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Have breast cancer. Done chemotherapy. Have vomiting, liver enlargement. Taking Liv-52. Possible to have no lump after treatment?

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My wife is under palliative care for breast metastases. Her cancer has spread over liver, bone, lung as per PET CT. We started chemo at TMH in Mumbai. After 1st cycle her breast lump reduced almost 70%, and after 2nd cycle it has no lump. She has completed 3rd cycle. After 1st chemo she had peripheral neuropathy, and after this 3rd cycle she has not peripheral neuropathy. Only one problem is persisting i.e. vomiting. The other problem that I had noticed liver enlargement, even after 2nd cycle it was enlarged. She started taking Liv-52 that reduced the liver size. Now it is bit normal.

My concern, if the diagnosis was TNBC, is it possible to have no lump after 2nd chemo cycle.
In the 1st chemo she was given paclitaxel and kmocarb. These are all Indian make. The 2nd chemo was kemocarb and the 3rd one was also same as 1st chemo.
Posted Wed, 10 Apr 2013 in Breast Cancer
 
 
Answered by Dr. Rohan Khandelwal 16 minutes later
Dear Sir,

Sorry to hear about your wife's condition. She is receiving treatment according to the correct protocol at one of the premier cancer institutions in the country.
It is possible for the lump to reduce in size and disappear after 2-3 cycles of chemotherapy. This suggests that the tumor is responding well to chemo and it is a good sign. This has got nothing to do with her triple negative status (which tells us about the hormonal status of the cancer) and governs the hormonal treatment.
As she has extensive metastasis, the treatment would mainly be palliative. Liver mets would take time to reduce in size and the live size would gradually come down.
Paclitaxel is known to cause peripheral neuropathy, which can persist for sometime after chemo as well. Vomiting is part and parcel of any chemo regime and is one of the most annoying side effects for the patients. She can try granisetron tablets/ injections to keep chemotherapy induced nausea and vomiting at bay. These drugs also cause hair loss and reduced blood counts. The doctors would be monitoring her blood counts before each chemo cycle.

Hope I have answered your query. Please feel free to clarify any other point.
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Follow-up: Have breast cancer. Done chemotherapy. Have vomiting, liver enlargement. Taking Liv-52. Possible to have no lump after treatment? 6 minutes later
Are these signs of responses showing it can be cured or she can have healthier life in the long run. Hope I am not overoptimistic or questioning some unbelievable thing.
 
 
Answered by Dr. Rohan Khandelwal 6 minutes later
Dear Sir,

As it has already spread to so many organs, it is difficult that it can be cured completely but the symptoms can be kept under control by chemotherapy. But you & your wife should always be hopeful as that is very important for a cancer survivor.

Rohan Khandelwal
Breast Surgeon
Above answer was peer-reviewed by
 
Follow-up: Have breast cancer. Done chemotherapy. Have vomiting, liver enlargement. Taking Liv-52. Possible to have no lump after treatment? 5 minutes later

We kept our hope and I am quite confident about our willpower to fight this disease. I only knew this disease always behaves unique. So I should be optimistic.

Anyway thanks a lot for sharing your time and knowledge.
 
 
Answered by Dr. Rohan Khandelwal 26 minutes later
That is very important. There are new cures being discovered each year and you never know what new treatment might come up in the next few months.
You can also search for breast cancer trials in which new drugs are given to patients with metastatic disease (sometimes these treatments are very effective).
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Follow-up: Have breast cancer. Done chemotherapy. Have vomiting, liver enlargement. Taking Liv-52. Possible to have no lump after treatment? 6 days later
Hi Doctor,

For the last 3 days her menstrual cycle has started, and it is heavy. Is it okay. Her hemoglobin level when we last was 9.8, which was far better than her 2nd chemo cycle i.e. 7.6. She received a total of 3 pc during her chemo from 1st to 3rd. After this last CBC report doctor had given two Iron injections for 3 days, the IM one for 3 days and IV one for 2 days. Is there any relation with these injections and menstrual cycle restart? Should I contact at TMH immediately?
 
 
Answered by Dr. Rohan Khandelwal 16 minutes later
Dear Sir,

It is alright if she is getting her cycles. If they persist for more than 5-6 days, then you can contact the doctor. Her blood reports look much better after the injections and blood transfusions. Just give her a balanced diet and green vegetables.
The doctors will assess her blood tests again before the next cycle and give her the necessary injections or transfusions at that time.

Please feel free to contact me if you have any other queries.

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Follow-up: Have breast cancer. Done chemotherapy. Have vomiting, liver enlargement. Taking Liv-52. Possible to have no lump after treatment? 4 hours later
Can we use Polybion B-Complex for peripheral neuropathy? Probably her bleeding is causing peripheral neuropathy. Today it was becoming difficult for her to keep slippers on her feet.
 
 
Answered by Dr. Rohan Khandelwal 31 minutes later
Dear Sir,

You can use polybion B- complex. The peripheral neuropathy is because of the chemotherapy and bleeding has not relationship with it. This neuropathy will increase with each progressive cycle.There is no harm in giving b complex.

Please feel free to clarify any other query.
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Follow-up: Have breast cancer. Done chemotherapy. Have vomiting, liver enlargement. Taking Liv-52. Possible to have no lump after treatment? 19 hours later
What are the steps that we should try to keep her bodyweight same. She has lost her weight from 92 to 82 in these 3 months. Is it okay?
 
 
Answered by Dr. Rohan Khandelwal 13 minutes later
Dear Sir,

Cancer patients lose weight because of certain compounds released by the tumour. Also another reason for weight loss is the chemotherapy which reduces ones appetite.
Best way to maintain her weight is to give her a balanced diet. She should be given lot of green vegetables and fruits.
In addition you should give her atleast 4-5 meals a day. She can have whatever she likes. You can use a multivitamin to boost her immunity and nutrition.

Please feel free to clarify any other query.
Above answer was peer-reviewed by
 
Follow-up: Have breast cancer. Done chemotherapy. Have vomiting, liver enlargement. Taking Liv-52. Possible to have no lump after treatment? 9 days later
On 6th of this month we did a CT Scan. Report is following. Please go through and explain me in a bit simplified way about her status. The doc here is impressed with the improvement. So they decided to proceed with another 3 cycle. Following is the report:

Final Report:

CT Scan of the Thorax, Abdomen, and Pelvis

Left breast mass is noted measuring 1.8 cm x 1.8 cm. Subcm axillary nodes are seen bilaterally largest measuring 1.3 cm x 1 cm. Right breast is unremarkable.

Multiple subcm sized soft tissue nodules are seen in both lungs the largest measuring 5mm in the right lower lobe. Pleural spaces are clear.

There is no significant mediastinal or hilar lymphadenopathy seen. The trachea and main stem bronchi are normal. The heart and mediastinal great vessels appear normal.

The liver enlarged and is studded with multiple target lesions with peripheral enhancement, largest of these measures 1.8 x 1.7 cm in segment VI.

Multiple periportal and retroperitoneal, largest of these measuring 1.9 x 1.1cm in the aortocaval region. The gall bladder, pancreas, spleen, kidneys and adrenals appear normal. The visualized GI tract appears unremarkable.

The urinary bladder is normal. The uterus and ovaries are normal. There is no adnexal mass. There is no ascites.

Lytic lesions are noted in the right iliac bone and left femur. There is cortical break along the anterior aspect of the left femur neck.


Impression:

- Regression in the left breast mass
- Minimal interval regression in the size of the largest pulmonary nodule which previously measured 1 cm.
- Interval progression of the hepatic and regtroperitoneal lymphadenopathy.
- Skeletal lesions are unchanged
- Mediastinal adenopathy has regressed
 
 
Answered by Dr. Rohan Khandelwal 9 minutes later
Dear Sir,

Thank you for sharing the report. The CT report shows some reduction in size of the breast mass and the lung metastasis but at the same time the bony lesions are the same size as previously. Also there has been enlargement of a few nodes in the stomach and chest due to cancer.
The good news is that some of the cancer is responding to treatment and if she is able to tolerate chemotherapy, another 3 cycles will further reduction in size of the cancer and you should proceed with the same.

Please feel free to clarify any other query.
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Follow-up: Have breast cancer. Done chemotherapy. Have vomiting, liver enlargement. Taking Liv-52. Possible to have no lump after treatment? 11 minutes later
Anything I should follow for bone cancer. Should I try to boost her immunity by applying spirulina or wheat grass powder? What do you suggest? She needs to bear 5th and 6th cycle as well. Her weight has reduced to 80 from 92 in this timespan of 1st cycle to 4th cycle. Though I feel this weight reduction is going to help her. What do you feel?
 
 
Answered by Dr. Rohan Khandelwal 4 minutes later
Dear Sir,

The cancer is the bones is from the breast only and not a separate entity. The chemo only is going to take care of those lesions. They might take some more time to subside.
You can give her supplements to boost her immunity. Although weight loss is beneficial but such a dramatic weight reduction can have adverse consequences as well. As I mentioned previously, give her a well balanced diet and encourage her to take a lot of fruits. Add haldi powder (curcumin) to her vegetables and milk. Curcumin has anti-cancer properties (especially against breast)...but it is still a supplement and not a substitute for chemo.

Above answer was peer-reviewed by
 
Follow-up: Have breast cancer. Done chemotherapy. Have vomiting, liver enlargement. Taking Liv-52. Possible to have no lump after treatment? 7 minutes later
Thank you for all your suggestions. She is taking her balanced diet. Eating fruit, but doc told to drink fruit juices. She is taking bitter gourd on a daily basis.

Today it is clear to me that bone mets are having the root of breast cancer. So the chemo for breast should control bone mets. Am I correct?

The weight reduction is from 1st of XXXXXXX to March 8th. Now our target is to try to keep her at that weight only. Hoping for the best.
 
 
Answered by Dr. Rohan Khandelwal 3 hours later
Yes..the bony mets are due to breast cancer only and the chemo should take care of them. There are some which are a bit resistant though.

If the weight reduction has been over a period of 2-3 months, then it is acceptable and you should try to maintain her at this weight only (avoid weight loss or gain).

Hope she gets more benefit from the subsequent chemo cycles.
Above answer was peer-reviewed by
 
Follow-up: Have breast cancer. Done chemotherapy. Have vomiting, liver enlargement. Taking Liv-52. Possible to have no lump after treatment? 6 days later
Hi,

We did the bone scan on 18th of this month, which said, Abnormal increased radiotracer uptake is seen on following areas:

D10 vertebra, Right 12th Rib posteriorly, Proximal shaft of left femur.

Medical oncologist said to consult with radiation department and take a light, and come back for the 5th cycle.

D10 vertebra and Right 12th rib posteriorly are the two new areas where lesions were noted.
We will be going tomorrow to XXXXXXX with radiation oncologist. Is radiation creates too much problem. My only concern is that she should be able to bear the process of treatment smoothly.

Please guide me......

Thanks,
 
 
Answered by Dr. Rohan Khandelwal 1 hour later
Dear Sir,

Thank you for asking your query. For bony metastasis, radiation works quite well and the radiation procedure is much less painful and troublesome as compared to chemotherapy.
The only issue with radiation is that she might need to visit the hospital daily for a few days during the treatment (depending on the radiation regime).
Infact radiation will reduce the pain at the sites of the bony mets. They will mainly target the radiation to the vertebra and the femur.

Please feel to ask any other query.

Above answer was peer-reviewed by
 
Follow-up: Have breast cancer. Done chemotherapy. Have vomiting, liver enlargement. Taking Liv-52. Possible to have no lump after treatment? 22 minutes later
So what about right 12th posterior rib? Is it going to be treatted by chemo only. Your reply is boosting our energy level.
 
 
Answered by Dr. Rohan Khandelwal 3 minutes later
Dear Sir,

I am glad that I am able to help you cope with your current situation but it is really your determination and the fighting spirit of your wife that is keeping you going and I hope for the best in the future as well.

The radiation oncologist will decide if they want to include the rib in the radiation field as well. It depends on the a lot of factors and it is a decision best left to them. You are in good hands and let them worry about that.

Please feel free to ask any other query.
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Follow-up: Have breast cancer. Done chemotherapy. Have vomiting, liver enlargement. Taking Liv-52. Possible to have no lump after treatment? 14 hours later
Hi Doc,
We have no options left other than keeping our spirits high. She needs to be in this world for a two year old kid. We do not want the kid to loose his mom at early age. Loosing mother is always painful, but at this age it is horrible.

Please pass on your opinion - Foreign medicines are more effective than Indian chemo drugs. Is it so? We are using Indian drugs and it is reacting fine. It is a bit difficult for us to maintain on foreign medicine but we can give a try if needed. What do you suggest?

I am not getting any clear opinion regarding this. I know it is a very sensible issue.... but it is only between you and me..... for sure.....

 
 
Answered by Dr. Rohan Khandelwal 8 minutes later
Dear Sir,

I can understand what you are trying to say. I see breast cancer patients everyday and with each passing year the age is coming down and it truly is sad to see some of them suffering so much.

As far as the drugs as concerned, there is not much difference. Considering her disease, the drugs are working just fine and I think you should stick to them and not experiment.

Hoping for the best.

Rohan Khandelwal
Breast Surgeon
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