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It doesn't seem that the doctors wait for a sign, or symptom, but instead they routinely order Cat Scans, Pet, MRI's. It seems its about every 3 months that they are supposed to do this for those that have breast and bone cancer - or at least thats what I have seen in my mothers case. I think there was a bigger time gap in between these last 2 scans though. She didn't have any "sign" that the cancer moved to the liver, but it did. So scans are necessary in order to watch for any changes.
FYI, The doctor didn't do the mastectomy - due to her age - nor did he think she would be a good candidate for chemo - so he put her on Femora, Zometa drip, and recently started her on these two injections - the name of the med slips my mind right now.
But anyhow, he now took her off the shots, also stopped the Femora, is keeping her on the Zometa and now is trying an Oral Chemo drug - Xeloda.
He basically told her - this is it, but she is an incredible woman, always with a positive outlook and nothing shakes her (except seeing blood) and she said, no this is not it, I'll be fine. I think she wants to be strong for me because she knows I am not well and no time is a good time to lose your mother, but some times are worse than others and this is one of those times. So, I am trying to keep positive too.
Good luck to you,
MO