Aunt has Lesion on Liver
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
Comments
-
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?
-
"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!
-
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.
-
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.
-
@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.
-
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.
-
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.
Categories
- All Categories
- 679 Advocacy and Fund-Raising
- 289 Advocacy
- 68 I've Donated to Breastcancer.org in honor of....
- Test
- 322 Walks, Runs and Fundraising Events for Breastcancer.org
- 5.6K Community Connections
- 282 Middle Age 40-60(ish) Years Old With Breast Cancer
- 53 Australians and New Zealanders Affected by Breast Cancer
- 208 Black Women or Men With Breast Cancer
- 684 Canadians Affected by Breast Cancer
- 1.5K Caring for Someone with Breast cancer
- 455 Caring for Someone with Stage IV or Mets
- 260 High Risk of Recurrence or Second Breast Cancer
- 22 International, Non-English Speakers With Breast Cancer
- 16 Latinas/Hispanics With Breast Cancer
- 189 LGBTQA+ With Breast Cancer
- 152 May Their Memory Live On
- 85 Member Matchup & Virtual Support Meetups
- 375 Members by Location
- 291 Older Than 60 Years Old With Breast Cancer
- 177 Singles With Breast Cancer
- 869 Young With Breast Cancer
- 50.4K Connecting With Others Who Have a Similar Diagnosis
- 204 Breast Cancer with Another Diagnosis or Comorbidity
- 4K DCIS (Ductal Carcinoma In Situ)
- 79 DCIS plus HER2-positive Microinvasion
- 529 Genetic Testing
- 2.2K HER2+ (Positive) Breast Cancer
- 1.5K IBC (Inflammatory Breast Cancer)
- 3.4K IDC (Invasive Ductal Carcinoma)
- 1.5K ILC (Invasive Lobular Carcinoma)
- 999 Just Diagnosed With a Recurrence or Metastasis
- 652 LCIS (Lobular Carcinoma In Situ)
- 193 Less Common Types of Breast Cancer
- 252 Male Breast Cancer
- 86 Mixed Type Breast Cancer
- 3.1K Not Diagnosed With a Recurrence or Metastases but Concerned
- 189 Palliative Therapy/Hospice Care
- 488 Second or Third Breast Cancer
- 1.2K Stage I Breast Cancer
- 313 Stage II Breast Cancer
- 3.8K Stage III Breast Cancer
- 2.5K Triple-Negative Breast Cancer
- 13.1K Day-to-Day Matters
- 132 All things COVID-19 or coronavirus
- 87 BCO Free-Cycle: Give or Trade Items Related to Breast Cancer
- 5.9K Clinical Trials, Research News, Podcasts, and Study Results
- 86 Coping with Holidays, Special Days and Anniversaries
- 828 Employment, Insurance, and Other Financial Issues
- 101 Family and Family Planning Matters
- Family Issues for Those Who Have Breast Cancer
- 26 Furry friends
- 1.8K Humor and Games
- 1.6K Mental Health: Because Cancer Doesn't Just Affect Your Breasts
- 706 Recipe Swap for Healthy Living
- 704 Recommend Your Resources
- 171 Sex & Relationship Matters
- 9 The Political Corner
- 874 Working on Your Fitness
- 4.5K Moving On & Finding Inspiration After Breast Cancer
- 394 Bonded by Breast Cancer
- 3.1K Life After Breast Cancer
- 806 Prayers and Spiritual Support
- 285 Who or What Inspires You?
- 28.7K Not Diagnosed But Concerned
- 1K Benign Breast Conditions
- 2.3K High Risk for Breast Cancer
- 18K Not Diagnosed But Worried
- 7.4K Waiting for Test Results
- 603 Site News and Announcements
- 560 Comments, Suggestions, Feature Requests
- 39 Mod Announcements, Breastcancer.org News, Blog Entries, Podcasts
- 4 Survey, Interview and Participant Requests: Need your Help!
- 61.9K Tests, Treatments & Side Effects
- 586 Alternative Medicine
- 255 Bone Health and Bone Loss
- 11.4K Breast Reconstruction
- 7.9K Chemotherapy - Before, During, and After
- 2.7K Complementary and Holistic Medicine and Treatment
- 775 Diagnosed and Waiting for Test Results
- 7.8K Hormonal Therapy - Before, During, and After
- 50 Immunotherapy - Before, During, and After
- 7.4K Just Diagnosed
- 1.4K Living Without Reconstruction After a Mastectomy
- 5.2K Lymphedema
- 3.6K Managing Side Effects of Breast Cancer and Its Treatment
- 591 Pain
- 3.9K Radiation Therapy - Before, During, and After
- 8.4K Surgery - Before, During, and After
- 109 Welcome to Breastcancer.org
- 98 Acknowledging and honoring our Community
- 11 Info & Resources for New Patients & Members From the Team