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Bone marrow damage after chemo and rads for breast cancer.
Hi,
I was diagnosed with stage III breast cancer in Dec 2009 and since that time, have undergone neoadjuvant chemo ( 4 x dose dense A/C, 12 weekly x taxol), followed by BMX, adjuvant chemo, 12 x carbo& 5FU given two weeks then one rest week and I just completed 33 rad treatments approximately one week ago. My neutrophils were consistently very poor all though chemo treatments and were supported by lots of neupogen shots, rbc was not stellar, but thankfully, did not require support and my platelets were low for most of the last 12 chemo treatments, but not low enough to require transfusions. The issue I am facing now is that my neutrophils are still consistently low ( around 1.0), although chemo finished 3 mths ago and platelets are also still low, around 120. My onocologist is concerned about the low counts so we did more tests this week, neutrophils still at 1.0, no change in platelets either, RBC looked fine, but I have high NRBC of 1. She also orderd a ANA Direct which came back negative. B-12 and folate were also normal. She is leaning towards a bone marrow study/biopsy? to try and get to the bottom of why counts are still poor. I'm wondering that given it's only been 3 months since completion of chemo and only 1 week since completion of rads, we need to give it more time for my blood ( or bone marrow) to recover. I get the impression that my oncologist is concerned about bone marrow damage or possibly secondary leukemia, however I have had 2 PET Scans, the last one late Dec 2010 that showed no cancer activity in my bone marrow, or anywhere else for that matter, so I guess I would like to know if it's common to continue to have poor blood counts for some time after treatments conclude or is my oncologist reasonable in her suspicion of something more serious going on? My cancer was IDC, 10 cm tumor in left breast, 3 of 8 lymph nodes positive (axillary).
Thanks so much!
I was diagnosed with stage III breast cancer in Dec 2009 and since that time, have undergone neoadjuvant chemo ( 4 x dose dense A/C, 12 weekly x taxol), followed by BMX, adjuvant chemo, 12 x carbo& 5FU given two weeks then one rest week and I just completed 33 rad treatments approximately one week ago. My neutrophils were consistently very poor all though chemo treatments and were supported by lots of neupogen shots, rbc was not stellar, but thankfully, did not require support and my platelets were low for most of the last 12 chemo treatments, but not low enough to require transfusions. The issue I am facing now is that my neutrophils are still consistently low ( around 1.0), although chemo finished 3 mths ago and platelets are also still low, around 120. My onocologist is concerned about the low counts so we did more tests this week, neutrophils still at 1.0, no change in platelets either, RBC looked fine, but I have high NRBC of 1. She also orderd a ANA Direct which came back negative. B-12 and folate were also normal. She is leaning towards a bone marrow study/biopsy? to try and get to the bottom of why counts are still poor. I'm wondering that given it's only been 3 months since completion of chemo and only 1 week since completion of rads, we need to give it more time for my blood ( or bone marrow) to recover. I get the impression that my oncologist is concerned about bone marrow damage or possibly secondary leukemia, however I have had 2 PET Scans, the last one late Dec 2010 that showed no cancer activity in my bone marrow, or anywhere else for that matter, so I guess I would like to know if it's common to continue to have poor blood counts for some time after treatments conclude or is my oncologist reasonable in her suspicion of something more serious going on? My cancer was IDC, 10 cm tumor in left breast, 3 of 8 lymph nodes positive (axillary).
Thanks so much!
Hi there, I personally do not know the correct answer. I only know from what you have said that both your and my cancer are very serious, along with the rest of the information you provide.
So, my feedback to you will be entirely based on my own experience, and what I would do. (and have done with my own treatment) , and which I do not regret doing.
I would wait! Three weeks out of chemo is a very short time, and from what I have heard, a bone marrow biopsy is very painful as well.
Then, lets say the results, (should you have the test) should be, and perhaps would be 'bad' or 'disturbing'? Then how much wiser are you for knowing that if you do not even know if by not testing at this time, maybe your condition and test results will by itself and with more time alone improve. As a consequence, a diagnosis done now on your current status may not be the least bit useful, or satisfying any longer in 8 weeks, and when you may, or may not wonder again.
You must also put yourself in your doctor's position, and what motivates her. of course she cares and worries about you, but there is this other stuff intensely running every doctor's conscience as well, and that is: 'What if she didn't test now even if that is what she believes is the right thing to do...wait?
What if she is wrong? The first concern of almost any specialist, and which is a huge part why our medical care is so expensive, is the fear of 'lawsuits', and I know that for sure.
All sorts of tests are done unnecessarily, and prematurely only because of the fear of lawsuits, and where the lawyers don't care if damage was dome because of neglect or because they really believed not doing a test like yours is in your best interest, and the test itself is not entirely harmless either.
These plaintiff lawyers are most often opportunist, and they take the cases they can win, and not the ones that are fair, or serious. They take the cases that makes the most money.
Anyway, if this was me, and because I feel so close to my care team, I would talk about what you just told us, and also your other fears. i would even ask her to honestly tell you what she would do is in your situation, or is you were her daughter or mother.
She could even give you a blood transfusion and which is a lot less invasive than a bone marrow biopsy. By having an honest talk about this, you very likely will not only help yourself but also your doctor.
KATRIN
PS: Too tired to edit
So, my feedback to you will be entirely based on my own experience, and what I would do. (and have done with my own treatment) , and which I do not regret doing.
I would wait! Three weeks out of chemo is a very short time, and from what I have heard, a bone marrow biopsy is very painful as well.
Then, lets say the results, (should you have the test) should be, and perhaps would be 'bad' or 'disturbing'? Then how much wiser are you for knowing that if you do not even know if by not testing at this time, maybe your condition and test results will by itself and with more time alone improve. As a consequence, a diagnosis done now on your current status may not be the least bit useful, or satisfying any longer in 8 weeks, and when you may, or may not wonder again.
You must also put yourself in your doctor's position, and what motivates her. of course she cares and worries about you, but there is this other stuff intensely running every doctor's conscience as well, and that is: 'What if she didn't test now even if that is what she believes is the right thing to do...wait?
What if she is wrong? The first concern of almost any specialist, and which is a huge part why our medical care is so expensive, is the fear of 'lawsuits', and I know that for sure.
All sorts of tests are done unnecessarily, and prematurely only because of the fear of lawsuits, and where the lawyers don't care if damage was dome because of neglect or because they really believed not doing a test like yours is in your best interest, and the test itself is not entirely harmless either.
These plaintiff lawyers are most often opportunist, and they take the cases they can win, and not the ones that are fair, or serious. They take the cases that makes the most money.
Anyway, if this was me, and because I feel so close to my care team, I would talk about what you just told us, and also your other fears. i would even ask her to honestly tell you what she would do is in your situation, or is you were her daughter or mother.
She could even give you a blood transfusion and which is a lot less invasive than a bone marrow biopsy. By having an honest talk about this, you very likely will not only help yourself but also your doctor.
KATRIN
PS: Too tired to edit
The only information I have in addition to that of your Oncologist is that I have often seen that it takes as long for the system to recover from Chemo as the length of the treatment. I think as long as your Oncologist feels the need to investigate I would certainly go along with it .... she is obviously being very particular not to let anything go unattended. Regards ....
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