How do you know if chemo worked

chicagomom

Hi ladies-

I just had my second round of TCH on the 25th of Nov.  4 more to go.  Is there a scan/test that will be performed so I know if it worked or not???  Some days I fear it may be everywhere and would like to be reassured after this is all done.....

Thanks

TenderIsOurMight

In early breast cancer, which includes stage IIa, there are no scans that I know of or that are recommended which enable contrast from where you were with the cancer to where you are now. Of course, your surgery removed the biggest part of the tumor and some involved lymph nodes.

PET scans are sometimes obtained pre-surgery/neoadjuvant chemotherapy if there is suspicion or great concern that your tumor may be more widespread, so you are not under-staged. These currently are not very common, but are undertaken in specific circumstances at oncologists urging.

More advanced measurable disease uses scans frequently to monitor response to chemotherapy. This may involve tumor cells in bone or body organ, and are helpful in giving feedback on current treatment. 

So far, circulating tumors in blood and disseminated tumors in bone marrow are not utilized in early cancers for direction, and at times are utilized in later stage tumors for prognosis and with some clinical trial algorithms, change of therapy.

It would be a great day in cancer-land to have a test which could tell you if it worked....

Thinking positively for you and yours,

Tender

weety

If you had scans before your chemo began, you probably will not be offered them again unless you have symptoms.  My onc chose not to scan before chemo. She said it was important (since I am also HER2+) to just get started with the chemo and herceptin rather than waiting another 2 weeks to get all the scans done.  In my case, she will do my scans after my chemo treatments are finished.  I think it is more for a baseline than anything else.

TenderIsOurMight

 Thought of this thread today:

 

Positron Emission Tomography in Monitoring Treatment Response in Women With Newly Diagnosed Breast Cancer

 

Abramson Cancer Center of the University of Pennsylvania, November 2009

 

RATIONALE: Comparing results of diagnostic procedures, such as positron emission tomography, done before and after chemotherapy or surgery may help doctors predict a patient's response to treatment and help plan the best treatment. PURPOSE: This clinical trial studies positron emission tomography in monitoring treatment response in women with newly diagnosed breast cancer.

 http://clinicaltrials.gov/ct2/show/NCT01018251?term=breast+cancer&recr=Open&rcv_d=14

Lizaroo

Hi,

I'm finding that one has to advocate for the necessary monitoring to ensure that the chemo is working and also to monitor for metastasis to other organs.  I am in the US (Oregon) and monitoring tests may be dictated by the level your oncologist is willing to advocate for you with the insurance agents to cover the costs.  I haven't found any definitive protocols for monitoring cancer treatment response but here's what I've been getting:

I am Her2+/EP-, node +, about stage 3 (they haven't staged yet because I'm getting chemo > then surgery > then radiation).  My chemo treatment was 4 AC bi-monthly treatments followed by 12 weekly TH, then will be H every 3 weeks for a year.

Mostly, my oncologist (and I) tested my response to chemo by physical touch.  My tumor completely flattened out during AC but retained its diameter (4.5cm).  After only 2 treatments of TH, it reduced in palpable size to 2 cm.  Then after 10 TH treatments, I had another ultrasound which confirmed 1.5 cm but I had to insist on getting the ultrasound to measure response to chemo against a baseline measurement.  

I got CMP bi-monthly during AC, monthly during TH to measure my blood chemistry which also can indicate metastasis to other organs under normal conditions.  Your liver and kidneys are under attack during chemo so your numbers will be really screwed up (drink plenty of water). Perhaps someone else can explain other chemistry panel test relationships that can show metastasis.  Also get a Vitamin D test to ensure you are absorbing enough of this.  Any others?

I got CA15-3 tumor marker tests every month and it went up during AC and first half of TH, then went down.  Without chemo, a rise in CA 15-3 indicates progression so I was worried.  But it was explained to me that this will rise during chemo while it is killing cancer cells and then fall as there are less cancer cells to kill.  Anyone understand this test?  I'm a bit fuzzy on the explanation, still.   

I got CA 125 (usually used for uterine cancers but also for breast cancer) before chemo, then around the 3rd week of TH. 

I got a muga scan before starting TH and again midway and then will get an echocardiogram when I'm finished with TH.

I had a baseline breast MRI and Bone Scan before beginning AC and will get those repeated after completing TH.  

I didn't get a baseline bone density scan (not the same as the Bone scan, which shows metastasis in the bones) and when I insisted midway in treatment it showed I had developed osteopenia, a precursor to osteoporosis, which AC can cause.  So I don't know if my chemo caused this or if it was natural progression with age.  If you haven't gotten one, I would insist on getting it because AC can cause osteoporosis (it can be reversed with a good source of vitamin D, calcium, plenty of water and weight-bearing exercises but get a good book on osteoporosis reversal).

There's so much more to monitor during chemo than just the cancer because of the toxic side effects of these drugs.  In general, do your research ASAP and present your recommendations to your doctor.  You have to advocate for your own monitoring and health.  You're going to be too tired to do your research probably so ask a friend.  

Good luck to you.