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FAQs on Breast Cancer

I have been diagnosed with a chest wall, scar-line or local recurrence after a lumpectomy. What are my treatment options

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In the case of a recurrence, treatment options are more often determined from a specific set of considerations related to your individual case. It is difficult to answer this question because all that can be presented here is general information. Given this difficulty, it is possible to say two things:

A. There are many women who experience a recurrence in the breast after a Lumpectomy, or a scar-line or chest wall recurrence after a Mastectomy. Many women who experience these types of recurrence are doing well after treatment--they are survivors.

B. The general treatment plan for a recurrence of breast cancer involves a Mastectomy or a local resection, possible Radiation and Chemotherapy. A recurrence to the scar-line or chest wall after a Mastectomy is usually treated with Radiation and/or Systemic therapies.

I have been diagnosed with a metastasis. What are my treatment options?

In the case of a metastases, treatment options are often determined from a specific set of considerations related to your individual case. It is difficult to answer this question because all that can be presented here is general information. Given this difficulty, it is possible to say several things:

A. Depending on the type and extent of the Metastases, Systemic therapies are usually indicated. Chemotherapy and Hormonal therapy can be effective in controlling breast cancer metastases. (Regardless of where the cancer is now, it is still breast cancer that has spread to other parts of the body.)

B. Radiation therapy for metastasis to the bone or brain can be very effective. Radiation therapy and radio therapeutics are often helpful for bone pain.

I have metastatic breast cancer which is now in my bones. What are the available treatment options?

While bone metastases can be difficult to live with, there are many treatment options available for alleviating pain and treating the cancer itself. These treatments include:

Aredia/pamidronate

This is a treatment that is not chemotherapy or hormone therapy (It is a drug in the family of bi-phosphonates), which can be taken in addition to those treatments.

Aredia can relieve bone pain from metastases, and in some cases may actually rebuild bone where cancer has destroyed it. Aredia may also prevent further bone lesions from occurring in other areas of the body. There are two kinds of bone mets, Osteolytic and Osteoblastic - most women with bone mets have Osteolytic lesions and this is what Aredia targets.

Chemotherapy

Various types of Chemotherapy are given to treat bone metastases as well as bone pain. Choices in Chemotherapy drugs are usually determined by the drugs the patient has previously been given (the doctor would want to try something new), and the potential for side effects (such as low white blood cell count).

In addition, an important factor can also be the administration schedule required--if you have to choose between a treatment that would require a visit to your Oncologist once a week versus once every three weeks, you might prefer going to the doctor less often (all other considerations being equal).

Radiation therapy

Many women receive Adjuvant Radiation therapy at the site of their bone metastases to relieve pain. The relief generated by Radiation tends not to last as long, but can be effective for some people.

Hormone therapy

This is a treatment option that is offered to women whose cancer is estrogen dependent. While it may not seem the most aggressive approach, Hormone Therapy is a very effective treatment for bone metastases. Many women who are ER+ and have bone mets are given an Aromatase inhibitor, like Arimidex or Femara, which can stabilize and even fight the disease in the bone.

Metastron

This treatment is a Radio-pharmaceutical which cannot be taken while on chemotherapy. Metastron targets Osteoblastic lesions, and can be taken in addition to Pamidronate. Metastron is administered by certified nuclear medicine technologists in the nuclear medicine department at your treatment facility.

It is injected into a vein in your arm and it is possible for one injection to alleviate bone pain for weeks or months. For the first few days after your injection, you will have to take some precautions due to the level of Radioactive drug in your system. However, after those days, you can resume your normal activities without concern.

Quadramet

This treatment is also a Radio-pharmaceutical, which is administered by a certified nuclear medicine technologist. Quadramet alleviates bone pain, and targets osteoblastic lesions. An injection of Quadramet can relieve bone pain for weeks or months; it requires the same treatment administration and precautions as other Radio-pharmaceutical drugs for bone metastases.

I feel so angry and upset that I have been diagnosed with breast cancer again. What can I do?

That it is very common to feel betrayed, upset and angry about your diagnosis--even more than the first time you had breast cancer. Many women feel that their body has betrayed them by "getting cancer" again, or that they didn't make the right treatment decisions the first time. These are normal feelings, and it is appropriate to reassure yourself that you and your doctor made the best treatment decisions possible the first time around.

Most women who are diagnosed with a recurrence or metastasis say they are more frightened about the diagnosis than when they first had breast cancer because they know more about the disease. Remember, when you first had cancer and the doctor told you, you were terrified? That's because you only knew a little bit about breast cancer. When you read books and talked with others, you may have still been scared, but you knew al lot more about cancer. You dealt with your fears and misconceptions. You replaced them with information and facts.

Think now about your feelings and tell yourself that you feel this way at this time because you only know a little bit about breast cancer recurrence or metastases. Lots of women have misconceptions about what it's like to have the cancer come back or spread. You'll read about metastatic disease, talk with others, and empower yourself with knowledge. Even though you might still be frightened, you'll know exactly what you are facing. You can feel more in control, even though having a recurrence or metastasis of breast cancer is a serious situation.

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