Metastatic Breast Cancer

[Dulin]

Sir:If you have an isolated lesion like on the distal femur, it was radiated, would it be possible that the cancer may never metastasize anywhere else?  The tumor markers are always around 57-60 (CA 27-29).  Our Oncologist told us once you have metastisis it usually never goes back down to a normal range, is that true?  Does this mean cancer cells are present and they just haven't shown up on scans yet?  The last scan was clear. Our Oncologist isn't very talkative and basically says I don't know to everything.  It would be nice to have some encouraging words at times.  I never had chemo due to other medical problems, however, I did have 11 positive nodes.  Thank for your answer.

[CCF-RN,MSN-rf]

Dear Dulin: Predicting cancer behavior is nearly impossible.  Most statistics are based on large groups of people and are based on probabilities.  Women who had positive lymph nodes are more likely to develop metastatic disease than those with negative nodes.  Women with one metastasis are more likely to have subsequent metastasis than those who have never had a metastasis, for example.  However, in any individual cases, the possibility exists that your case will not be "average."  It is possible, though not likely, that your cancer will not metastasize further.  Additionally, if it does metastasize further, we cannot guess whether it will be in two weeks, two months, two years, or longer.  The good news is that, for now, you do not have active disease by scan.  

We do not use the CA27-29.  We do not feel it is reliable enough to base therapuetic decisions.

[surgeon]

It's theoretically possible that a person could have a single metastasis that could be controlled long-term, or even cured. In practical terms, one assumes that when there's a metastasis somewhere, there are others. Tumor marker blood tests aren't really all that reliable; how they behave after treatment may or may not actually reflect what's going on. The fact is that women can live very long and normal lives even with a diagnosis of metastatic breast cancer. And, as you are finding out, we really don't have ways of accurately testing for tiny tumors. So when your oncologist says he doesn't know, it's because he doesn't. People in your situation have to figure out how to put the uncertainty on the back burner and live on the basis of what they do know: "I feel fine now, and I will tomorrow, too!"

[Belleview Teacher]

I was diagnosed with BC in October, 2003.  Since then I have had a mastectomy, chemo, a bone scan and a CT scan of the thorax and abdomen.  The tumor had clear margins, the sentinel node biopsy was negative as were the scans.  In spite of all the good things and my favorable prognosis, I have found myself obsessing and thinking almost continuously about what might happen. This has led to lots of depression and anxiety.  When I read your comment above about putting things you don't know on the back burner and living with what you do know today, it was like a light bulb went off for me.  Now, every time I start to obsess, I say to myself, "Put it on the back burner."  Thank you for this.  It might have just been a routine comment, but it has changed my thinking and my ability to deal with my everyday life.  Thank you.

[cc1962]

I agree that it is useful to try and remind oneself to put it on the back burner.  Detaching from worry is something that you need to firmly practice with yourself to get good at it.  What works for me is to tell myself to trust in Jesus.  Mat 6:34  So don't be anxious about tomorrow.  God will take care of your tomorrow.  Live one day at a time.    From a physiological standpoint, worry lowers the levels of natural killer cells and the Tcells that you need.  Autosuggestion works too, tell yourself 20 times "Nothing is going to bother me."  (I'm practicing all these).
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