Can idc metastasise to the GI tract?

Dx idc/DCIS Jan 2003, 2 cm tumour,stage & grade 2. Lumpectomy, total axillary removal, 3/18 nodes positive. ER+, HER2-
6 x FEC chemo, 25 rads, 3 boosters. Currently osteopenic, taking alendronic acid and calcichew/Vit.D3

Have had Crohn's for 38 yrs; 30 yrs on prednisone, last 8 yrs, oral and now injections methotrexate, 12.5mg weekly.

Stopped Arimidex 3 months ago due to severe bone pains, waiting to see new Onc for alternative Aromatose Inhibitor.

Recent gastro problems:
upper right quadrant pain; lower abdominal pain, after eating just a yoghurt.
loss of weight, some 14 lbs
nausea
bloating
no appetite, barely eating.

Saw gastro 11 June, had CT scan (liver,pancreas,abdomen) 26 June (no results yet), having upper endoscopy 9 July.
Current symptoms do not feel like a Crohn's flare.
I am concerned that the breast cancer could have metastasised to my GI tract, although I have never heard of it.
Is this possible?  I never seem to "present" normally - had no pain before dx with Crohn's, non-palpable breast tumour, found on regular mammo.

Can anyone help please?

Liz.

[BJSaws]

Although my doctor says it is extremely rare, I had a friend whose breast cancer metastasized to her colon.  I hope everything comes out ok for you.  I was also diagnosed in 2003 and have seen you posting on the other BC forum many times.  My thoughts and prayers are with you.

[lizziecee]

Hi - many thanks for your response.

When I saw my gastro for the upper endoscopy I asked him if bc could metastasise to the GI tract and he said he personally has not seen it (but there again, he has never treated a patient with concurrent Crohn's and stage 2 bc, nor had my first Oncologist), but he had read about it.  

The CT scan done a few weeks prior showed old pancreatitis with califications, and evidence of inflammation around the distal ileum.  The upper endoscopy showed oseophagitis, probably caused by the bisphosphonate alendronic acid that I was taking for 18 months because of bone density loss due to 38 yrs of steroids and 4 yrs of Arimidex. I have stopped both drugs on his advice and have been referred to an Endocrinologist for evaluation of alternative drugs/infusions. An urgent DEXA scan is being arranged as I am already osteopenic and had two fractures in both feet last summer.

As the Crohn's is active, my gastro a week ago, put me on an elemental diet (Fortijuice) and low residue food if I can eat any solids. He has doubled my methotrexate injections to 25mg weekly, doubled the domperidone for the nausea and doubled the omeprazole for the burning in my oesophagus. Budesonide (a steroid) has also been added to try and get me well enough for surgery on the two strictures in my small intestine.  

I am seeing him in clinic tomorrow morning for the histology results of the biopsies taken of my oesophagus and just praying they are benign. He said I have "serious decisions" to make, whatever that means.....aarrgh, just want to feel well again, especially as 11 of us are going to Spain mid August for a week to celebrate my husband's 80th birthday and I can't let them down, as many arrangements have been made and paid for.  I am hoping the gastro can sort the medication out to keep the inflammation under control, then I can have surgery on the strictures when I return.

Thank you for your concern and prayers.

Liz.

[BJSaws]

Hi Liz,
     I hope all went well with your biopsy results and you are joyfully planning your trip to Spain.  I have a cousin with Crohn's, so I know what a burden it can be.  Keep thinking positive.  
Brenda

[lizziecee]

Hi Brenda -
still playing the waiting game as there was a snafu at the hospital last Wed. The gastro dept had made me an appointment in a general clinic with a gastro I have never heard of or seen before.  I have only ever seen my Consultant gastro for the past 5 yrs. Student nurse told me he was "on leave" so my husband intervened as I was getting cross and asked to see my IBD nurse. Student nurse said: "she is not in clinic today: - hubby's response: "Well, was that her ghost we saw walking through the clinic 5 minutes ago?"

I did see my IBD nurse, who has always been very helpful, and she apologised for the mix up. I declined to see the other gastro as it would have been a waste of my, and his, time.  IBD nurse called later that day with an appt to see MY gastro next Wednesday, as he is going on holiday for 3 weeks in August, and I need to get my chemo, steroids and other meds sorted out if I am going to make Spain on the 17th.

Steroids have kicked in and I am feeling a lot better, although now got insomnia (it is 4.30 am here).  I am eating one small low residue meal a day as well as the Fortijuice nutritional drinks. Gastritis still a problem, even when drinking water, so guess the omeprazole isn't do its' magic.

Coincidentally, I have been called for a 3 yrly mammo next Friday and kinda dreading it. My idc tumour was found at my 3rd, 3 yrly mammo (a disgrace we only get them here every 3 yrs) but was non palpable, so I have no idea what a bc tumour feels like. Another snafu there - I didn't receive the recall for 2 months as the hospital confused me with another lady with the same name, then lost my records and by the time I had a compression mammo, ultrasound and core biopsy, the cancer had spread to my lymph nodes, or perhaps it was already there at the original mammo.

Just want to get this week over with and some answers.

Many thanks again for caring.

Liz.  

[lizziecee]

Hi Brenda - just a quick update....IBD nurse called early Tuesday morning to ask: "What are you doing today?"..Uuuhh?  when was my social life of any interest? Told her my newly widowed friend was coming over with her 3 grandchildren for the day, to use our outdoor heated pool, tennis courts and paddle in the sea at low tide. Hubby making pizzas from scratch and getting the older kids to help - why did she ask? Another snafu with the gastro clinic and it is now on Friday (tomorrow), but my gastro could see me that day, Tuesday. Told her "no way" - it is a 3 hour round trip by car and ferry, and besides, I couldn't let my friend down at such short notice. After all this waiting I can't believe 3 days are going to make any difference to the outcome.

I already had an appt for a regular mammo at a travelling unit in a nearby town on Friday, so rang them to reschedule --aaargh! They told me it was sent by mistake and as I have not been discharged by my bc surgeon, the travelling mammo unit cannot get involved. I sometimes think I am a "white witch", since if I hadn't called to reschedule, we would have been under pressure to get back for the mammo, only to be told, I guess, that it couldn't be done.

Done some research on bc mets to the GI tract, and although rare, it can and does happen. My current symptoms do not feel like a Crohn's flare at all, but will have to wait until tomorrow to get the histology results on the inflammation in my oesophagus, and what the gastro intends to do about the inflammation in my terminal ileum, and whether I need surgery for the strictures. My head is spinning at times, but as my mother said: "You were last in the queue Liz when patience was given ou!." Too true.....

Hope you are well.
Liz.

[BJSaws]

Hi Liz,
     Wow!  Like you, my biggest problems with my doctors have been their office staff.  It seems like they are always making some kind of scheduling error, or just don't seem to know what is going on around them.  I, too, am a little short on patience when it comes to what I consider incompetence on their part.  Hopefully, your appointment tomorrow will go well and some of this will be settled. I'll be thinking of you.  Please let me know how things go.
Regards,
Brenda

[lizziecee]

Hi Brenda,

just a quick update.....finally saw my gastro in the hospital yesterday and had a long consultation. He apologised for the mix ups in the gastro clinic, but not his fault - he blames the overpaid, underworked admin staff!

News was good - histology resuls on the biopsies of the oesophagus "non specific".
Strictures on the MRI scan look okay enough to be left at the moment. Inflammation in the terminal ileum seems to be getting sorted out with doubling the methotrexate and adding in budesonide steroids. Said he won't prescribe the newer anti-TNFa biologic drugs because they can cause lymphoma, especially in someone who has had cancer, and additonally, they will cause the strictures to get worse.

Dr. Hayward said he is not sure what caused the current flare - possibly too little methotrexate, coupled with side effects from the bc adjuvant med Arimidex, and the bone density med Alendronate. I have stopped both of those for the time being. He has strongly suggested I see an Oncologist to sort out future breast cancer an bone density drugs. I have an appt with my GP on Monday and this time, will insist on a referral. Last time I saw him, about a month ago, he wrote to an Oncologist I have never met, asking for "advice", my gastro and I believe I need a face to face meeting with her, to put the Crohn's into context with the bc. With our socialised health service, it is up to the GP to do referrals to specialist Consultants, so I will have to be proactive. I saw a different GP 2 weeks ago and she is so much better than my normal male one - she said she was going to refer me to a Professor of Endocrinology, that I saw last February, to try and sort out the bc meds, but no appointment as yet. Unfortunately she is on holiday next week so I have to see the male GP, as here are only 2 drs in their practice. living in such an isolated area as I do, it would be a long drive to a different practice, and I doubt they would accept me as they are still required by law to proide an "out of hours" service, wih home visits in an emergency.

All in all, I feel so much better mentally - actually slept for 9 hours last night. Gastro has okayed my trip to Spain later this month, just have to make sure I take my meds.

Thank you so much for your concern - how are you doing? Do you have secondaries?
Hope they are under control.
Take care, and kind regards,
Liz, in Cornwall, England.

[BJSaws]

Hi Liz,
     I'm so glad you have finally gotten everything sorted out and that your trip to Spain in still on.  You have certainly had your share of doctors' visits.
     No, I don't have secondaries.  As of now, I am cancer-free and have had no complications from my mastectomy in 2003.  I am doing well.  
     Have fun on that holiday!
Regards,
Brenda
Ocala, Florida, US