when and how to test for progression?

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I find it very surprising that she did not get scans at diagnosis.  I did.  

I too am a little surprised that staging at Dana Farber did not include some scans.  It seems to me that if there WAS metastatic disease present to any degree, that could be conclusively found.  I understand what he's saying about things that are not conclusive, but stage IV tx plans start off differently than stage III, so I would think they would want to have a good idea that MBC was not present. 

I had a chest x-ray, PET/CT, and a bone scan to see if I was already stage IV.   Ruling that out made me stage IIIC, and determined the tx plan.  Within the first year after finishing all my tx, hip and sacral pain that was later attributed to Arimidex resulted in another bone scan, and some lung nodules seen on the initial PET/CT were followed for another year with additional CT scans (none were every biopsied) until they finally resolved on their own.   Was that overkill compared to what your wife's onc thinks?   Perhaps it was.  Vigilence itself, although it made me feel better that the doctor was looking into my every ache and pain, is not going to prevent me from dying of breast cancer.

General pain that moves around, and especially if it's in the joints could be a possible Tamoxifen issue.   Fractured ribs are fairly common after radiation.   My understanding is that metastatic disease pain is generally very specifically in a certain place and doesn't move around, and once experienced does not come and go.   I too highly recommend stepping up the exercise if she is not already active; it helped me tremendously.   If she has a pain or a cough or other specific issue that lasts for 2 weeks or more, her onc should be investigating it though, and ruling out MBC.   If he's not responsive to her, and she's unhappy about it, maybe she needs a different onc.  There are a number of different philosophies for how best to follow this disease, so why not have a doctor that follows one that fits what makes you both comfortable.

I was Stage IIIc at dx, and was sent for an pet scan and maybe a MRI to rule out progression.  Honestly, I felt like my onc was surprised I wasn't Stage IV considering the inter mammary node, vascular invasion and size of the tumor.

Kathleen is correct.  Any symptoms which last longer than two weeks and worsen should be checked out.  Persistent and progressive are the key words.  

I see my onc twice a year (after 5 years) and have labs done which include tumor markers at those visits.

What type of follow up care is she receiving?