Oncology (General Cancer)/Breast Cancer spread to Bone

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QUESTION: my wife is 50 years old and was diagnosed with breast cancer 4 years ago,she had her right breast removed completely along with all lymph nodes.she was given the all clear after intense treatment and was clear for 2 years. BC has spread to the spine and later to various parts of the bone. She feels weak and in pain even though she is under treatment to control the cancer and the pain. Her cancer hormone receptor positive. She has been on hormone therapy for the past four years. She has just had radiotherapy on her affected spine and ever since her pain has increased and platelet count decreased to 70. which is below the normal rate.   she was told that this was curable. she is in so much pain and so weak, she eats little although she is overweight.  she sees the consultant once a month and has a very good support network. Her condition is totally heart breaking to watch her suffer. please tell me if we should still have hope or we should be preparing for the worst?
Thanks in advance for your help

ANSWER: When I treat breast cancer, I monitor whether the treatment is working or not.  I use markers like CA27-29, and I watch for changes in calcium and enzymes reflecting bone destruction.  I could give you better advice if I knew some of these issues.  It sounds like the treatment isn't working anymore, and the question is whether to go to second or third line hormone therapy, or go to chemotherapy, or add a hormone modifier to her regimen.  And as far as the pain is concerned, if it is localized in the spine, and the area has already received radiation, a procedure called "vertebroplasty" may be of use.  But you had better prepare for the worst if nothing is changed with respect to her treatment.  Hope this helps.  

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QUESTION: my wife is 50 years old and was diagnosed with breast cancer 4 years ago,she had her right breast removed completely along with all lymph nodes. She was given the all clear after intense treatment and was clear for 2 years. BC has spread to the spine and later to various parts of the bone and 1 cm of cancer tumor inthe lever one month ago.  She feels weak and in pain even though she is under treatment to control the cancer and the pain. Her cancer hormone receptor positive. She has been on hormone therapy for the past four years. She has just had radiotherapy on her affected spine and ever since her pain has increased and platelet count decreased to 70-80. Her blood Hb was 8.2 two weeks ago and was given blood in the hospital.  she is still in so much pain and so weak, she eats little although she is overweight.  she sees the consultant once a month and has a very good support network. Her condition is totally heart breaking to watch her suffer. please tell me if she should go to chemotherapy or Hormonal therapy when given the choice by her doctor.
Thanks in advance for your help

Answer
I would recommend chemotherapy at this point, given your description and her history.  That being said, there is a drug, everolimus, which sometimes makes patients who have become resistant to hormone therapy sensitive again.  You might talk to your onc. about that.  In any event, her options don't look good, but I think chemotherapy is more likely to work quickly.  Hope this helps. And by all means, insist on a consult from a pain specialist if your oncologist doesn't seem to be able to help this.  Pain can always be helped.  

Oncology (General Cancer)

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Donald Higby, M.D.

Expertise

I can answer almost all questions related to the treatment and natural course of most kinds of cancer, especially cancers of prostate, colon, lung and breast.

Experience

I have been a practicing medical oncologist for 36 years, and have been chief of service at a major medical center for 25 years. I've also done research in cancer treatments.

Organizations
American Society of Clinical Oncology

Publications
New England Journal of Medicine American Journal of Medicine Journal of the American Society of Clinical Oncology Hematology Transfusion Medicine

Education/Credentials
MD, Stanford University Internal Medicine residency, St. Louis University School of Medicine, St. Louis, MO Medical Oncology Fellowship, Roswell Park Cancer Institute, Buffalo, NY

Awards and Honors
America's Best Physicians, last 14 years

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