Mom diagnosed in 5/96 (then age 50 & otherwise good health) with breast cancer discovered when her leg broke and shoulderblade/back was fractured from cancer eating through her bones. Treatment was immediate radiation to leg, back & shoulder (for pain) and Tamoxifen (no removal of breast). From approx 9/96 to 1/01, just Tamoxifen. In 1/01, surgery to remove "orange size" tumor in lymph nodes area, but only able to remove about approx 1/3, so radiation followed. In Fall 01, small spot of cancer found on each lung so Dr changed drug to Arimidex. In Spring 02, tests showed that Arimidex not controlling spots on lungs. In 4/02, Mom received first shot of Faslodex. Otherwise, last bone scan showed no detectible cancer in bones and last scan of tumor in lymph node areas showed tumor undetectible. Dr going to see how Faslodex does for few months, but says next option is chemo. What is probability Faslodex contain cancer and for how long? Is chemo next option? If so, discuss quality of life and prognosis? If declines chemo, what is prognosis? Should she explore cyber knife for lungs since results seem good in past with radiation? Is there other treatment options I should be researching? All things considered with recommended or possible treatment options, what is prognosis? Please provide me with any information you can on treatment options and quality of life and prognosis with same. In addition, please provide me with cites to publications or other information that may assist in educating me on treatment options, quality of life and prognosis under Mom's circumstances. Thanks.
Dear ConcernedDaughter: When your mother was diagnosed, she had stage 4 breast cancer. I am assuming that it was estrogen receptor positive - there was a biopsy correct? The prognosis for stage 4 breast cancer is approximately 15% 5 year survival. As you can see, she has beaten the odds already. It also points out that we are often wrong in giving prognoses. No one really knows how long a person will live. It is also the reason that I cannot begin to give you a prognosis now. It all depends on how the cancer grows, how it responds to treatment, etc. It is impossible to predict. Will Faslodex contain the cancer? We don't know and if it does we don't know for how long. Chemotherapy is probably the next option. Quality of life depends on how she tolerates it and which drugs she is given. Some women tolerate very well, others have more difficulty. Trials do suggest that chemotherapy improves survival in breast cancer but this cannot be applied to an individual - trials are published based on large groups - we obviously cannot compare NO chemotherapy versus chemotherapy in the same woman to see which is better. The cyberknife is experimental for lung tumors and only limitedly available. Whether or not it could be done in her situation would need to be determined by that institution. I do know that the cyberknife lung trial at the Cleveland Clinic is currently closed. Also, if there are multiple "spots," this is probably not the best option. There are also other experimental drugs that are both chemotherapy and other medications. These may or may not be suitable for your mother. She (and you if she is willing) will need to discuss these options with her oncologist (hopefully someone who specializes in breast cancer). Unfortunately, we just don't have all the answers and cannot predict what the future will hold. Hopefully, she will continue to do well as she has for the last 6 years. A good reference is Dr. Susan Love's Breast Book. She discusses many of these issues in ways all can understand.
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