Fatty Liver Disease and Tamoxifen

liway

Hi - I'm new to the forum, I was diagnosed with breast cancer in November 08 and had a mastectomy in December.  I had multifocal tumors(5) and 2 of 10 lymph nodes positive.  I've gone through 8 rounds of chemotherapy and 25 sessions of radiation.  But I'm feeling really well and started back to work.

I went to the doctors because of some pain in my back and abdomen, found out I had a kidney stone and fatty liver.  A month later I went to the family doctor for a check up and my liver enzymes have increased over the month before.  I have been doing research and found there is a definate link to Fatty liver disease and tamoxifen use.

Has anyone been diagnosed with the same thing.  Is there anything I can do to help decrease these effects.

whippetmom

What????? Like I need one more thing to have to worry about....now it's a fatty liver and increased abdominal girth?  It never crossed my mind but now that you have started this thread, I'll be researching the patootie out of this along with everything else I am researching this week.  I just came up with a clinical trial of an aromatase inhibitor vs. Tamoxifen in re: liver issues published this month.  You can bet I'll be emailing my oncologist about this tomorrow!  Thank you for sharing this information!

whippetmom

Okay, I came up with a recent publication showing animal testing with tetradecyithioacetic acid [TTA] which is a fatty acid, and Tamoxifen.  Apparently this fatty acid ameliorates the untoward aspects of Tamoxifen on the liver.  I need to research a bit more on this.  But I'm all on it....

 http://www.jlr.org/cgi/reprint/M600148-JLR200v1.pdf?ck=nck

"The tamoxifen-induced accumulation of triacylglycerol was prevented by co-treatment with TTA, through mechanisms of increased mitochondrial and peroxisomal β-oxidation"

Additionally, TTA is found to prevent adiposity - the development of adipose tissue formation, which is really key, as so many women complain of weight gain with Tamoxifen - especially belly fat.

http://www.jlr.org/cgi/content/abstract/43/5/742

http://www.biomedsearch.com/nih/Dietary-supplementation-tetradecylthioacetic-acid-increases/19740081.html

TTA is purportedly safe and well-tolerated...

http://journals.lww.com/cardiovascularpharm/Fulltext/2008/04000/Pharmacology_and_Safety_of_Tetradecylthioacetic.10.aspx

Hmmm.  TTA is found in products used by bodybuilders - to burn fat and not muscle during intense workouts. 

http://www.a1supplements.com/TTA-500-120-Capsules-p-17917.html

I would discuss this and any supplement with your oncologist.  I plan on discussing this with mine tomorrow.  You can get this product as a supplement, although this is probably a loaded dose - meaning we would want to cut it in half or even quarter the dose -buy little empty gel capsules at the health food store.

Interesting topic.  

Deborah

Anonymous

Oh Yeah,

I went Bilat mx because I wanted to avoid radiation and Tamoxifen.  I had already been prescribed Fosamax because of low bone mass.  I had been taken off of it years ago because of the jaw bone studies.  Bilat mx allowed me to skip radiation & Tamoxifen (previous oopherectomy).

whippetmom

A bilateral mastectomy does not eradicate the need for Tamoxifen.  In your case, having a bilateral, in conjunction with your type of cancer - DCIS - precluded your "need" for Tamoxifen or an AI.  Not so for those of us with invasive BC and bilaterals.  

whippetmom

TTA inhibits growth of human breast cancer cells...

http://www.springerlink.com/content/lx3k165612u36228/

Erika09

Hi Deborah - Nice to see you here!  I've been doing so much digging on Tamoxifen and its side effects. I am supposed to start on it next month but I am questioning if the benefits outweigh the side effects.

I found this thread when looking up fatty liver & tamoxifen.  I'd be very interested in knowing what your onco tells you about it and TTA. I will also ask my onco about it when I see her again in three weeks.

whippetmom

Hi Erika:  I have not emailed my onc yet but I have ordered the TTA supplements.  I just looked at my records and I had a liver panel performed last May - and it was normal.  So getting another one less than a year out will not hold much weight I am afraid.  Frankly, I know my onc is not going to have a clue about TTA and I wish I had known about this to discuss it with her during my bi-annual appt. last week! I have to "email" her through the Kaiser system and so I cannot link all of the above websites or references to her.....

I'll let you know....

SoCalLisa

Yes, I did have that and it became severe...I switched to arimidex

whippetmom

Lisa:  Severe?  This is outrageous!  Do you mind me asking if your oncologist ever ordered a baseline liver panel?  Was it ever suggested that liver enzymes should be monitored while on Tamoxifen?  I mean, this is well-published.  I do not recall seeing this as a potential risk in any literature given to me!  I am astounded to be learning about this!  My head has been in breast reconstruction threads for the past year.  Gee, I come up for a little air and see this post pop up and horrors!  Look what I find!!

GryffinSong

I was diagnosed with fatty liver deposits right before I went on tamoxifen. Guess I need to bring this up when I meet with my new oncologist in two weeks. I just moved across the country, so I'm starting over with doctors. I don't feel comfortable going on arimidex because my bone density is extremely low. But now I have to worry about my liver?!?!?

Thanks for bringing this up.

SoCalLisa

my liver panel was ok, it was the biopsy taken when they took out my gallbladder that showed it

no cancer, but liver disease

edited to say it was seven years ago..

whippetmom

Oh NICE!  So it is essentially a silent disease for some.  Thank goodness for that pesky old gallbladder! What might have occurred had you not needed it out?   

SoCalLisa

Hepatic Effects

Changes in hepatic enzyme concentrations (e.g., increased serum AST [SGOT] or ALT [SGPT] concentrations) and increased bilirubin and/or alkaline phosphatase concentrations have been reported in patients receiving tamoxifen therapy. Rarely, more severe hepatic abnormalities, including fatty changes in the liver, cholestasis, hepatitis, hepatic necrosis, and death, have occurred. A causal relationship of these adverse hepatic effects to tamoxifen has not been established; however, following rechallenge with tamoxifen, adverse hepatic effects occurred in some patients.

whippetmom

Lisa - Was there any inference that Tamoxifen was somehow culprit for your gallbladder issues?  Tamoxifen induced gallstone formation has been well documented....

http://www.medscape.com/viewarticle/453386

So if Tamoxifen also induces the accumulation of triacylglycerol - [triglycerides] - ..and the finding of severe liver disease...how is this NOT related?   

DaylilyFan

Layne, sometimes I think specialty docs share your "sledgehammer" attitude!  Oncs regard cancer as a snake that has to be killed before it strikes again and to h...l with any other consequences.  

And the poor patient is in the middle of all this!  My mother had COPD & CHF.  Just about any treatment that helped one problem made the other one worse.  It helps if you have a sharp PCP to run things by, but those are a rare breed. 

liway

Thanks so much Wippetmom for you thorough research on this subject.  I will definately bring this up with my doctor and see what they think.  I don't like the idea of the liver not functioning properly.  I will look into the TTA and also have my pharmasist researach it as well, why not, it can't hurt.  I'll keep you updated on my next appt with the doctor.  I will be going monthly for blood work to check my liver enzyms, next appt at the end of the month.

charmainejensenvoisine

I was dx with fatty liver years ago although my primary physician does keep an eye on my liver enzymes throughout the year by doing quarterly blood panels.  Next time I get into seeing my primary care physician I will ask him again now that I am on Tamox to do a liver enzyme blood test as has been since February that I have had blood work done and was not on Tamox then.  I saw my Oncologist today and failed to tell him about my fatty liver as I was not aware of Tamox and fatty liver until I came across this thread.

I am already into menopause and have been for a few years now, and having more effects of the menopause probably because of chemo and more so because of the Tamox.  When I saw the Oncologist, he said he will probably keep me on the Tamox for a term and then change me to something else -- we discussed the different meds that I can go on for women that are post menopausal.

Charmaine

Triciaski

This is a bit of a rant, please bear with me.  

My onc does a complete metobolic panel every few months, and he has never said anything about my liver enzymes. However, my regular internist has been concerned about elevated liver enzymes for the past 6 months. HOWEVER, he (the internist) has never said a thing about tamoxifen being linked to liver disease. He's had me stop drinking wine for three months, retested, no difference. Next he suggested I go off my cholesterol medication, which I said I really didn't want to do. So he sent me home telling me to lose weight and completely stop drinking --like both of those are so easy to do. 

After researching a bit, which took me all of 5 minutes, it appears to be well known that tamoxifen causes fatty liver. I also found another article in the "International Journal of Obesity" that links tamoxifen to "Syndrome X," a condition common in middle-aged men that causes large guts, high blood pressure, high cholesterol, and type II diabetes -- all the major risk factors for heart attack and stroke.

http://www.nature.com/ijo/journal/v25/n2/full/0801488a.html

The study links tamoxifen use to the development of Syndrome X in women, and that seems to be exactly what's going on with me. I have gained almost 20 pounds all in the belly and my blood pressure, which was a bit high before tamoxifen, is now very high and not controlled even on two meds. I AM REALLY MAD. WHAT IS WITH MY DOCTOR? I know it's important to try to prevent the recurrence of breast cancer, but what about the risk of heart attack or stroke, which seem very real possibilities for me at this time.

I CAN'T BELIEVE that my doctor did not make the tamoxifen/liver connection and that he isn't in consultation with my onc about the best treatment plan for me going forward. I took myself off tamoxifen yesterday and we'll see what my liver tests are like in a few months. I don't feel the need to consult with my doctors about this. I'm scheduled to see both of them in about 6 weeks and have more liver tests; we can talk then. In the meantime, I'll be looking for another doctor.

Sheesh!
Tricia

charmainejensenvoisine

Tricia: Thank you so much for sharing this article, much appreciated.  I am gonna contact my Medical Oncologists office and check with his secretary if he has an email address, I would like to share this article with him. 

Charmaine

limegreen

I have been taking tamox daily since March 23 and ran across this thread and now I'm a little bit worried.  So far I haven't had really any se's aside from the occasional minor night sweat and my period seems to have stopped.  I am 47 and had my bi lat mast Jan 13th.

I try to exercise on a regular basis and watch what I eat and only now rarely have the occasional cocktail or glass of wine because I've been reading and hearing that more than one drink per week increases risk of recurrence or new bc.

I cringe at the prospect of having liver problems and will look into those links that whippetmom posted. 

nanamims

I'm a 12 year bc survivor who took Tamoxifen and had liver problems. Are you still working on this issue?

mumito

I have been on Tamoxifen for 2 years and this year my scan showed a fatty liver.Now I am concerned.

208sandy

Yikes!  I was having huge problems on Arimidex and Femera and the oncs (2) wanted me on Tamox which I refused - glad I did - on Arimidex and Femera I had highly elevated chloresterol, bp and blood sugar readings - after three months everything back to normal except for chloresterol which is only slightly elevated now and it is my fault, also have lost 20 lbs. without dieting and I am able to walk for miles and volunteer two days a week, etc. - the poster that wrote about oncs and the "sledge hammer/snake" scenario is right - my PCP thank God is a great diagnostician and a very sensible young lady who has seen me through this mess - honestly we need more research by drug companies - these drugs just don't work for so many of us and I hate that we aren't told the truth.

Sandy

gail323

Found this topic of interest - I am an 8 year survivor.  I was on Tamoxifen for 5 years without running into any diffiulty with liver problems.  A little over 2 years ago my oncologist switched me to Femara and I continued to take it until February. 

 Over the past year, my alk phos has been elevating - not severely -  but enough so I questioned what it was from.  My February lab work showed my alk phos was higher than ever and my CA 27 29 was also higher than it had been.

 Lab work was scheduled for three consecutive months and I told him that I would no longer take the Femara because obviously (to me, anyway), it wasn't working and it is entirely to expensive.  

March showed my alk phos back to normal and the CA 27 29 had dropped by half.  April, alk phos still is normal and the CA 27 29 is now normal.  I guess it says to me that the Femara was causing the liver problem and was not controlling the cancer numbers.  I am back on Tamoxifen for the past couple of months so I guess we will see what happens.

Anonymous

hah! then my intuition on ordering Liver Function Tests (not Liver Tumour Markers) to ensure that my mother's liver is in good working order is right! before taking either Tamoxifene or chemo or Herceptin-- have your Liver Function Test-- to ensure its not a pre-existing condition.

sometimes we really have to rely on intuition and gut feel-- even if it seems (at least initially) our logic is not making terms with it.

someone told me that intuition was given to the female species only and not given to men... proud to be a woman.

if oncologists cannot make the liver/tamoxifene connection, they probably do not make the liver/chemo+herceptin connection either..

ladies, if you are taking any of these (tamox/chemo/herceptin) same goes for those who are taking Vit C or Vit B infussions -- consult a hepathologist first-- get them (hepathologist and oncologist) to talk to each other..!

cuyamacaranger

My best friend had breast cancer in 1992.  Lumpectomy followed by radiation and tamoxifen and she was good to go.  10 years ago developed cancer in her bones, but it remained dormant for 10 years.  One year ago she started having digestive problems that were classic liver failure, but her internest danced around IBS and ulcers until 10 months and 25 pounds less (she was normal weight to begin) she starts developing iscites (fluid buildup in the abdomen).  THEN her oncologists test her and yep, her cancer has come back.  BUT, though there are cancer cells in the fluid, she has no tumors.  She has fatty liver disease to the point that she will not survive.  In two months she has had two rounds of avastin and taxerol, but the chemo itself damn near killed her. She is now in the hospital on morphine and may die this week. She is a non drinker, and after the original cancer ate VERY healthy foods only.  So I believe that the tamoxifen did affect her liver, absolutely.  However, without it, would the cancer have come back sooner?  I don't know.  I just think she should have been correctly diagnosed sooner this time and they may have saved her, or at least given her more quality time.  Insist that your doctors are open to questioning and being challenged.

kris2009

I am 45 and new to the forum and thought I should share my continuing treatment and hurdles. On March 24th of 2009 I had a Bilateral Mx followed by 6 rounds of Chemo, reconstuction and Tamoxifen. In September of 2009 I started the Tamoxifen and within 2 months had pain in my back behind the right side of the floating rib, accompanied by aching joints and swelling. In Jan of 2010, while thinking this was all normal after Chemo, I shared this with my MO who ordered a blood panel and a MRI. Later the same day I had a Annual Pelvic Ultrasound (standard for those on Tamoxifen). The MRI showed a shadow on my right floating rib close to the the spine. He ordered a bone biopsy, at the same time they found a dermoid cyst in my left ovary. It was recomended to remove both ovaries. The Bone Biopsy came back negative. The pain continued and I tried to just live with it, thankful that both biopsies showed no cancer.

I had my final reconstructive surgery in June 2010. Meanwhile the pain in my upper right abdomen continued. By November 2010 the pain increased and was also not just in the backside but in the front too. My MO had me stop the Tomoxifen for 2 months to see if the symptoms went away. The swelling, aching joints and some fatigue went away but not the pain. In January of 2011. He did a blood panel and had me start Arimidex. My panel came back indicating "Fatty Liver" he said it wasn't serious and would do another blood panel in 3 months. He also told me to loose the weight I had gained all the previous year and mostly in the middle. Before the March 2009 surgery I weighed 127 and now weigh 157-160, I am 5'5". I eat mostly organic, vegetables whole grains and fish. The only meats eat are pasture fed and not too often. I don't drink soda. I rarely drink alcohol, a few times a year and only one drink.

In April of 2011 I had another blood panel indicating lower counts but still fatty liver. We would continue to test every 3 months. In May the pain worsened and I went in again as the area was tender to touch, he sent me for a Bone Scan and Ultrasound. All came back clear, no gallstones, liver or gallbladder tumors and no bone tumors, thank goodness. I still have the pain, mostly after eating. I have an appointment with my GP on the 22nd, and I am considering another MO. I am at a loss and really don't want to take the Arimidex. Tamoxifen and Steroids(taken day before, of and day after Chemo) can lead to "Fatty Liver" and my MO is aware of this. All he wants to do is watch it right now. Ugghhhhh!     

Gaga

So glad to find this topic.  I thought I was nutz.  I had bilat mx 18 months ago, going through reconstruction now. ONC put me on Arimadex, I lasted only 4 months the side effects for me were awful.  The joint pain was so bad I needed vicodin just to move about and to get to sleep. Hot flashes were out of control. ONC switched me to Tamoxifen, I have every side effect listed on this as well.  Now this month I have learned that I have a fatty liver.  I have bloating and pain in my upper right abdomen.  At times its so uncomfortable I am beside myself.  My ONC said no problem Tamoxifen didnt cause it.  ( fibber)!  I will see my NEW ONC in a week.  Also I will be having my 2 year check up soon, is it normal for the ONC to order NO tests of any kind, in 2 years?  PCP ordred the ultra sound on the liver, but they guessed it was fatty liver because they could see it was enlarged but they couldnt see all the way through it.  So I am going to push for an MRI.  My old ONC said he thought it might be my gallbladder.........Ah no I havent had one for 10 years.

riley702

I'm at this point now. Tamoxifen gave me a fatty liver and all the other signs of metabolic syndrome (abdominal girth, fasting glucose >100, slightly elevated blood pressure and my blood lipids went through the roof). I was switched to Aromasin in November, but still have the same symptoms plus joint pain, esp. in my hands and fingers. I have decided on a 3 month vacation from Aromasin, and asked my doc to write me a script for Metformin for the metabolic syndrome. It reduces the fatty liver, triglycerides, and makes my body more sensitive to insulin. It's still reversible at this point, so I'm adding lots of exercise as well (a recumbent bike is easier on my achy joints). Oh - I also had gallstones on my liver ultrasound, but they are "too small to cause trouble now". 

Barbie41855

Over the past two months my AST and ALT levels for my hepatic panel have been higher than average and I am thinking fatty liver. I see my oncologist Friday. I was on tomoxifin for two years!