Metaplastic breast cancer

Hi, I underwent a lobectomy in August 2007 where the path report came back with metastatic breast cancer. Original cancer diagnosed in July 2003 was metaplastic as was the lung nodule in August. I have felt pretty good since the surgery until the last few weeks. I have pain in my left side by my ribs, and I feel sick. No vomiting, but nausea, and tired. I have elected not to have treatment since this cancer is treatment refractory. Is this part of the disease, or do I just have a touch of the flu?

[Dennis MD]

Hi.
Sorry I’m having a hard time understanding your post.  This is how I understood it.  You were diagnosed in 2003 with breast cancer, and then underwent surgery to the breast.  In 2007, you developed a lung nodule and subsequently underwent lobectomy of the lung.
What was the initial stage of your breast cancer?  
Aside from surgery, what other treatments were given to you previously?
Aside from pain, what are your other symptoms?
There is a possibility that the pain is related to your cancer.   This could mean an involvement of the bone, or recurrence in the lung.
I would suggest consult with your oncologist for further evaluation and management.  
Good luck.

[troeste]

I did have a mastectomy in 2003 and a TRAM. I was doing ok until July 2007 when they found the lung nodule. I had the lobectomy. Initial breast cancer report:
Tumor size: 3 x 3 x 3 cm. Margins of excision: All margins of excision are free of neoplasm. Tubule score: 3. Mitotic score: 3. Nuclear grade: 3. Bloom-Richardson grade: 3. Angiolymphatic invasion: Definite angiolymphatic invasion is not identified. Comment: The metastasis measures 1 cm in greatest dimension. There is microscopic extranodal extension of the metastasis. I think that is IIB? I had AC and Taxol, no radiation. No other treatments. I have pain in my joints, pain in my ribs, and nausea. I also have headaches. I had a pet scan in January that showed increased uptake in the illiac joint, some increase in liver, renal collection. Nothing appears on the CT. I don't want to overreact. I just don't know what to expect, and don't want to appear like I'm just waiting to get sick.

[Dennis MD]

Hi.
Thanks for the clarification.
You opted not to have further treatments after undergoing lobectomy.
Chemotherapy will help in reducing the risk of local and distant recurrence.  This will address the possible remaining micrometastasis after you had your lobectomy.  Since you may have bone metastasis, bisphosphonates will also be beneficial in controlling the bone metastasis as well as relieve the bone pains.
Perhaps what you should do now is to undergo metastatic work-ups to know your present disease status, whether you have progressive disease now or whether it has already stabilized.  
Good luck.

[troeste]

Because my cancer is metaplastic, the treatment otions are not very effective. I don't think I mentioned the cancer is hormone receptor negative and HER2 negative. If you know of any treatment that has been effective on metastatic, metaplastic breast cancer I would love to know. I know the cancer will continue to move and grow. There is so little known about treatments. My PET scans show uptake, but CT is not picking anything up yet. I wondered if the joint pain, rib pain, nausea, headaches were cancer related, surgery related, or .....

[Dennis MD]

Metaplastic carcinoma is one of the uncommon subtypes of invasive ductal carcinoma.  As such, it can be managed in a similar fashion as invasive ductal carcinoma.  That is the reason why you were given AC-Paclitaxel chemotherapy regimen.   If there is disease progression with this regimen, you can be given other second-line regimens available.
It will be hard to tell exactly whether the joint pain, rib pain, nausea, and headaches are cancer related or not since these are non-specific symptoms.