52 yr old female with stage 4 breast cancer with metastases in multiple lymph nodes and multiple bones over the spine and b/l femur

[Mjmumbai]

My mom 52 yr old had been complaining abt back pain on and off since last 6 months and was taking treatment for it with worsening symptoms then noticed a lump in the left breast with inverted nipple one month back and was recently diagnosed with metastatic breast cancer following a biopsy and PET scan. .the biopsy revealed grade 2 with ER +ve 90% PR +ve 25%, HER2 -ve Ki67 25 and pet scan showed multiple lytic lesions in the spine and the acetubulum (>10 metastases in the bones) and multiple lymph node metastases in and around the left breast. Her main problem currently is back pain and pain around the right hip and buttocks with difficulty in turning, sitting and walking..major problem is sitting although she feels better with analgesics (dynapar ec) and rest. we are very worried as to what should be the treatment protocol now..we had consulted a doctor in the town side and he has referred us to a doctor in borivali which is close to our place..but we are not sure if we should start with chemo or hormone therapy & biphosphonates..also should radiation be given or should we consult an orthopaedic surgeon for spinal surgery?? We stay on the fourth floor without a lift thus even travelling for radiation is a problem..the situation right now is making us feel so helpless..we are very worried abt the prognosis..kindly help and give your valuable advice..thanks

[tiger72]

Dear MjMumbai:

We can understand your tension & worry. Please share your mothers report with us such that the expert doctors on this forum can help you. Once they go through your mothers report, they can guide you.

We all are with you. You can share all your fears & queries with us.

Please be strong & positive.

With regards,

Tiger72.

[roxboxfox RadiationOncologist]

She needs Palliative Radiotherapy

She is indeed at high risk to have fractures.

One needs to assess how suitable and feasible is it to offer Palliative Chemotherapy.

If not, then Hormones is another option.

She also needs bisphosponates

Rohit

[Mjmumbai in reply to roxboxfox]

Sir, Thanks a lot for ur advice..our current doctor has advised palliative radiotherapy with hospital admission so that she doesn't have to travel..should we go for radiation as soon as possible or can we manage with analgesics for the time being??

If we go for radiation how long Wil the pain relief be? And can we do it again if required?

[Mjmumbai]

Dear tiger72 & roxboxfox,

Thanks a lot for ur guidance..the first doctor we consulted had recommended us altraz 1mg/day plus zolondronate and the second one near our place has recommended letrozole 2.5mg/day with zolondronate..now we are unsure as to what we should take?? Can u Pls guide? Also we took an mri spine in advise which reveals l1 vertebra loss of height & retropulsion of posterior cortex indenting cortico medullaris & causing mild canal stenosis (AP diameter =7.2)..what do u think abt this??

[roxboxfox RadiationOncologist]

She need Radiotherapy soon...not only to Spine but also to her acetabulum.

Analgesics alone will be inefficient.

Hormones you have both options

There is :

Anastrozole 1mg

Or

Letrozole 1mg

Both are reasonable options.

Zoledronic acid infusions to be taken once a month.

For Radiotherapy options are

Nanavati Hospital

Kokilaben Ambani

Or Tata Memorial Hospital

[Mjmumbai in reply to roxboxfox]

Ok..thanks a lot sir..il try to get an appointment for radiation very soon.

[Mjmumbai in reply to roxboxfox]

Sir,

Is palliative radiotherapy useful in reducing the risk of fractures or is it just for pain?

[sumeet_shah Administrator in reply to Mjmumbai]

It helps in both. Main intent is pain relief. For radiation therapy, I would strongly suggest you to see Dr. Rohit Malde at Nanavati Hospital. You will rarely get a doc who gives so much time to a patient.

Radiation should be given as soon as possible.

As for Letrozole versus Anastrozole, both are same in efficiency and it does not matter which one you go for.

[Mjmumbai in reply to sumeet_shah]

Sir, Thanks a lot for your valuable guidance

[Mjmumbai in reply to roxboxfox]

Thanks a lot sir..will try to get in touch with you as soon as possible