Treatment Options

I am a 38 yo woman who was first diagnosed with Stage 2 breast cancer in 1997.  Had a lumpectomy, followed by 6 doses of chemo (adryomycin), 33 radiation sessions, and 5 years of tamoxifen which ended this past summer.  Early September of this year, a routine examination revealed a spot in my lung on my chest x-ray which turned out to be metastatic breast cancer.  Four nodules were removed from my left lung and no other evidence of cancer was discovered in other ct scans of liver, bone scan, etc.  I am now faced with treatment decision.  There appear to be two prevailing schools of thought.  One, is to have a hysterectomy (I am premenopausal) and try just hormonal therapy (i.e. Arimidex or Femara).  The other is to begin with six doses of chemo (Taxotere w/ Xeloda), followed by hormonal therapy.  I should mention that a hysterectomy was already in the forecast because of fibroids.

My goal is twofold.  Maintain some quality of life and achieve some longevity.  I have a 4 yo daughter and a loving husband.  I want to be around for them and me.  During the first bout with the disease, I tolerated chemo very well and never had to stop working.  So while I'm not looking forward to it, I'm not afraid of it either, especially if it will help me in the long run.  Any thoughts out there?  Please help!

[CCF-RN,MSN-rf]

Dear monag:  There is no easy answer to your question.  The dilema is this:  Since all the cancer was removed (but the possibility exists that other cells could be out there but not visible), you are back in the situation of adjuvant treatment.  In a setting such as this, it is difficult to know the value of chemotherapy because there have not been trials for this scenario.  Further, you cannot measure your success as an individual because there is no disease to check for response.  It is not unreasonable to consider the hysterectomy (with oopherectomy) - particularly if you were headed that route anyway.  Hormone therapy may be a more reasonable approach to preserving quality of life, since the benefit of chemo is unknown.  You may experience some discomfort (symptoms) with the menopause that will ensue upon removing ovaries.  Chemotherapy can then be reserved in case of a future recurrence.