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Breast Cancer: Stage 3 & 4 Community
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Avatar universal

What would you do?

I am 42 and I have just finished 8 cycles of chemo over the last 6 months. I have advanced inflammatory with mets on my liver and oestrogen positive.  I have been extremely luck and have had an excellent response to the treatment, now my forward thinking team have given me the option of whether to have a mastecomy or not.  They are not convinced it will achieve anything, as they cancer has already spread to my liver.  Do you have any advice?
many thanks
PinkPip
12 Responses
Avatar universal
Hi.
It’s good to know that you responded very well to the treatment given to you.
What chemotherapy regimen was given to you?
For stage 4 cancer, treatment goal is palliation.  Treatment is given to control the disease, relieve cancer-related symptoms, and improve the quality of life.
Since you have a hormone receptor positive breast cancer, you will respond to treatment with hormonal therapy in the form of tamoxifen or any aromatase inhibitors.  I do have patients with metastatic breast cancer with liver metastasis who responded well to hormonal treatment, some with resolution of the liver metastasis.  
Unlike in colorectal cancer where an isolated liver metastasis can undergo resection, there is not much data to recommend resection of liver metastasis in primary breast cancer.  Other modalities that can be employed to manage liver metastasis in primary breast cancer include radiofrequency ablation, cryoablation, or tumor embolization.
I think you need to discuss all treatment options with your oncologist, weighing the risks and benefits of treatment.
Good luck.
Avatar universal
I had 4 cycles of Epirubicin and Cyclophosphamide then 4 cycles of Taxotere, all spaced at 3 weekly intervals. Would anything be gained by having a mastecomy?  Would it reduce the chances of the primary reoccuring?  Thank you so far for your feedback,
PinkPip
Avatar universal
Hi.
Thanks for the update.
It would be hard to tell exactly if mastectomy will still benefit you.  You were diagnosed upfront with metastatic breast cancer, and you were given chemotherapy using sequential epirubicin + cyclophosphamide and docetaxel.  How did you respond to treatment?  What is the status of the breast cancer and the liver metastasis?  If the liver metastasis had a complete response to treatment, you may benefit from having a mastectomy done.  However, if there is progressive disease in the liver metastasis, the benefit of having a mastectomy done will not be as good.
You can respond to hormonal treatment with tamoxifen or any of the aromatase inhibitors available and achieve either stable disease or complete response.    
It is still best to have a multidisciplinary approach in the management of breast cancer.  You need to sit down with your oncologist and surgeon and discuss the best treatment option for you.  
Avatar universal
Great prompt feedback, many thanks.  I have had a complete response to the chemotheraphy and as far as a scan can show, I have not got liver mets or any breast/lymph node tumours, but obviously because of the nature of the disease is can re-occur anywhere in the primary or secondary at any point. My multidisciplinary team have been very good and given me time to think through the option of surgery or no surgery, but they are not sure what to do, because normally people do not have the response I have had.  My liver function has never been affected by the mets and is normal too.  

I feel great in myself and always have, it was only the chemo drugs that made me feel ill and I didn't have any signs of the cancer until there was a slight discolouration in my nipple area.  I will have surgery if it reduces the percentage chance of it returning,

many thanks again,
PinkPip
Avatar universal
PinkPip,

How were the liver mets dx.  Did you have a biopsy or did they just assume it was cancer from the scans?  The reason I'm asking is that I sometimes wonder if BC patients are not often misdiagnosed of Mets.
Avatar universal
They were diagnosed from a CT scan, an MRI scan, my oncologist could feel the lip of my liver and I was burping a lot ( this is apparently a classic sign) . Funnily, my husband said the same thing today, is it possible for Mets to completely respond to chemo and not show up at all, I don't know.

PinkPip
Avatar universal
Hi again.
It’s great that you had a complete response to your treatment.
Inflammatory breast cancer is hard to treat.  Most of the time, it is associated with dismal prognosis.
Anyway, since your liver metastasis also responded completely to treatment, the option of having a mastectomy done on the remaining breast is feasible.  That can minimize, or even eliminate, the risk of recurrence.
As for the question on whether a metastasis can fully respond to chemotherapy or not.  I think you are a very good example of it since your liver metastasis has completely disappeared after treatment.  I do have patients who have complete resolution of liver metastasis after treatment.
Ideally, a biopsy of the possible metastatic site should be done in order to document whether it really is a metastasis or not.  However, the clinical profile of that specific primary site can help the oncologist decide whether to push for a biopsy or not.  Liver, lung, and bone are common sites of metastases for breast cancer.  Perhaps that is the reason why your oncologist did not push for a biopsy anymore.
Avatar universal
Thanks for that,  I went to see my oncologist yesterday to talk through my options a bit more.  I have had a bone scan before starting chemo, which was clear and a CT scan on my lungs, abdomen etc, again clear.  He has suggested putting me on Arimidex (anastrozole)  1mg daily and Zoladex (goserelin) a monthly slow release capsule, in the meantime, before I make any decisions about surgery.  I presume this is because my periods have not come back and he wants to reduce the oestrogen in my body.  He also said that there is a percentage chance that the cancer could come back in my chest wall after a mastecomy and surgery could be in vain.
Is there anything else I can be doing?  I will try anything, thanks again for your expert advice,
PinkPip
Avatar universal
Hi.
Hormonal treatment is sufficient in the management of your breast cancer.  This minimizes the risk of recurrence in both local and distant sites.
While you are taking hormonal therapy, it is very important to have regular surveillance check-ups with your oncologists.  Monthly breast self-examination should be done and report to your oncologist any lump in the breast palpated.  This will help in the recognition of possible recurrence so that prompt treatment can be instituted.
Please do post any update.
Good luck and God bless you always.
Avatar universal
Thank you for all your advice, I have found it very helpful, I will keep you updated and God bless you too,
PinkPip
Avatar universal
Thanks a lot for your sevice minded replies,it is very very useful like me and the humanity.
Best REGARDS
Avatar universal
The lastest studies indicate that having a masectomy in stage 4 increases life span. This is thought to happen because the circulating tumor cells go back to the origanial tumor site after treatment and get revived. Some plastic surgeons are also doing reconstruction at the same time as masectomy in stage 4.
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