Aunt has Lesion on Liver

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morrigan_2575
morrigan_2575 Member Posts: 824
edited November 2021 in Stage IV/Metastatic Breast Cancer, Open to All To Contribute

hi all

Hope you can provide some guidance. My aunt has BC about 23 years ago, 16 years ago she had her second BC. First time it was in the left breast, lumpectomy+radiation and 5 years of Tamoxifen. Second time it was in her right breast, she did another lumpectomy+radiation and Anastrozole for 5 years.

She went to her Oncologist in June for routine blood work and her protein was high. He sent her for a CT Scan and they found a lesion on her Liver. They were supposed to do a biopsy but the Dr said her lesion was too close to her Diaphragm and he couldn't do a needle biopsy. She's 83 and has a blockage years ago so they don't want to do surgery in order to biopsy the lesion.

So the Oncologist decided to just put her on Anastrozole and monitor her Bloodwork. Does that sound right to you? I feel like they're a little to Blasé about it. I also don't want to upset or worry her unnecessarily

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  • moth
    moth Member Posts: 4,800
    edited August 2021

    Hi, I hope some ER+ people chime in. You might want to ask about this on the liver mets thread https://community.breastcancer.org/forum/8/topics/...

    I think I see anastrazole combined with fulvestrant more commonly than on its own, but her age & ability to withstand treatments might be guiding some of the treatment recommendations. I will pm you a screenshot of the NCCN guidelines for ER+ metastatic

    How aggressively does your aunt want to treat this? does she understand that this a terminal disease?


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  • morrigan_2575
    morrigan_2575 Member Posts: 824
    edited August 2021

    "How aggressively does your aunt want to treat this? does she understand that this a terminal disease?"

    I don't think she does. When she asked her Oncologist what the worst case was, he told her she'd have to go on 2 pills (didn't say which) but, that she'd be around for awhile.

    I was thinking about it after posting and, I'm sure her age plays a roll in how they treat her. There is the concern of quality vs quantity. I honestly don't even know what choices I would make at her age.

    Thanks for the PM!

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  • ShetlandPony
    ShetlandPony Member Posts: 4,924
    edited August 2021

    Hi, morrigan. So your aunt took tamoxifen for 5 years, then got 2 more years apparently cancer-free. Then a new breast cancer was found, she took anastrazole for 5 years, then got 11 more years apparently cancer-free. Is that right? It sounds like these cancers have not been particularly aggressive, though one of them is persistent. I'm guessing that this slowness would make an oncologist lean toward choosing easier treatment over aggressive treatment. And low-key treatment could keep the cancer at bay long enough for your aunt's natural lifetime, without subjecting her to more side effects. I think the two-pill option would be an anti estrogen such as anastrazole plus a targeted therapy like Ibrance. This targeted therapy could double the progression-free survival time. So this is where your aunt and her oncologist need to talk about how her health is otherwise, what is her own individual life expectancy. Do the ladies in her family live into their 90s and is she in great health otherwise? Or is she rather frail? Is she willing to put up with a lot for a better chance at seeing that next grandchild? Age alone should not determine the course of action. It has to be individualized. I would ask if the recommended treatment would be the same if your aunt was age 53. If not, why? In her position I might seek a consultation with a geriatric oncologist. It could probably be done via telehealth and you could attend.

    It makes sense to me that the doctor would not order a biopsy that is too risky. I think monitoring ought to be not only with blood tests (liver enzymes) but also with scans (CT, MRI, or PET), typically every three months. I would ask why use tamoxifen or anastrazole again since eventually one of those failed; how about aromasin? (These are all anti-estrogens but not exactly alike.) Fulvestrant/faslodex is another one, but it is some pretty big injections that I hate to think of giving to an older lady, so I would be inclined to try the others one first. Again, your aunt has to say what she is up for, what her goals and values are. (Choosing quality over quantity is not "giving up".)

    It sounds like you are a good ally -- sensitive to your aunt's feelings, looking out for her, without wanting to take over. Help her make sure she has a smart, compassionate doctor who is in her corner, and you have done a lot.

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  • SeeQ
    SeeQ Member Posts: 884
    edited August 2021

    morrigan - I think first line treatment is usually an AI (the anastrozole) and a CDK 4/6 inhibitor (Verzenio/Ibrance/Kisqali). I'm not sure if your aunt's age or other health conditions could affect the decision process. The insurance approval process for the CDK inhibitor could take several days - could it be that they're working on that and starting the anastrozole in the mean time? I started the anastrozole first, and Verzenio about a week later.

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  • morrigan_2575
    morrigan_2575 Member Posts: 824
    edited August 2021

    @ShetlandPony - Thanks for your reply that's good information. Yes, that's pretty much her situation of on/off cancer times.

    She's in pretty good health for 83, lives alone, still drives, no real issues. My mom and 2 aunts are the only ones alive of 8 siblings. My eldest living aunt is 95, my mom is 84 and my aunt is 83. I think we all assumed (at this point) that my mom and aunt would live into their 90s like their sister.

    I think I might have to get out my mindset with treating cancer (throw everything at it) to something more realistic for her age.

    @SeeQ - thanks for the info, I didn't realize that AI+ CDK Inhibitor was the first line action. For some reason I thought they'd start with Chemo again. I will check with her on the other pills Ibrance or Verzenio to see if he plans to include them. I'll also tell her to request Scans every 3 months, that blood work isn't enough.


    Thanks everyone who replied, I was thinking they're not being aggressive enough but, most likely that was my own issue/fear.







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  • ShetlandPony
    ShetlandPony Member Posts: 4,924
    edited August 2021

    A general principle with ER positive Her2 negative liver mets is to start with hormonal therapy, often with Ibrance, Kisqali or Verzenio, unless the mets are so large or numerous as to put the patient in imminent danger, in which case chemo would be used first to get things under control. And even in this case it would not typically be the big double or triple combo one might use for early stage. Stage iv is a marathon, not a sprint.

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  • morrigan_2575
    morrigan_2575 Member Posts: 824
    edited November 2021

    The AI she was on wasn't working and the mass grew so now they were able to do a Biopsy. He told her it was cancer and, coming from her breast but, he never used the word Metastatic or Stage 4. I have no idea if that's the right method but, I'm certainly not going to say anything to her or my mother.

    Got the full pathology report and now they're saying it's not Breast Cancer that spread to her liver, it's Liver Cancer, from her Bile Duct. She has to start on a low dose Chemo but, they said they caught it early. I know have to do research.


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