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Category:

Metastatic Breast Cancer

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Question:  #1921 05/13/2003		Q:	I was dx in Sept 2001 with a 6 cm lobular tumor, Grade 2, her 2 neg, ER+/PR-; neo adju. of Adria/Tax, mastectomy Feb, 2002, CMF admin according to Day 1-8 regimen. I have had normal tumor markers until recently (April 2003 when 27.29 esclated to 50 and CEA to 9.5. PET was normal. Very soon after these results (less than a week) my right arm swelled, developed a red, slightly erythmatous raised "rash" in the "under" side of the biceps. What is the incidence of developing cellulitis with lymphedema/ or are these symptoms of lymphedema only? Thanks.
		A:	women having axillary node dissections followed by radiation to the axillae have a higher incidence of lymphedema than most other women. Lymphedema can develop at any time-- there is not magic cut off for passing the window of concern. Talk with your doctor to verify that this IS what you have . antibiotics usually clear cellulitis. Sometimes though there can be strange things going on related to breast cancer that may be trying to manifest themselves--- small risk but worth investigating. Lymphedema produces swelling of the arm and a feeling of heaviness of the arm. usually not redness or the arm being hot to the touch like cellulitis can do. Ask for an evaluation by a rehab medicine therapy who is certified in lymphedema management too for assessment.
Question:  #1922 05/13/2003		Q:	I was diagnosed straight to Stage 4 early last year. I had a 5.6 cm IDC in my left breast, which was hiding behind a benign cyst – neither my annual mammogram nor follow-up ultrasounds show it – until I had the cyst aspirated. I had a lumpectomy (because three doctors estimated the tumor as under 2.5 cm; no one had a clue how big it really was) and axillary node removal. 7/8 nodes were VERY positive, and followup testing showed 7 liver mets, the largest 1.5 cm. Both the primary and the mets were HER-2/neu+ and very ER/PR+. I had 4 rounds of A/C, then switched to Herceptin and taxol. The A/C completely killed off all the liver mets within 4 months, by the end of July. However, the same day I got that news, I also discovered that a rash near my lumpectomy scar was more breast cancer (although it was ER/PR-), and I had an immediate mastectomy. My onc switched me to Herceptin, taxotere, and carboplatin, and that seemed to work very well. (I went off the Herceptin and taxotere when my ejection fraction dropped significantly.) No cancer was found in my body by PET in November and by CT in December. But in mid-December I developed another rash, on my shoulder along the bra-strap line. Then I found a nodule near my mastectomy scar, and biopsies confirmed that both spots were skin mets – the shoulder was ER/PR-, and the chest wall was ER/PR+. In February, I went on Herceptin again (my EF rebounded completely) along with Arimidex, but had significant side effects, and the mets progressed some. Same problem with tamoxifen. Then I went on Navelbine, and the mets practically disappeared (visually) within just a few days. But then I had to go to the ER with a Navelbine side effect, and scans done then showed two more liver mets, both under 1.5 cm. Last week I very quickly developed a rash and what look like some tiny blisters in a large area on my chest wall. Regular topical treatments had no effect, and I’m pretty sure it’s more skin mets. I’ve gone 180 degrees around from where I was in November, and am pretty upset and frustrated. I see my oncologist later this week when I have my next chemo, and I have tremendous faith and trust in his abilities, but this seems like it’s time for a second opinion (and I’m considering Johns Hopkins, even though I live in Denver). No one seems to know much about treating skin mets, and with the liver mets we’ve just been doing more chemo. Even with these mets, I feel good and energetic, have a good appetite, and honestly don’t even feel like I have cancer. My CEA is around 10, and my CA27.29 is in the mid-50s – both are quite accurate for me and are rising very slowly after a big drop when I started Navelbine (CEA went from 40 to 9). I’ve always been optimistic, and keep trying to stay on the right side of the survival bell curve. But I just keep feeling like nothing we’re doing is really effective against the skin mets. What do you think?
		A:	You have been through a great deal.Medical oncology usually doesn't do second opinions for women who live so far away. They instead recommend that the medical oncologist treating you calls them to discuss your case on the phone. Email Lillie Shockney at shockli@jhmi.edu and she will instruct you how to make this happen. Sounds like the local skin recurrence could be inflammatory breast cancer. sometimes to confirm this a skin punch biopsy is done. In any case, send her an email so she can help you.
Question:  #1923 05/13/2003		Q:	I am 46 years old, and was diagnosed with metastatic breast cancer. My breast cancer is moderately infiltrating intraductal carcinoma, ER and PR positive, Her2 negative. The cancer metastasized to the T7 vertebrae, and is 9 mm in size. My oncologist is treating me with 20 mg. tamoxifen daily, and a 4 mg. Zometa infusion every 4 weeks. Is this therapy aggressive enough? I had a second opinion, who agreed with the oncologist that I am seeing. I just feel like they should be fighting this more aggressively.
		A:	It is fairly common to do this type of regimen, especially initially when mets are found. It's good news that it is hormone receptor positive too.
Question:  #1924 05/12/2003		Q:	My wife has had breast cancer in January 3, 2000. In February 2000 her breast was removed and 8 lympt notes. After going to chemo and radiation for a year. She was clean. A year later, the other breast had cancer and "inflamatory cancer" appeared on her chest. She immediately had it removed and continues to take chemo. She has been on chemo for a year now and had decided to stop the chemo (her way of life is not good). What are her chances of survival with out taking this chemo? I know its a difficult question to answer but an approximate idea would suffise. Thank you.
		A:	It is too hard to determine this... it requires a great deal of information and frankly a formal consultation, examination, review of her pathology slides, her xrays, review of her prognostic factors--- so many things. She is telling you though that she'd rather live a shorter life and feel good than a longer life and feel rotten taking chemo.Some patients do great for a long time; other see the disease pick up speed quickly.. her doctor should be able to shed some light on what he anticipates her course to be... we hope that she falls into the group of living a long life though, and yes, quality of life is important.
Question:  #1925 05/12/2003		Q:	My wife has a suspicious lump in her breast that they think could be cancer and her doctor recommended an imaging study to look for enlarged lymph nodes in her axillas. He talked about CT vs. MRI. He was leaning towards the MRI. Can the MRI give a good enough picture if the nodes are enlarged or not. He said for looking for enlarged ones it was good, but not so good looking for cancer in normal sized ones. Is this true, or should we ask for a CT scan? Thanks
		A:	MRI is used more commonly for looking at breast tissue and assessing what can't be seen on mammography or ultrasound. CAT scans are usually used for looking at lung, bone and liver. Axillary nodes are sometimes evaluated with ultrasound but the only definitive way to determine if cancer is involved in the nodes is a biopsy.
Question:  #1926 05/07/2003		Q:	A close friend of mine (41 yrs old) who was recently diagnosed with multicentric invasisive ductal carcinoma. She has a 2-3 cm lump in one quadrant and an area of calcifications that also had cancer cells. she had a bone scan an ct scan and the ct scan showed 1 cm spots on lung, liver and spleen. In addition, showed a lymph node on the opposite underarm from where her cancer is. does this mean the cancer's spread? she is waiting to hear from the surgeon who is scheduled to do a unilateral modified radical later this week. she is at an excellent cancer center in new york. prior to the ct scan, she'd been told that she would have chemo and radiation. she'd had one palpaple lymph node on examination. thanks so much.
		A:	sometimes the doctors decide to do a biopsy of findings on scans but usually spots are a sign of mets... they might decide to also do a biopsy of the node on the other side (armpit). She will have a lot of treatment and hopefully will respond well to chemo and radiation. hang in there with her... she'll need a lot of support.
Question:  #1927 05/06/2003		Q:	I asked a question earlier, but to recap, I had stage I brca in 2001, no nodes involved, and a bone scan showed abnormalities in places that previous scans did not, and areas that were not previously injured. One area in particular...2001 scan showed 'clean' on dorsal vertebrae, this can showed a hotspot or two. I had a couple "smashed' thoracic vertebraes in 1970, so any lingering problems from them should have showed at ALL bone scans...this is what concerns me, and of course, the hotspots on the left rib (front) and lateral. Possibly the lateral ribs on right (the fall in January that cracked a couple ribs caused pain ONLY in the back near the spinal column, not on the side - which if memory serves, lateral means. Should my doctor decide that there is nothing to worry about now, but suggests a waiting period and a scan down the road, would it be possible for me to send Hopkins all my chest xrays and ct scans (I had plenty of those over 2001-2002 due to kidney stone and complications from getting too much fluid (CHF w/unexplained fever); plus the bone scans from 2001, 2002 and 2003? I doubt if I'd be able to travel personally to Hopkins at this time (money), but would the doctors there be willing to look at the xrays and scans and offer a 2nd opinion? Thank you so much!
		A:	I hear your concerns... unfortunately, we don't do re-reviews of these types of xrays without seeing the patient. You would need to be seen and physically examined and possibly even have more xrays done here. So consider going to a comprehensive cancer center closer to your home where you can get a second opinion from a medical oncologist and hopefully have your case presented at their case conference/tumor board presentations.
Question:  #1928 05/05/2003		Q:	A lump distant to the initial lumpectomy (and 2nd biopsy) was found, and will be biopsied in a couple weeks. Hotspots showed up on left and right rib, both laterally and posteriorally, and on spine. Now, I've had several spinal fractures, but in my memory were that they were in the cervical spine - told I was very lucky not to have been paralyzed - a hiking accident in 1970. Isn't the dorsal spine the 'middle' (cervical near neck, dorsal middle and lumbar bottom, if my A&P still serves me ) I must mention to doc that this dorsal vertebrae is not in area of prev. injury. I also fell and injured a couple ribs in the back in January, so the hotspots there can be explained...but... How long can we say the hotspots on the bone scan are due to previous injuries, and at what point should we question? Will there ever be a way to tell a potential mets from hotspots caused by previous injuries? My initial tumor was 1.3 cm, and I had lumpectomy, clean nodes, AC plus rads and currently take 20 mg Tamoxifen/day. I am currently on 50 mics of duragesic and take 3-4 vicoden/day for severe back pain that has increased over the last say 5 years, more so in the last year (my first bout with cancer was in 2001, it's now May 2003). I have lost weight - 5-6 pounds in the last 3-4 weeks. My surgeon says she'll hobnob with the radiologist to see if there are explanations for the hotspots in the bonescan, and if there's none, there will be a bone biopsy (OUCH!).
		A:	Hot spots are tough to evaluate. you can have a hot spot that is from a bone fracture from 10 years ago.comparing bone scans from today to previous and future films is our best method today for evaluating things.The bottom line though for definitive answer is a biopsy. ugh.
Question:  #1929 05/05/2003		Q:	Six years ago I had a bilateral subcutaneous mastectomy done due to numberous benigh cysts and frequent abscesses. The pathology report showed atypical hyperplasia Lobular in the left breat and hyperplasia in the right. I have currently noted a hardened area along my ribcage, approx. 8th rib. It is not tender and I only accidently discovered it. My gp says it is nothing...something to do with calcifications in that area as we age. I am still worried that this could be bone metastasis. I have an appointment at my breast center in two weeks. Any info you could provide would be appreciated. Thank you.
		A:	Hopefully your surgeon will take a closer look and examine you and possible do some tests such as an ultrasound or even MRI to see what this might be. that would give you more peace of mind than you presently have.
Question:  #1930 05/05/2003		Q:	Freind diagnosed at age 29 in 1991 with pre-menopausal stage 2b invasive ductal breast cancer, ER neg PR pos, 2/15 lymph nodes positive. Treatment received was mastectomy, 6 mos of CAF followed by 5 years of Zoladex injections. Has done very well since. In Januray 2003 had an MRI for knee pain which revealed chondromalasia, and a suspicious lesion medial aspect of the distal femur. A lesion is also noted on plain x-ray. A bone scan was done and was negative. Has seen an orthopedist, had synovial fluid aspiration and steroid injection. Are any further tests indicated? or is safe to assume bone scan is accurate? Also has a blueish-grey nipple discharge on remaining breast (expressed only not spontaneous discharge). A ductogram was attempted but duct could not be cannulated. Cytology of expressed breast fluid showed apocrine cells. What are your thought for further evaluation of this?
		A:	Bone scans are pretty accurate usually. sometimes a bone biopsy is done to confirm the lesion as well as confirm the type of cancer that it is. MRI of the breast is sometimes helpful in seeing things inside that can be seen on mammography/ultrasound. She was diagnosed young and being young the disease has a higher incidence of returning sometime in her life time... sad to say but true.
Question:  #1931 04/30/2003		Q:	I apologize if you have received this question a few times, but I keep getting error messages when I send it. My mother in law was recently diagnosed with breast cancer with mets to liver and lungs. The good news is that her bloodwork is good, organ function good, and she feels pretty good. Do to fear/denial she waited over 2 years to get the tumor in her breast checked out. I was shocked to see how large it is, over 10cm and ulcerating through the skin. Her cancer is estrogen/progesteron positive, Her2 negative. She is on hormone treatment and will be starting Taxol. My question is, how likely is it that the Taxol/hormone treatment will significantly shrink this tumor? They do not want to do surgery because she also had pulmonary embolisms, and needs to be on blood thinners. She claims the breast tumor is not painful but her biopsy surgeon did express concern about possible rupture. The oncologist doesn''t seem as concerned.
		A:	wow, a sad example of the risk of delayed diagnosis that was preventable. i'm sorry to hear that. 30% of the time there is a good response to chemo given as neoadjuvant therapy. Hopefully she will fall into the 30%. The degree of hormone receptor positivity may influence this and hopefully she was highly positive for ER/PR.
Question:  #1932 04/30/2003		Q:	In September of 1995 my mom found a lump in the right breast. It turned out to be cancer. She then had a mastectomy and it was found in three lymph nodes out of 17. In April of 1996 she was just un-easy about the possibility of it showing up in the left breast, so she had it removed. (It had pre-cancerous cells). She was on Adjuvent chemotherapy from September of 1995 for 4 months and after that went on Tomoxifen pill for four years. Her scan then showed it was in the left clavicle and she had it removed in May 1999. They took her off of Tomoxifen because obviously it wasn’t working. She then went on Taxol chemotherapy for six months. She then went on another oral chemo something that ended with vista for year and a half. Then the cancer returned in the T-8 Thoracic spine in February 2001. She had 10 radiation treatments and five chemo treatments (Not sure what was the name). Then she was put on Femara chemo pill. It then showed up in the left adrenal gland July of 2002 and they took her off Femara and put her on two treatments of Taxol. After Taxol they did a CT scan and the tumor had not changed. They they started 4 treatments of Doxil followed by aromasin pill. They were going to remove the adrenal gland because one scan showed no chance - no growth and no shrinking (they did a biopsy and it was part of the original breast cancer) (which all have been) when they did another scan (pet) to make sure it wasn’t in any other part of the body before they did the surgery, it showed it on the right adrenal gland. They are now not recommending surgery but another form of very aggressive chemo. They have not said which one yet. Would it benefit her to get a second opinion from John’s Hopkins or does it sound good what they have done so far? What would you recommend at this point. She is 64 years old and otherwise is very good health otherwise. She is a big fighter and willing to do whatever it takes to live!
		A:	... and though she is very ill she is blessed to have you for her daughter. that is clear. Usually when there is evidence of metastatic disease like what you've described, the doctors will steer away from surgery and treat instead with chemo. Hopefully she will respond to this next treatment too. Keep hanging in there with her.
Question:  #1933 04/29/2003		Q:	My mom is 55 years old and has just been diagnosed with metastatic disease to the liver with multiple lesions on the liver. One is 5 cm. She is scheduled for a liver biopsy with various scans at the end of the week. She lost rapid weight and couldn't eat - 30 lbs in a month and we took her to the doctor who found this. She had severe anemia and had to have blood transfusions in the hospital. They then proceeded to do a scope to see if her primary cancer was in her stomach and it wasn't. She was released from the hospital for the weekend and now we have to wait until the end of the week for her cat scans and till the following week for her results. They suspect it is in the colon or lungs. They say the colon is more treatable. We are going crazy wondering! What do you think of this? It doesn't sound very good. Every day that goes by she hardly eats and we worry. Why does it take so long to get a definitive diagnosis. I get the feeling the doctors are taking their time because there isn't too much they can do. Can a person weighing only 95 lbs. get chemo.
		A:	oh my... she is in a grave situation. She is blessed though to have the love and support of her family. Extensive weight loss, weighing now under 100 lbs, and knowing that the liver is greatly involved imply that she is very ill and options are limited. Knowing the source of the primary may not provide much help from a treatment perspective but is important for the sake of you and other family members because it tells you the type of cancer she has which impacts your family's medical history now. The liver needs to be functioning fairly well to metabolize drugs, especially chemo. The doctor may sit and talk with you and she seriously about what time lies ahead and how best to spend it, looking at a quality of life perspective. You wouldn't want to give her treatment that only makes her feel worse and may hasten her death due to complications from it, but you want to know what the options are of extending her life and helping to ensure she has good quality of life during that time frame. I wish I had better wisdom to offer. Spend as much time at her side as you and your family can. These are previous moments to be remembered and valued. We hope that the biopsy shows a primary type of cancer that can be treated to some degree thus providing her more time with you.
Question:  #1934 04/27/2003		Q:	Dear Doctor! Thanks for your quick reply,although it wasn't what I wanted to hear, well, most of the time we don't want to hear bad news! but I'm still not giving it up nor my Mom, she is in Hospice care and she feels much much better, no pain, started to eat, what I wanted to ask you Doctor, is , that have you ever heard of someone who sort of "came back from end of stage"?????? What I mean is I know there is no full recovery at all, but have you heard of anyone with such a serious disease surviving it for long long years???????????? Thank you! (I just wanted to let you know that my Mom cancer history has started like 11 years ago)
		A:	There are women who have had stage 4 breast cancer and have lived for more than 20 years with it. Her doctor though clearly believes that she is at the end stage of her disease and life to have chosen to place her in hospice... part of the agreement when enrolling in hospice is that the patient will not be receiving active cancer treatment anymore- no more chemo therapy or other treatment to fight the disease. Instead the focus is on controlling pain and helping the patient achieve closure with her life and spend quality time with family. As mentioned before, she is blessed to have a loving daughter like you. spend as much time as you can with her for these are precious moments...
Question:  #1935 04/27/2003		Q:	Too late to change Doctor? My Sister (49 today) was diagnosed with IDC - 3B ten years ago and underwent the entire regimen including total mastectomy, chemo, radiation, and reconstruction. All was great until 4 months ago when a suspected inner ear problem turned out on MRI to be metastatic breast cancer on the Brain and Lung with some indication of small irregularities on the Liver. There were 8 lesions on the Brain and a large mass on the lung. The largest Brain tumor at 3cm was removed with a Craniotomy. This was followed with WBRT. On biopsy it was determined that the tumor character had changed from + to - so hormone therapy, including Herceptin was out. The Lung, et al was approached with 8 sessions (1 cycle) of Taxotare 35mg/mm2 weekly followed by a Cat Scan. The scan done last week showed the Lung mass unchanged, however several additional nodules appeared. In other words the treatment failed. The most distressing symptom has been the constant dry cough - there is no pain or apparent cognitive deficit. The medical oncologist plan is to now try 6 weekly sessions of Gemzar followed by another scan. My concern regarding this Physician is the following: 1) He appears to be too conservative in his treatment options and not willing to consider more toxic approaches at this stage even though my Sister may wish so. 2) He feels my Sister would not do well in any Clinical Trial because of her Brain involvement (which I understand) and because it is too "regimented" a process for her (which I do not understand). 3) He can not offer any relief for the intense 24 hour cough other than high steroid intake (Decadron) or narcotics 4) He does not discuss treatment options - he presents the treatment as a matter of fact and you are left to challenge him with alternatives. I am quite aware of my Sister's prognosis based on historical studies. However she is now alert, very sociable and I think deserves more options - particularly palliation of the most distressing symptoms. She is being treated at a large NCI center now. Is there any hope for better treatment options by seeking another opinion at this late stage and/or transferring treatment to another institution 2 or 3 hours distant. I don't think I've moved into a cycle of desperation here, I just would never forgive myself if I accepted without confirmation that this is the best that can be done.
		A:	There may be benefit in getting a second opinion from another medical oncologist at a facility that treats a large volume of breast cancer patients, especially those with mets. The relationship between the doctor and patient needs to be a solid and trusting one as the doctor holds her life in his hands... bottom line. so pursue having her evaluated elsewhere with the goal that more options can be offered and something can be done about the cough- quality of life is key..hopefully a fresh set of eyes upon her and offer possibly some alternative options that can buy more time.
Question:  #1936 04/27/2003		Q:	One year after the birth of my 4th child, at age 39, I was dx with stage 3A lobular, invasive breast cancer (right breast) in Oct 2001. Estrogen receptor positive/sentinel node positive. Had a bilateral mastectomy for prevention, 8 rounds of chemo, 30 rounds of radiation, finishing in July 2002. August CA 27-29 was 18, but it rose to the 80's in Nov. 2002. Dec 2002 PET and CAT highlighted ovaries and right chest wall. Had complete hysterectomy December 29, 2002, and pathology was clear. January 2003 CA 27-29 rose to 332 and I began Arimidex. February rose to 368, March up to 403. Had CAT and PET last week. CAT came back clear. Waiting for PET results. Does the high tumor marker count mean cancer if I have clear scans? If it is cancer - how else can we find it??
		A:	Tumor markers that keep climbing are worrisome as they are supposed to be predictors of trouble elsewhere, but nothing is 100%. sometimes there are other things we don't even know about that can elevate tumor markers. How you feel and how your scans look are just as important if not more so than your blood tests. So report any symptoms you may have like weight loss, back pain, shortness of breath and such to your doctor right away. You've taken aggressive action against this disease and that is a good thing. We hope that your blood tests start looking more favorable and that you continue to feel well.
Question:  #1937 04/27/2003		Q:	I am doing research for my friend, who is 30 yrs old, and the details of her diagnosis are: Metastatic breast cancer to the liver Estrogen receptor (ER) positive Progesterone receptor (PR) positive Her2-nu positive I am trying to find out any info you may have about any clinics in New Zealand (or perhaps Australia) that treat cancer patients with a treatment that is not yet FDA approved, therefore not available in the USA. I do not have much to go on and thought I would try you for any possible leads you may have. Thank you for ANY info you may be able to provide. If you have any other thoughts beyond my specific question, that would be very welcomed as well.
		A:	wow.. what a tough situation. Gee, i don't know of any medical treatments there to be able to advise you about. There are a few international breast cancer organizations though that might be able to help you. Go to the google search engine and type in "international breast cancer organization" and see what pops up for you. Remember that there is no magic bullet for mets to the liver. When there is an isolated tumor in the liver it is possible sometimes to laser ablate the tumor. That is something that is offered at Johns Hopkins by Dr. Mike Choti. (thought i'd mention it in any case.) Take care and thanks for being a wonderful friend to this patient.)
Question:  #1938 04/24/2003		Q:	Hello! My Mom is just 53 years old and dealing with metastatic breast cancer to her bones, lungs, wind pipe and skull also. She was sooooooo fine until february when everything started, first she got allergic to the contrast media so she could hardly breath, and basically from than on, all of a sudden she has bone mets, and after that lung and now skull and brain (behind her eyes). is it possible that metastatic breast cancer comes that quickly???? ANd the other thing is that her eyes started to hurt , she also feels so week and she is constantly crying, and she is so scared, full of fears, the only place she can be is the bathroom, she says all other part of the house scares her, big, places scares her! why is that???????? Fear of death??? tomorrow she is going to a private clinic(hospice) what is that exactly, it means that this is the last stop??????????????????? Please answer all of my questions!!! I'm so scared, I dont' want my Mom to die, I know she wants to live, it is so not fair!!! The most difficult thing is that I'm in The States she is in Europe........ I don't think I'm going to survive if something happens, she is just so important to me!!!!!!!!!!1 Please answer me ASAP and be honest!! Thank you!
		A:	I'm so sorry to hear of your mom's situation. she is blessed to have a loving daughter however... What you are describing is end stage breast cancer. when the disease spreads to these organs as it has and the body isn't able to stop its growth, nor is chemotherapy or other treatment, then the doctors usually recommend stopping treatment and helping the patient and her family begin to achieve some sense of closure with her life. Hospice is such a program for that--- for patients the doctor anticipates will pass away within a 6 month period. Your mom is probably frightened and also may be having some thinking difficulty if her cancer has spread to her brain as well. This is a time for you to come together as a family so if you are able, do consider flying over to be with her for a while. Talk with her doctor about what he thinks her condition is right now and how much time she has-- as mentioned, if he has enrolled her in hospice then the criteria for enrollment if less than 6 months. Try to be strong for her. Find out how she wants to spend her time, for time is precious... This is a special time for the two of you now. Also consider seeking a counselor for yourself who can help you cope with the stress and trauma of this situation.. take care..
Question:  #1939 04/21/2003		Q:	I was diagnosed with breast cancer in March 2002 & had chemo followed by radiation now it has metastasised to my lungs & bones. what is the best treatment for it ?
		A:	The treatment now depends on many factors-- your age, what chemo you've already had, and what the prognostic factors were from your pathology when the tumor was originally removed in march 2002. there is no one right treatment for metastatic disease-- all of these things and others must be factored in to determine what is best for you. So sit down with your medical oncologist and explore what game plan he/she recommends, ask her to explain how this treatment plan was selected and what to expect. Consider your situation now a chronic disease-- the mission is for your body to live in harmony with the breast cancer--- like diabetics do by taking insulin each day, they get their disease in control and live in harmony with it... Ask the doctor how far as the cancer spread and what is a realistic outcome for your specific situation and ask him/her to be honest with you about it... no sugar coating. you have the right to know where you stand. we wish all the best for you and hope you respond well to treatment.
Question:  #1940 04/15/2003		Q:	My sister was diagnosed with breast cancer approximately 7 1/2 years ago. She had a mastectomy and Chemo and also took 5 years of Tomoxifen. On 01-29-03 she was diagnosed with metastatic breast cancer. The MRI showed the cancer in her spine, specifically C5, C6, C7 & T1 with a fracture in C7. The CT scan revealed a tumor 5x6 cm start at the aortic arch and going down to the left lung. She has now completed 14 days of radiation to her neck,a round of Dexamethasone, is currently on Arimidex and has had 2 chemo treatments out of 6 using Taxol. The chemo treatments are once monthly. The doctors have never mentioned surgery to remove the tumor, should they? A nuerosurgeon stated he would not perform surgery on her neck at this time. Do you feel the doctors are doing everything possible? My sister is only 41 can you tell us a realistic prognosis?
		A:	sorry to hear of her recurrence and that it is stage 4 breast cancer. usually with stage 4, the tumors that are found are not surgically removed but instead systemically treated with chemotherapy. keep in mind that the actual original source of the disease is not in her neck-- it was what was in the breast more than 7 years ago and took a while but found its way to other organs. so systemic treatment is the more common treatment. Sometimes resections of tumors are done if they are causing localized pain or difficulty eating/breathing and then it is for palliative treatment and not really for control of the disease itself.
Question:  #1941 04/09/2003		Q:	I went into remission after a masectomy, radiation and chemotherapy for metastic breast cancer which was diagnosed in March 1990. I also took tamoxifen for five years. In March 2001 I was diagnosed with metastic breast cancer to the left mastoid, pelvic and spine. I had a mastoidectomy and radiation treatment. I am currently receiving Falsodex and Zometa on a monthly basis. (Originally started off with Femara and Aredia). I am currently having occasional pain in the hips and knees which is often relieved with Tylenol or Bextra. I am currently scheduled to take a series of tests to determine if there is further mets to the bones or new mets to the organs. My main concern is the level of my CA27-29 count which is 438. Does the constant increase in the CA27-29 test an indication that cancer is spreading at a rapid pace? Also my doctor indicated that chemotherapy will be the next alternative. My question here is how effective is chemotherapy to metastatic breast cancer to the bones?
		A:	the CA 27/29 continuing to climb is worrisome and you should ask your oncologist who worried he/she is about it too. Chemo sometimes helps with bone mets as does radiation. You don't know until you try it sometimes....we will hope that the treatments that lie ahead for you are effective in getting this disease dormant once again.
Question:  #1942 04/09/2003		Q:	Hi!! Here is my Medical Pathology report as of 04/02/03. Clinical History: 59 Year old female, status post mastectomey with a large right sided pleural effusion. Deive Microsocopy: pleural Fluid Cellular speciman reveals numerous large balls of malignant cells with hyperchromatic nuclai, coarse chromatin and prominent nucleoli. Findings are consistent with metastatic adenocarcinoma, breast primary. Categorization: positive for malignancy. I have been taking Arimidex for two weeks. No talc treatment recommended yet. Please tell it like it is.
		A:	Well, what you are describing is stage 4 breast cancer-- breast cancer that has spread beyond the breast to the lungs causing pleural effusion. Arimidex is designed to help control this disease that has spread. Your cancer will be considered a chronic condition--- like a diabetic who needs to take insulin, you will need to be taking some form of cancer treatment with the goal that your body live in harmony with the disease. How well you do can't be predicted really but your doctors will keep you informed as to whether they believe the disease is progressing or being suppressed by this treatment. hang in there dear...
Question:  #1943 04/03/2003		Q:	I have been diagnostic with Malignant Pleual effussion, right lung, I have had breast cancer for 12 years, stem cell transplant Jan 1999, Fluid built-up in lung of 1100 cc. My Oncolgy doctor has started palliative care, with Arimidex. What is my long term prognoses? I understand the Arimidex is a short term 5-6 months treatment with the use of Feslodex next for 10 months. What is after that?
		A:	sorry you have had such a long battle with this disease... Your doctor will be hoping that you get a good response to the new therapy he has prescribed. I'm not sure what therapy may be recommended later. Take this a day at a time... there are always new clinical trials being developed so stay in touch with NCI for possible new options in the future.
Question:  #1944 04/02/2003		Q:	my sister has metastic breast cancer to her bone, lung and rib. She just started the zometa drip and femara pill two weeks ago. Her rib is twice as painful. Can femara pill or zometa cause this much pain to her rib. She also just finished two weeks ago 3 weeks of radiation to her 3 tumors on her spine. Please help??
		A:	pain of this type is usually caused by the cancer being in the bone (marrow) which can be very painful. talk with her doctor about measures that can be taken to help reduce her pain level. radiation usually helps and I see she has had that but if she still is getting worse the doctor needs to intervene.
Question:  #1945 03/15/2003		Q:	I am 42, premenopausal, and was diagnosed with breast cancer in Oct of 2000, had a lumpectomy and the margins came back positive for cancer so I had a mastectomy directly after. I was considered a stage 1 with a 2cm tumor, adenocarcinoma, fast growing and aggressive, and non-invasive cancer throughout the rest of the breast and 17 negative lymph nodes. I had 4 treatments of adriamycin and cytoxan.I opted not to take Tamoxifen because my tumor was negative to weakly positive for estrogen receptors, and as it was I had trouble regaining energy after and began suffering joint pain and continued fatigue. Had a negative bone scan in late 2001. At a regular doctor visit they found trace blood in my urine. I had a cystoscopy and an intravenous pylogram which revealed nothing abnormal, but still continue to have trace blood in my urine. All of my blood work has been normal, but my blood pressure has steadily increased over the last 2 years, it was 138/90 last check. Recently I had a CT scan of my abdomen and pelvis because of digestive difficulties, irregular and heavy menstrual periods, night sweats, and lower back and pelvic/hip pain. The scan showed cysts on both ovaries. I then had a pelvic ultrasound which showed a 3cm simple, clear fluid filled, cyst on my right ovary that is "leaking" and a 2.6cm complex, debris filled cyst on the left ovary. The radiologist recommended a follow up pelvic ultrasound in 6 weeks to see if the complex cyst has resolved. Ironically, the side (the right) with the simple cyst is the side where I am experiencing extreme pain in my hip and back. Now I must wait 6 weeks. Should I be scared, should I see a GYN oncologist if surgical evaluation is recommended, can ovarian cysts cause blood in the urine? I am a nervous wreck, medical care in my area is overwhelmed by a shortage of doctors and increasing population, should I aggressively pursue second opinions on this? Thank you.
		A:	yes, consider seeing a gyn oncologist for evaluation. Remember that ovarian cysts are unrelated to breast cancer so don't connect the two. Blood in urine is unlikely to be caused by ovarian cysts so a good urologist for evaluation might ease your mind.
Question:  #1946 03/14/2003		Q:	my daughter,34 had a lumpectomy and chemo and radiation for cancer that was small with no lymph node involvement. 18 monthes later,Nov., 2002, she found a lump on the opposite rib cage. An ct scan found 10 lung lesions and she started on taxol. In Dec., an mri found 2 brain lesions, one was removed by surgery and the other disappeared after 5 weeks of radiation. A recent PET scan showed 4 lung lesions left. She has one chemo to go and we are hopeful her lungs will be clear. We have sent what was left of her rib tumor (most of it disappeared after her first chemo treatment) to a lab that is trying to make a vaccine out of it for her. We are also trying to find clinical trials for her. I'm having a hard time finding anything for neu2 neg. patients. Anything new out there for her? In other words, where do we go from here?
		A:	Consider calling 1-800-4-CANCER to see what they can offer for metastatic clinical trials. There are several vaccine trials across the country but you'd need to check to see what the specific protocol is to see if she qualifies. Consider too checking on www.cancerfacts.com for listings. we wish her well and hope that future scans show additional shrinkage of her tumors.
Question:  #1947 03/03/2003		Q:	In October of 200 diagnosed with breast cancer (Stage 3). Received courses of A/C and Taxol, then surgery and radiation. Started tamoxifin following surgery with minimal side effects. January 2003 found very small spot on left rib (opposite side. Removed and started on Arimidex. Do you have any info regarding bone mets and arimidex?
		A:	hhmm. check with 1-800-4-CANCER for information on this. this is the cancer information service hotline. remember that each person is different and responds differently. we hope that your disease is soon in control so that your body can live in harmony with it and achieve remission.
Question:  #1948 02/28/2003		Q:	Sir: I had a liver transplant 3 years ago and now have breast cancer with 11 positive nodes. I have a low ejection fraction and am unable to do chemo due to my suppressed immune system and low ejection fraction. It's been one year and my cancer has metastisized to my distal femur. I've had radiation, was on Arimidex, now am on Femara and Zometa. What kind of chance do I have for any kind of survival? Also have you ever had anyone with and organ transplant with cancer that has had chemo? I feel like I'm in a hopeless situation. Also, do you think I would qualify for a clinical trial? Thank you so much.
		A:	sorry to hear your bad luck. gracious. you have had a lot happen in one life time. prognosis? hard to say and no one should be trying to out guess this-- particularly without even seeing you and learning more about you. clinical trials may disqualify you due to organ transplant issue. yes, we've had patients here though who have been treated off protocols who have had transplants- kidney though. Get a second opinion at another large cancer center and see what they recommend for you. hang in there..
Question:  #1949 02/28/2003		Q:	Sir: If breast cancer has metastisized to the distal femur and being treated with radiation, how likely is it that it will spread to other places? Thank you.
		A:	it is unknown... each patient is unique on this. radiation is helpful in stunting the growth usually though. the cancer in the femur isn't what would move onto other organs-- it is the cancer from the primary site that has already found its way elsewhere that is the question. disease can sit dormant for a long time then "wake up". your doctor will follow you closely for that reason. hang in there..
Question:  #1950 02/28/2003		Q:	What are the most common sites to which breast cancer metastisizes?
		A:	bone, liver, and lung are the most common sites.