New Diagnosis/Treatment Plan - A few questions

jar5781

Hello,

My best friend ( 36 years old ) was diagnosed with invasive duct carcinoma, ER/PR positive, HER2 negative, with a 4 cm tumor in her right breast almost exactly a month ago. The first course of action was mastectomy + chemo, but the subsequent PET scan showed one spot in her liver. As of today, treatment plan is to start an Aromatase Inhibitor + Lupron + IBrand tomorrow.

My questions for her are as follows;

1. The process of selecting a dr ( originally breast surgeon, and recon surgeon, and oncologist, but now just oncologist) has been tedious and has delayed some of her decision making. I think one of the biggest questions she has is whether to lean towards a doctor whom she feels closely connected with and connects with vs. a doctor who may not lend that feeling but is at one of the top 3 cancer centers in the country. The former is still v. well qualified and actually a former doc at the well known cancer center, so it seems like that is a great fit, but I'm having a hard time making sense of how much the center vs the doctor matters. She is in NY so her options are so wide, it almost makes it more difficult. Now that surgery is off the table, the entire process is easier because we are not selecting 3 doctors at once in one system, or dealing with reconstruction, etc, but I'm still very curious to know the opinions of those who have been through it.

2. Any insight on liver mets so soon after the primary diagnosis? The last time she had a mammogram was 4 years ago, so its possible the cancer has been there for some time, but this is the first time it was noticed ( she indicated feeling like something was "happening" in that breast several months ago which prompted the mammogram). I'm curious about the path of treatment deviating from surgery to hormone therapy, if others have ended up having a mastectomy anyway, etc.

3. Any insight on the path of treatment? Ie, Hormone first, no chemo? And what about the litany of other liver options I've been reading of? Should we be considering those or just following the course recommended?

4. Side effects...any insight on what to expect and how to mitigate?

Thanks for letting me cruise this board as an honorary member, I'm not geographically close to her and she is inundated with info and appointments and managing life outside that, so I'm hoping learning and gathering info is a source of support.

With lots of respect,

Allison

randrgirl

Hi Jar,

I don’t have answers to your questions but someone else will be by shortly l’m certain to help you. In the meantime, I’m sorry about your friend but she most likely feels very supported having a thoughtful friend like you. This is a tough desease to deal with but you will receive some great support from the community here

ElaineTherese

Hi!

I was diagnosed at Stage III, not Stage IV. You might want to check out the Stage IV boards and the liver mets board in particular. These are just some quick thoughts:

1. Your friend will be with her oncologist for the rest of her life. She should feel comfortable with him/her. She's lucky to be in New York and to have such great choices. (I live in OK.)

2.It's not unusual for someone who is Stage IV at diagnosis to skip surgery, but there's some debate about that. (Some women do get the surgery because there's a theory about reducing the tumor load.)

3. Many oncologists do begin the treatment of Stage IV ER+ breast cancer with hormonal therapy. Indeed, many Stage IV breast cancer patients do achieve NED (no evidence of disease) just on hormonal therapy. It's not that your friend will never get chemo; it's just that oncologists like to save the "big guns" for later when all the more tolerable treatments don't work any more.

4. Your friend appears to be pre-menopausal (she's getting Lupron, an ovulation suppressor.) I'm doing Zoladex (different ovulation suppressor) and an AI (Aromasin). In terms of side effects, your friend should expect to get the side effects associated with menopause because the Lupron will throw her into menopause. Think hot flashes, night sweats, mood swings, dryness, etc.

Best wishes to you and your friend! I'm sure she appreciates her kindness. If you have more specific questions about mets, be sure to visit the Stage IV board. There are already some existing threads that might be helpful to you and your friend (e.g. about the surgery issue).

Icietla

Member Bestbird, who has written a excellent guide to stage IV treatments and is active in our Stage IV forum section, writes to you:

------------------

Allison, iIt is very kind of you to reach out on behalf of your friend. I believe you'd receive more responses if you posted your questions on the Stage IV and Metastatic Breast Cancer forum:

https://community.breastcancer.org/forum/8

1) Personally, I think great cancer centers can have a wide range of skill sets and bedside manners in their doctors. I'd suggest reading reviews of oncologists in her insurance plan, checking their credentials and years of experience, and ensuring that she is comfortable with her choice. No matter what, she should seek a second opinion about her tx.

2) If your friend has only 1 liver met, she has Oligometastasis (limited disease) which is highly treatable with a combination of localized and systemic therapy, and which typically renders her prognosis a bit better than most. This is a conversation she should have with her doctor. Sometimes removing the met, combined with systemic therapy, can enable the patient to have no detectable disease for quite a long period of time.

3) If your friend is premenopausal with ER+, HER2-, then an Aromatase Inhibitor + Ibrance is typically the first treatment along with an ovarian suppression drug (for which ovary removal is another option). That said, she should discuss localized therapy to the liver (such as ablation of the met) with her doctor along with systemic therapy.

4) Ibrance typically causes white blood cell counts to drop. The ovarian suppression drug may cause menopausal symptoms.

For detailed information regarding each of the above, along with information about cutting edge research and side effect mitigation, you are welcome to request a complimentary copy of my 145 page booklet by visiting:https://www.inspire.com/groups/advanced-breast-can...

Icietla

I am so sorry about your friend's diagnosis. I know it is a terrible shock for both of you. I am sure it is a comfort to her to know that you care so much.

In the Hormonal Treatments discussion section, we have numerous discussion threads on the Aromatase Inhibitor medicines and their side effects. Here is a good thread on doing well on Aromatase Inhibitors__

https://community.breastcancer.org/forum/78/topics/854403?page=1

Evette13

My step daughter has IDC H2, they found a few spots on her left breast but what I need to know is... they found the largest spot on her Sternum and that is where they started with the Chemo which has caused her a LOT of pain. But I haven’t found anything about the Sternum spot so far online. Can someone enlighten me please