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    What do the following scan and blood test results indicate?

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Posted on Tue, 8 Aug 2017 in General Health
Question: Again a follow up question on my aunt's T2N0M0 breast condition.

Today met the doctor with Dxa Scan report and he was not interested to see the Vitamin D report as it was not suggested by him.

He mentioned bones are weak and advised.

1. ZYCLASTIN 5MG through IV once in a year.
2. Arachitol vitamin 600000 d3 injection
3. ALMITY tablets twice a day

And follow up visit after 3 months.

1. Since her Vitamin D level was around 68, did it really make sense giving 600000 D3 injection?
2. ZYCLASTIN 5MG is also a bisphosphonate? They have charged for 2 injection as the one available is only of 4MG.
3. Is it really needed to take ALMITY tablet twice daily till the next follow up which is after 3 months from now?
4. Is it a general protocol to visit the doctor every three months in the first year after completing the treatment?
doctor
Answered by Dr. Indranil Ghosh 1 hour later
Brief Answer:
Zyclastin is zoledronate

Detailed Answer:
Thanks for following up.

Zyclastin is zoledronate and should be given to her. But better to give 4 mg twice a year which is standard for breast cancer. In any case 3 mg was wasted in her.

As vitamin d level is sufficient now, I would not consider such high dose. Almity is calcium with low dose vitamin d which is necessary for her.

yes for first 2 years 3 monthly follow up is standard.

Regards
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Indranil Ghosh 21 minutes later
Thanks for the response.

Since Arachitol vitamin 600000 d3 injection is already given, do you think it is harmful for her?

Zyclastin 5mg is suggested once a year by our doctor. I agree that 3mg is simple wasted.

Can you recommend any good medical oncologist in Bangalore?
doctor
Answered by Dr. Indranil Ghosh 4 minutes later
Brief Answer:
Don't think it will harm

Detailed Answer:
in XXXXXXX you can contact Dr Satheesh.
https://www.google.co.in/url?sa=t&source=web&rct=j&url=https://www.sehat.com/dr-ct-satheesh-medical-oncologist-bangalore&ved=0ahUKEwiqtum_35XVAhWBfrwKHQ8rAwoQFgggMAE&usg=AFQjCNGvBaPHmFVYFRtZO_PBVcFQQD5g6g
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Indranil Ghosh 14 hours later
Thanks for the response and suggestion on the doctor.

She is feeling feverish and also complaints on the headache. Is it common to have these symptoms after taking Zyclastin?

If yes, then kindly suggest on any medication she can take to cope with this.

If no, then should we consult the doctor for this?
doctor
Answered by Dr. Indranil Ghosh 25 minutes later
Brief Answer:
This is quite common

Detailed Answer:
We usually give only paracetamol and it responds. If it persists then consult her doctor.
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Indranil Ghosh 23 hours later
Thanks for the response.

Just one question on Chemotherapy given to her.

As discussed with you earlier, initially there was confusion on giving chemo to her as she was node negative but the tumor size was 3 cm and doctors left it to us.

Later we did Endopredict test which came back high risk (21%) of distant metastases in next 10 years with only 5 years of Endocrine(Hormone) treatment.

After Endopredict report our treating doctor told that he dont want to introduce Adriamycin to her because of its potential side effects to heart and he was of opinion that the Hormone treatment is more beneficial than more toxic Chemotherapy and suggested TC chemo *4 cycles and Femara for 10 years.

I did take second and third opinion during that time. One suggested FAC*6 cycles and the other FEC*4 followed by D. Even these doctor told she can take TC also but the first doctor was keen to give her FAC over TC.

We went ahead with the opinion of our treating doctor and gave her 4 cycles of TC. I was reading an article yesterday, which says Adriamycin based chemo is good for high risk patients so was bit concerned.

1. If she was your patient, then what regimen you would have suggested?
2. Do we really need to worry since Adriamycin is not given to her?
3. If needed, can we still give Adriamycin to her?
4. Is the 21% is considered really a very high risk? Our treating doctor is not much concerned about this percentage.

Please help with your inputs.
doctor
Answered by Dr. Indranil Ghosh 5 hours later
Brief Answer:
Please refer below

Detailed Answer:
I understand your concerns but there is no point pondering over the treatment already done.

My answers..
1. I usually give administer 4-6 cycles FEC but even 4 cycles TC has similar efficacy. It is just the preference.
2. Not at all
3. No benefit now and not indicated also
4. Yes, for a small node negative hormone positive tumor this is certainly high. But all the steps are being taken, like chemo, zoledronic acid and possibly 10 yr hormonal therapy, to minimize the risks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Indranil Ghosh 1 hour later
Thanks for the response.

1. So, even you would have not recommended Adriamycin.

2. Just curious to know what is the difference between FEC and TC and how exactly the decision is taken on these regime and the cycles? There are many regime mentioned in the NCCN site and each doctor has different opinions on choosing it and I feel it is difficult for the patients/guardians to take decision and end up regretting later.

3. Even with high risk, is there a possibility of complete cure?

B/W we are consulting the below doctor and I will also speak to Dr Satheesh C T as suggested by you.
http://www.sakraworldhospital.com/doctors/Dr-Vineet-Gupta-Institute-of-Oncology/59


I mean she is treated by below doctor so far after surgery.
http://www.sakraworldhospital.com/doctors/Dr-Vineet-Gupta-Institute-of-Oncology/59
doctor
Answered by Dr. Indranil Ghosh 2 hours later
Brief Answer:
Adriamycin and epirubcin are similar

Detailed Answer:
Both are anthacyclines. And there are various protocols which all have shown benefit in their trials and so one of them has to be chosen according to institution and/or doctor preferences. Patients only have their say regarding whether to take chemo and the side effects preference, etc but regime is chosen by doctor.

In fact TC was better than AC in an US trial. http://www.cancernetwork.com/articles/adjuvant-tc-superior-ac-early-stage-breast-ca

So please have faith on your doctor.

Yes, even in high risk, there is 80% chance that it won't spread, and it will be even better if you add chemo and extend hormone therapy, so probably 90% chance of her doing well.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Indranil Ghosh 37 minutes later
Thanks a lot for you well wishes.

Kindly see if you can answer below questions as well.

1. ALMITY tablets is suggested twice a day and each time 2 tablets. So, per day 4 tablets. Is it recommended dosage?

2. I have read that dairy products are bad for cancer and she is avoiding all the dairy products along with milk. But the doctor advised her to drink milk. Let us know your views on this please.

3. I am not sure why the surgeon has not done Sentinel node biopsy and went ahead with axillary dissection(17 nodes removed) during surgery. Even we were not aware of this procedure, as we immediately rushed her to operation after diagnosis. Now she complains pain and numbness in her hand everyday. I feel that with sentinel node biopsy her pain would have subsided much quicker. Also, she is at high risk of developing Lymphedema because of axillary dissection. Kindly advise what measure we have to take to make her feel better quicker and also to reduce the risk of Lymphedema.

doctor
Answered by Dr. Indranil Ghosh 10 hours later
Brief Answer:
See below

Detailed Answer:
4 calcium tablets per day is on the higher side, though possible. Usual dose is 2 per day.

Milk has not been proven to cause any harm in cancer patients and it improves bone density, so she can definitely take milk.

Regarding sentinel node, I am not in a position to comment whether it was possible or not, without having examined the patient at that time. Lymphedema and pain are less after sentinel node.
Now she needs to do regular exercises as advised to her and avoid any injury, needleprick or blood pressure measurements on that arm.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Indranil Ghosh 14 hours later
Sorry the suggested calcium tablets were 2 per day.

Thanks for all your suggestion and positive feedback. We are hopeful that she will do fine and be cured. Will get back to you in case I have any questions in future.
doctor
Answered by Dr. Indranil Ghosh 8 hours later
Brief Answer:
You are welcome

Detailed Answer:
Regards
Above answer was peer-reviewed by : Dr. Yogesh D
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Dr. Indranil Ghosh

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Practicing since :2004

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