mainly, the whistling sound and question about 4.25 doses of Faslodex!! I hope I can ask a follow-up: The last line of your reply said, "so more isn''t necessarily better". My question was if there is a (that word got erased again!!) between my mother feeling better after the fourth dose of Faslodex and the medscape article suggesting that it takes 4.25 doses for Faslodex to show an effect? I did not understand your answer of more not being necessarily better. Would you mind explaning that a bit? Thanks a lot!!!!
		A:	i see... yes, the article does say that it takes 4 cycles of treatment before results can be manifested. I thought you were inquiring about the individual dose. i had someone else asking if they could take double the dose per treatment to speed up the benefit, and to that the answer is no, it doesn't work that way so more doesn't translate into it being better and working faster. hope that helps.
Question:  #80 2/14/2009		Q:	Lillie: I have written to you before--tumor size 13 cm, 21 out out 26 lymph nodes positive back in Nov of 2005, went through chemo and radiation, now on Arimidex. Question is I just had my 3 month check up and my CA 27-29 was 29 (which I understand is good). But even if it was 29, does that necessarily mean I have nothing going on? I have been having pain in my hips and knees and was wondering if I could still have something going on? Thanks,
		A:	you are correct that the tumor marker test provides no guarantee that there aren't cancer cells somewhere. it is one tool but not all emcompassing. we pay far more attention to symptoms. given you have bone pain, make your oncologist aware. he will probably want to do a bone scan to give more piece of mind. we will hope this is just arthritis. LS
Question:  #81 2/14/2009		Q:	I have extensive liver mets.......both lobes ....left lobe completely cancer. I am on my 6th chemo.....Ixempra. One week after first infusion ALT 72, AST 49, ALP 335. Next week ALT 56, AST 39, ALP 322. The next week before my 2nd dose: ALT 50, AST 53 (back up), ALP 279. Are these reliable, and what do they tell? ALT 72 56 50 AST 49 39 53 ALP 335 322 279 Thank you!
		A:	no test is perfect. these are liver enzyme levels. it gives them some sense of how your liver is functioning.
Question:  #82 2/14/2009		Q:	Hello Dr.Shockney, Thanks as always for the valuable forum. I did ask you the questions below in my last message last week. I thought my questions had some omissions of words which made it incomprehensible. Hence, I have asked them again. I hope you will answer. My mother has stage IV breast cancer (bones and nodules in both lungs) since June 2006. After a complete response with initial chemo(Docetaxel/Carboplatin), she was on Arimidex until Oct 2008. There was a recurrence in lungs(small nodules) and bones. Zometa was given for the bones and she has been treated with 250 mg of Faslodex since Oct 2008. I have written about her episodes of breathlessness to you before. Since her fourth dose of Faslodex on Jan 22, 2009, she has been feeling much better - walking, taking a bath etc without any oxygen(as yet!!). Since two months, there is a a night-time whistling sound in her sleep. She can feel the whistle. The Pulmonalogist thinks that until it turns into breathlessness,it''s not a major issue. Two questions: a)Your comment on the night-time whistling and the opinion of the Pulmonalogist? b)I have read on medscape that it takes on average 4.25 doses of Faslodex to see an effect. Since my mother felt better after the fourth dose of Faslodex, is there any here? Thanks a lot!!
		A:	glad to hear that she is doing okay presently. the whistling is probably a little bit of symptoms similar to asthma and usually this is not treated at this time if the symptoms are limited and sounds like they are. great that she has managed to stay off of oxygen too. trust the doctor on the dose of the meds. it clearly is working. so more isn't necessarily better. LS
Question:  #83 2/9/2009		Q:	I was diagnosed on Aug 08 with HER2 positive breast cancer. I had a lumpectomy and lymph node extraction. the nodes were positive. I have been through 6 rounds of Chemo and was about to start radiation when I had a PET scan. The PET scan showed a suspicious (cancerous) para-aortic lymph node. My radioligy oncologist says things like this do not happen. the rest of my scan was clean including the spot of the breast cancer. My oncologist is recommending a needle biopsy of the node and possible removal. I want to know where this could have come from, what it could be and what the course of action should be from here. Is this "normal?" What is the prognosis when something like this happens? I would really like any information you can provide on a situation like this. Could the PET scan showed a non cancer node, and what would the odds of that be? Thank you for your time.
		A:	PET scans show abnormalities, biopsy will diagnose that abnormality. Your doctor may first perform a needle biopsy of node to determine diagnosis before removing. If cancer is in this node, more systemic therapy is likely. ds
Question:  #84 2/8/2009		Q:	hi thanks so much for the response - I am the one with the sister with BC who had lesions disappear on follow up bone scan. It was a bone scan not PET/CT that showed the initial lesions. And follow up bone scan which showed them gone.
		A:	then either systemic treatment (chemo or hormonal therapy) or local treatment (radiaton) put them into remission or the original bone scan wasn't correct. cancer won't disappear on its own.
Question:  #85 2/9/2009		Q:	Recently had severe pain in my upper back when breathing or moving. The pain has diminished but if I cough hard, there is still a slight pain. Could this be a symptom of bone mets? Would the pain be intermitent? I take Femara and have read that this can diminish bone strength. What can you tell me about this? Thank you for answering my questions.
		A:	Any pain like you describes needs to be evaluated for any problem with lung or spine. Pain on breathing could be a serious non cancer problem. I hope you are sharing this information with your physician. Femara can cause joint pain and bone loss, but your physician will look at more information to help decide cause of symptoms. ds
Question:  #86 2/8/2009		Q:	I am 42 yrs. old. I was diagnosed with breast cancer Dec. 1, 2008. I had a mammogram, ultrasound, and bilateral MRI prior to my surgery on Jan. 16, 2009. I am triple negative, grade 3. The largest of 2 tumors was supposed to be 2.2 cm so we started reconstruction with an expander along with my left side mastectomy. Pathology surprised everyone and the largest was 3 x 3 x 5 cm. My lymph nodes were negative. My oncologist ordered a PET scan and a muga scan. The pet scan came back with a spot on my liver and the liver MRI came back saying it was suggestive of cancer. My oncologist told me we will try to biopsy it using ultrasound. Providing the biopsy can be done and it does come back as cancer, which I fully expect it will, then what? Do they still treat me with the same chemo agents? TAC 6 cycles at 3 week intervals followed by 6 weeks of radiation? Or do they operate on my liver? He said the biopsy would be difficult and could be inconclusive if they were unable to get the right tissue. What if they cannot confirm it is cancer? How much time does someone like me have? What would it depend upon? Is it worse to have a metastisis right away or after cancer returns, or does it make no difference? I have 2 children ages 5 and 7 and I can''t believe this. I''ve got to be here to raise them. I got the news at 6pm on a Friday. It was a rather short abrupt phone call. Any thoughts? I have no idea what is to come. Thanks. Kari
		A:	Kari, I'm really sorry to hear this. Having metastatic dz is a far different diagnosis than not having it, as it is not thought to be curable. That doesn't mean not treatable, but the goals of therapy would be different and this could influence treatment as well. Although this is agonizing, I'd advise you to follow through with all of what your doctors are currently recommending. Also, getting a 2nd opinion in situations like these is always a good idea. Hang in there. Best.
Question:  #87 2/8/2009		Q:	What are the statistics in relation to hormonal therapy for metastatic breast cancer? What percentage of women benefit for longer than five years?
		A:	Your question is not really answerable as every woman is different depending on the extent of disease, prior therapies and now the advent of newer therapies (Aromatase inhibitors). However, that said, having hormone responsive therapy is usually a better thing to have in the metastatic setting as there are more drugs to treat versus ER/PR negative disease, and hormone therapies are in general, far more effective at long term disease control than chemotherapy. Hope that helped.
Question:  #88 2/8/2009		Q:	I was diagnosed and treated in early 2007 with stage 1 IDC, 2 foci. I had chemo first, in which the entire tumor disappeared. It was ER/PR+, Her2Nu+. I had breast conserving surgery in Sept. 07, followed by radiation. My chemo was A/C 4 rounds, followed by Taxol/Herceptin, then radiation. I just went for a bone scan on 1/19/09 and they found a small focus of tracer uptake in a right mid lateral rib. My breast cancer surgeon had told me something about if I ever have xrays or scans that something may show up because of the surgery since she had to remove much tissue. There is only 1 small spot, everything else was clear, and my chest xray was also clear. I find it hard to believe that after all that treatment, I would have a bone metastases. What is your opinion on this? Thanks
		A:	Unfortunately breast cancer can come back in anyone at anytime. However, scans, xray, etc can have "false positive" results. There is no way of knowing unless a biopsy is performed, but with such a small spot, this may not be feasible. I would follow your doctors recommendations which are to probably follow this with serial scans. It's frustrating I know, but hang in there.
Question:  #89 2/8/2009		Q:	Hello Dr.Shockney, Thanks as always for your forum. Over the past six months, I have asked you questions about my mother (who lives in India) about her stage IV breast cancer diagnosed in June 2006 (bone and nodules in both lungs). I have some updates and my questions follow. As always, I apologize in advance for the length of this message!!!! The last we communicated was in Dec 2008 regarding her bouts of breathlessness. She was on Medrol(tapered dose) and doing fine. During the third week of Dec 2008, she had an intense attack of breathlessness on the way to the hosptial(the event was moderately severe at home rendering her dependent on oxygen for a day or two before we were in the hospital). While in the hospital, the breathlessness was very bad and sent her heart rate to 200 and was not coming down. The doctors put her in the Intensive Care Unit and gave her high doses of steroids. They asked us to expect the worst. In an hour, her heart rate was about 130, and stabilized to about 120 in the next couple of days. She was always on oxygen. She had a similar attack a week later after she was given her monthly dose of Falsodex. The attack was less severe than the first. This time, the steroids worked in less than 10 minutes and brought her heart rate that had gone up to 160 to 120. Finally, after 15 days in the hospital, she felt a lot better, was off oxygen for the last 5 days, the heart rate was around 110 and was sent home on Dec 30, 2008. Since then, the pulmonalogist recommended she use a nebulizer with steroids (duolin and budecort )about 5 times a day. She felt slightly breathless during early morning on Jan Jan 16. When she was rushed to hospital, they found her to have a low value of blood sugar(she is diabetic). She was mostly fine and her monthly dose of Falsodex went without any issues. They observed her for about a week and let her go. The heart rate was around 100-110. The General Physican said that she has tachycardia and medication for that was given as well. Also, the pulmonalgist said that the Tuberculosis diagnosis from Oct 2008 was a very mild one. The CT-scan of the chest does not show any classic signs of TB. She is still on the anti-TB medication. One capsule which is a combination of the isonazaid and Rifampicin. She has been fine since - walking in home, watching TV, using the restroom by herself and bathing/sponge-bathing regularly. My questions: 1)The only complaint is a night-time whistling(wheezing?) sound when she sleeps. She says she is conscious of it. How dangerous is this? The pulmonalogist said that she has bronchospasms and is on the highest dose possible for the anti-spasm medication and is unsure why she still whistles in her sleep. He advised that unless it proceeds to turn into breathlessness, it is not of concern. What do you make of this? 2)After the fourth dose of Faslodex(250 mg), she has been feeling a lot better when compared with the last 4 months. Any here? 3) Is 250 mg the standard dose for Falsodex? Does the 500 mg dose work better or worse? 4) She had resistance on Arimidex in July 2008. If Faslodex does not work, does switching to Femara makes sense (since they are both aromotase inhibitors)? 5) Does resistance on Faslodex mean it will not work with Aromasin either? Kindly let me know!!!! Thanks a lot for your knowledge and patience with this long message!!!!
		A:	Dear Zent76, Can't comment on pulmonary issues (1). (2)Don't understand what the question is (3)250mg is the standard dose. Wouldn't do any other dose at the current time. (4)It is unknown whether resistance to Faslodex crosses with resistance to AI's. There is some evidence however that switching classes of AI's (steroidal vs. non-steroidal) could be effective.
Question:  #90 2/8/2009		Q:	hi, thanks so much for this service. my sister has stage III BC, ER and PR+, her2- nodes, has had 6 rounds of chemo which has eliminated the tumor which was initially 7.5cm. She had a baseline bone scan before chemo which showed uptake in lung, ribs and skull. no biopsies. only explanation we know of for hot spots other than mets is lung infection last year. further bone scan shows the hot spots have disappeared. Doctors say no way of knowing whether they were cancer or not as no biopsy done, but if they are not there anymore that''s good. My question is this (because my sister wants some idea of what she is facing, it affects her treatment choices) - how likely is it that hot spots will disappear over the course of 3 months or with chemo if they are NOT mets? Are there any stats of likelihood of this all being coincidental? We know there''s no certainty in anything and no way of being sure either way but if you have any idea of likelihood we would so much appreciate it.
		A:	Your sister's story is a bit odd. Are you saying these other lesions appeared on bone scan or PET/CT scan? At any rate, it might be a good idea to get a 2nd opinion before proceeding further. Certainly, disappearance of lesions is usually a good thing, but your questions can't be answered without really examining the scans and other reports. Hope that helps.