Hello DR MY NAME IS AREF My sister 46 years old she had breast cancer three years ago the cancer size were 6 cm and most lymph nodes were involved, mastectomy and lymphectomy has done and she had chemotherapy and radiotherapy courses with trastuzumab and tamoxifen , Last week she went for istop screening and the result was bad as she got few spots of mitasteses in here bones as well as unilateral plural effusion which has asiration of this effusion and sent for lab, my sister and whole our family got horrible psyclogical shock My question what options of treatment better for here as well as do you think still she has chance for endocrine treatment after she took tamoxifen and trastuzumab as we do not prefer the chemotherapy at this stage Thanks in advance for your kind help