Post treatment is this expected ?

[debden]

This forum has been so wonderful during the course of my treatment, which has all gone very well, thank you!  I had a 3cm invasive ductal (ER/PR-; Her2+ 13.8FISH)tumor removed, 2 of 8 lymph nodes positive with extensive extranodal extension, 4 rounds of A/C, 4 of Taxol,12 months of Herceptin in a clinical trial and 7 weeks of radiation to the tumor site and lymph areas.  I experienced menopause, my last period was in Feb 2002 and am on Effexor XR for hot flashes.  One week ago I experienced very heavy vaginal bleeding with large clots, I had an endometreal biopsy, papsmear, ultrasound and blood tests. These tests revealed working ovaries, which the gynecologist instructed me to address with my medical oncologist, but asserted that I am definitely not menopausal. (I am 42)

Blood tests did reveal hypothyroidism, the doctor asked if I had been fatigued, which of course is a yes, and my finger nails have been brittle and peeling.  I didn't really think much of these symptoms, just figured it was the cumulative effects of all of the breast cancer treament.

My questions are: I have been under the impression that it would be best for me not to have working ovaries, if that is the case how might this be handled, and is it possible that the radiation to my sternum and axilla somehow affected my thyroid?

Also is the person posting with the nickname "surgeon" a representative of yours and if not, could that person please clarify if they are posting as a qualified medical professional or is that just a nickname?  Thank you very much!

[debden]

Thank you all for your input. For my situation, I had viewed menopause, (thanks to the wonder of Effexor XR for the night sweats) as a sort of perk side effect of the chemo.  Needless to say, I am amazed and awed by my body's recuperative powers.

I did want to clarify that I am considered early stage (2) and thanks to the suggestion of a wonderful oncologist at the Cleveland Clinic was able to get into a clinical trial close to home for adjuvant herceptin for prevention of recurrence in Her2+ breast cancer. Thanks again!!

  

[CCF-RN,MSN-rf]

Dear debden:  Sounds like you were in temporary menopause, which can happen during chemotherapy.  Since your tumor is estrogen/progesterone receptor negative, the ovarian function may not be a big deal and may even prevent other problems.  You should discuss this with your medical oncologist.  If there is an indication, ovarian function can be stopped either surgically or chemically (with drugs).  But there may not be any reason to do this.  

The radiation therapy can affect your thyroid if it were in the field but it usually is not.  I have heard some woman experience hypothyroidism as a result of chemotherapy, however.  Or, it could just be coincidence.  The good news is that there are medications that can correct your thyroid function.

"Surgeon" is not a representative of ours.  We do not know the background of "surgeon." We take no responsibility for "surgeon's" postings - as we do not with others. However, we have been reviewing the answers provided by surgeon and find that they are generally accurate and often helpful, so we have left them for others to read - as we do other non-medical postings.

[ritavv]

You have touched on two subjects that I have been interested in.  
I saw (and saved) the following post at WebMD's thyroid message board:
by Brunilda_Nazario_MD (WebMD), on 2/26/2003  
There actually may a connection you are right. First in the treatment of breast cancer many times radiation to the breast is used and yes that will cause hypothyroidism within a few weeks to months.
Secondly many papers have been written about the association of thyroid disease in women who had had breast cancer most frequently the finding of hashimotos disease.The reason for the association is not clear it does not seem to be related to the chemotherapy and some researchers have implicated that it may be related to thyroid antibodies or the fact that thyroid hormone may drive cancers. A few other have try to figure out which type of thyroid diseases are more associated with a better survival as well . A recent yet small study found that the Hashimotos patient with breast cancer did have a better survival. These are all small studies as more reasearch is done we will be able to uncover more details of these finding.

The other subject of interest is 'working ovaries'!  You may want to do some searches on ovarian ablation.  However, most of the studies I've seen have to do with early stage cancer.  To get you started, you could go to:
http://www.cochrane.org/cochrane/revabstr/ab000485.htm
or
http://www.breastcancercare.org.uk/Breastcancer/Youngerwomenandbreastcancer/Ovarianablation/Inwhatcircumstancesisovarianablationused

I, personally,had developed ovarian cysts from the Tamoxifen and am now getting Lupron shots for chemical ovarian ablation. It is working well for me.

[surgeon]

It's not likely that the radiation affected the thyroid, unless your field was modified in some particular way for some reason. Chemo could affect it. You might also have been borderline hypothyroid for other reasons before treatment. Being ER/PR negative means hormones aren't likely stimulating your tumor; so ovarian status may be less of an issue in your particular case. Ovarian ablation is not routinely done; but it has a role in certain circumstances. Namely, when the breast cancer is know to have spread and is ER positive. Tamoxifen effectively blocks the effect of estrogen on tumors, which is why it is used when appropriate, and "medically" takes care of working ovaries. Finally, no, I am not affiliated with Cleveland Clinic (although, coincidentally I went to medical school in Cleveland). I do this to help, gratis. I am a board-certified general surgeon, fellow of the American College of Surgeons, who has been in practice for 26 years and whose practice has included very large numbers of breast cancer patients.