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Done chemotherapy for breast cancer. Now have lower back pain. Tests showed lung cancer. Are reports okay?

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My Mother had Breast Cancer around 9 years ago. She had Chemotherapy done at that time and was basically cancer-free for the past 9 years. Recently, around 6 months back, she complained about Lower Back Pain and tried various Alternative therapies like Massage and Acupuncture. When it didn't subside, the doctors ordered Bone Scan, X-Ray, MRI and CT scan. The attached findings are a result of those procedures. The Biopsy results are forthcoming and we should have them by end of day today.
However, based on the attached reports, the doctors have diagnosed a case of Lung Cancer. We don't know yet if it is Primary Lung Cancer or Secondary Lung Cancer. He has mentioned that there are around 5 spots in the lungs and one small spot in the liver and that the cancer from the Breast previously has travelled to the Lungs and Liver through the blood. The Biopsy will confirm decisively whether it is Secondary Lung Cancer or some form of Primary Lung Cancer (either Small Cell or Non-Small Cell).
As for treatment, he has recommended Radiation Therapy followed by Chemotherapy in the next few days.
We would like to know if these recommendations are in keeping with the findings, are the reports okay or not and what should be the correct course of action?
Posted Wed, 5 Sep 2012 in Cancer
Answered by Dr. Indranil Ghosh 4 hours later
Thanks for writing in.

I am afraid that it appears that the breast cancer has recurred. But still, a biopsy is required to establish that it is recurrence of breast cancer and not something else like a new lung cancer. A biopsy also establishes the receptor status (ER/PR/Her2), by which we can guide the targeted therapies. I gather that the biopsy has already been done.

Even if it is hormone sensitive, because of the many lung and liver lesions, chemo is justified and can be followed by hormone therapy (Femara). If it is hormone negative then the only option is chemo. If it is Her2 positive, then Herceptin may be used.

Radiation may be given to decrease the pain.

Overall I feel that the correct course of action has been taken. But unfortunately it is not a curable situation. Life expectancy is around 2-4 years but certainly can be more.

Hope I have answered your query. I will be happy to answer any follow-up queries.
Best Wishes,
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Follow-up: Done chemotherapy for breast cancer. Now have lower back pain. Tests showed lung cancer. Are reports okay? 18 hours later
The Doctors at Fortis, Noida have prescribed Femara, Zoledronic, palliative Radiation Therapy and Chemo Port. The Biopsy results are yet to come. There are still several questions that are troubling us. If you could take sometime to look at the attached Report and answer the questions below, that will be very helpful:

1. Will Chemo done earlier during Breast Cancer 9 years ago be effective at this time? I read somewhere that the cancer cells will not respond to the same drugs.

2. Does the size and intensity of Lung and Liver lesions affect the treatment strategy? Or is the treatment a combination of the above 4 options only - Femara, Zoledronic, palliative RT and Chemo Port?

3. As per our understanding, once this treatment is completed, there is still a chance of cancer cells coming back again in the lungs and there is a high probability that Chemo will be ineffective then. Is that correct?
Answered by Dr. Indranil Ghosh 4 hours later

I had gone through the reports yesterday only and my opinion was based on those.

To answer your specific queries-

1. As the gap is long, chemo given 9 years back can be re-challenged. But some drugs are toxic to the heart and those should be preferably not be repeated. If you can send me the details of previous chemo, I can suggest a proper regime now.

2. Size and intensity definitely guide the treatment. As there are multiple lesions in lung and liver,chemo should be given first followed by hormone therapy. Broadly chemo, hormonal, RT and supportive treatment (like zoledronate) are the options

3. Chances of response to chemo -30-40%, another 30% stable disease, rest may increase through chemo. In that scenario, some other chemo should be tried. If three lines of chemo fail successively, then it can be assumed that chemo will not work. Hormone therapy may still work. In any case, it is not curable and chances of disease disappearing completely on CT scans (albeit temporarily) is only about 5%.

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Follow-up: Done chemotherapy for breast cancer. Now have lower back pain. Tests showed lung cancer. Are reports okay? 7 days later
Dr. Indranil,
We have received the Biopsy Report. I have attached the Report. Please do go through it. Does it convery any information on the case?

Chemotherapy has started - 2 rounds have been given. Radiation was given for the first day today. There were some side effects from Chemotherapy like stomach cramps and some fever. As per the Doctors at Apollo (Sarita Vihar, New Delhi), Chemo will go on for around 6 months.

Answered by Dr. Indranil Ghosh 10 hours later

The report is quite important in that as it is hormone receptor positive, we have the option of hormonal therapy after chemo. That may increase the chances of response and disease control.

Fever and vomiting are common side effects of chemo. Her oncologist must be giving her something to tide over these. Usually chemo is given for 6 cycles which may be a little less than six months.


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