breast cancer stage 4

[sai12345]

hi...my mom has breast cancer,unfortunately v found it only in stage 4..noe she underwent  6 cycles of chemotherapy,6cycles of bone injection and radiation as well...v found dis out in nov2007,after chemo d secondary traces of disease in liver was found to b nil...wit small traces of it in bone and much controled in breast wer the lymph became very small also wer sgot 23 ad sgpt 29 ad alkaline phos 143...after chemo doc prescribed for a tab oncolet on daily basis once in mornin..ad a bone injection (zoldonat-4mg) once a month..dis june she got a pain in her left shoulder so doc adviced for a radiation cycles in bone,shoulders and after tht in breast...now after dis s she continuin tab oncolet...but d decreased status of d disease after chemo s now found to increase again..in liver d sgot ad sgpt levels r significantly elevatin each month..now sgot s 152 u/l and sgpt is 142 u/l ad alkaline phos is 632..y s it so? how can v reduce these enzymes level in liver..wat ll b a cause? should d doc change d tab oncolet?ll tht brin bac liver in normal state..i want my mom to survive for more years....pl help me out....thanks for ur valuable suggestions in advance...

[sai12345]

ya...but it seems mom has two different cells one is in breast and other in liver (some he3+, i guess) ,for oncolet the breast cells are  being controlled but not the liver cells ,thats why disease has reoccured in liver ,is what the reply the doctor gave me,so in order to control both,mom needs to take oncolet and xeloda together....

[Fernando Roque, MD]

Hi.  Of the drugs you mentioned, Xeloda (Capecitabine) and Oncolet (Letrozole) are the ones exerting therapeutic effects on your mother's cancer.  All the other drugs are just supportive medication.  Xeloda is a cytotoxic (kills cancer cells) oral chemotherapy drug.  Oncolet is a form of hormonal treatment designed to reduce the circulating estrogen in your mother's body, thereby reducing the growth stimulus of the cancer cells.  I'm not sure how the two drugs are being given to your mother, but it would be better to stop Oncolet while she's still taking Xeloda.  Oncolet can decrease the efficacy of Xeloda, and should be given only after treatment with Xeloda has been finished.

[sai12345]

hai..i met my moms consultant in person this 5th...we took blood test too..this time her calcium levels where increased but alkanine phos is 721(is this terrifically high?!!!)  sgot also incresed to 221 where sgpt was maintained at 142 itself...doctor asked mom to take 6 more cycles of chemotherapy  for liver,but as she was tired of chemos and radiations,mom asked whether we can  try out with any tablets  before therapy..so now doc has prescribed for the followin capsules..cap XELODA 1-1-1, DOMSTAL 1-1-1, COBADEX 1-0-0, DEXORANGE 0-1-0, MET NEUROBIN 0-0-1,LIV52 1-1-1,ESSENTIALE-L 1-0-1 ...along wit this she takes oncolet,shelcal,livogen and ultracet...this she has to take for 21 days where first two tablets is for ten days...again blood test wil be done to check whether the enzyme levels are reduced..if not den doc says chemo is the only way as of now...after takin al these tablets..for five days,i could find that she is brisk,her diet has slightly improved,sleepin better,but often complaints of hand pain and knee pain..when i enquired about this to our doc as u said...he replied tht this pain persists becoz of bone metastatis only..no other reason,few cells won subside for treatments or wil tak time,thts y often she feels the pain...is this right... pl post ur suggestion on her current medication...thnks a lot for ur replies...

[Fernando Roque, MD]

Hi.  If your mother has been debilitated because of the radiation therapy, she can rest for around two to three weeks before starting the chemotherapy.  If her fatigue is accompanied by anemia (low hemoglobin in blood), she can be given erythropoetin injections to improve her red cell count.  The erythropoetin can also increase her sense of well being and reduce her fatigue.  Another drug which can be used to increase her energy levels as well as her appetite is megestrol acetate.  You can ask her doctor if these drugs can be given to her.

I'm not in the best position to assess whether your mother's life span can be increased with the treatment she's receiving.  Her oncologist is more knowledgeable about her condition and should be able to make a more accurate prognosis.  What I can say is that a lot of the current treatments used for advanced breast cancer do improve the survival of patients.  If your mother responds well to the chemotherapy, this might prolong her life.  Let's hope for the best.

[sai12345]

hi....k thanks for ur suggestions...ll talk to my doc abt dis...last one month ie from 24th june to 24th july she had radiation cycles and on 24th july she took  bone injection...though doc know abt her livers abnormality in june itself..he didin treat it or rather change the tab oncolet(which is supposed to stop the disease spreadin) till now...wer d pain in hand also continues..wen v askd him abt dis...he says...ur moms condn s very critical...maximum she can live for next three months only...even tht is possible only if she takes chemo now...so v ve decided to tak chemo from dis wed...but mom is already too tired becoz of radiation...if chemo s gvn now...how can she withstand...dis liver secondaries of disease cant be cured in any tab or wat??? my mom's life span cant b increased??

[Fernando Roque, MD]

Hi.  If your mom is taking Ultracet only twice daily, and she is still experiencing pain, the dose can be increased up to two tablets every 4-6 hours (but any dose increase should be done gradually).  Alternatively, she can switch to stronger pain medication such as morphine or oxycodone.  My guess is that her lingering hand pain may have a neuropathic pain component, that's why it's not responding well to the Ultracet.  Neuropathic pain is a kind of pain which comes from injury or inflammation of nerves.  The nerves running to her hand could have been injured if she had a mastectomy on the breast on the same side as her hand, or if there are enlarged lymph nodes in her armpits which are compressing the nerves on her arm.  For neuropathic pain, another medication like gabapentin (Neurontin) or pregabalin (Lyrica) should be added.

As for the CA 27-29 blood test, I agree with your consultant that this is probably unnecessary.  Monitoring treatment efficacy of the oncolet or the chemotherapy is best done by observing the size of the metastatic nodules in her liver.  Decrease in number and size of these metastases is a better gauge of the effectiveness of treatment than CA 27-29 levels.

[sai12345]

hi...thanks for ur responses..v spoke to d doc yesterday.he told tht liver enzyme increase is not becoz of oncolet...its a sign for the disease reoccurance and they took ultrasound scan ad confirmed it seems...so now few cycles of chemo s needed it seems to control it in d liver and also he may change oncolet tab dis time during her review....for pain control she takes ULTRACET tab mornin ad evenin along wit two other vitamin tablets...doctors r not givin a proper reason for her still continuin hand pain...if u wish pl send me ur mail id...i ll scan d reports and mail u...so tht u can guide us clearly...or post ur suggestions accordingly...

i heard tht few doc suggest takin CT 27-29 blood test in order find out the oncolet tab's efficiency in mom's body...but our consultant told no to dis too...wat do u think about it??

[Fernando Roque, MD]

Hi.  To determine if the increase in liver enzymes is due to side effects from Oncolet or from the recurrence of cancer metastases in the liver, an imaging procedure such as a CT scan or a liver ultrasound needs to be done first.  If no metastatic nodules are seen on CT or ultrasound, then the possibility that the increase in liver enzymes is due to new lesions in the liver is already ruled out.  the next thing to do is to temporarily withhold the daily intake of Oncolet.  If the liver enzyme levels go down after stopping Oncolet, then this confirms that the enzyme levels increased as a side effect of the drug.

As for your other question: if your mom's pain has not decreased even when zoldonat and radiation have been given, it's possible that the source of the pain is not from the bone metastases, but from somewhere else.  This needs to be investigated further by your mom's doctors.  Furthermore, I see no reason why your mom should continue to be in pain provided that she's taking adequate pain medication. So this (the adequacy of the pain medications) may be another aspect of your mom's treatment which needs to be reviewed by her doctors.  What pain medications are being given to your mom, by the way?

[sai12345]

hi..after radiation in shoulders,back bone and breast still mom has  pain in her left arm??? i heard radiation ll reduce cancer cells and it ll b effective for a minimum period of one yr...but even den y s she gettin d pain? also radiation was not given for her liver,doc says to continue oncolet as of now..can see to d condition after one month....by reviwin the radiation results in her body...s d doc treatin d condition wise...pl gve ur opinion..or if u need more details abt my mom's results...ll send u too....

[sai12345]

thanks for ur kind reply...but i need to know y these enzymes in liver has increased...s tht due to secondaries of cancer or jus liver damage which may b becoz of drug oncolet's side effect???

[Fernando Roque, MD]

Hi.  The increasing serum liver enzymes (SGOT, SGPT and alkaline phosphatase) may be due to two possibilities.  The first is that the drug oncolet (letrozole) may be exerting a toxic effect on the liver.  The increased liver damage manifests as increases in the serum liver enzymes.  If this is the case, the dose of oncolet should be reduced or the drug temporarily discontinued to allow the liver to recover.  The second possibility is that the increase in serum liver enzymes is a manifestation of recurrent cancer metastases to the liver.  This can easily be checked by doing a repeat ultrasound or CT scan of the liver, to see if there are new tumor lesions or if existing lesions have enlarged over time.