Breast pain in metastatic breast cancer

[Mjmumbai]

My mom 52 yr old was diagnosed with metastatic breast cancer with widespread bone metastases in Jan 2016 (er,pr+ve).. hormonal therapy letrozole started in Feb 2016..on follow up visit after evaluation doctor said there was local increase in tumor and started us on fulvestrant 500mg yest..since yest evening she has severe breast pain and it is not subsiding even with painkillers..is this normal? Is pain expected after fulvestrant or is it due to the physical examination? What can we do to reduce the pain? I can only see the doctor again on next Wednesday..what can I do till then to help her?

[roxboxfox RadiationOncologist]

Probably this is tumour flare phenomena and this should be transient. It is a rare side-effect seen in 1% of patients. It will usually subside in a weeks time.

Pain management in a step wise fashion is usually recommended.

with Paracetamol (full dose)

followed by addition of NSAID @ Full dose

Then Opioid Analgesia usually does the trick.

You will need an experienced Oncologist and Pain specialist to support and tide over the crisis.

I m sorry that you have no support till Wednesday, and wonder if your General Practitioner or another specialist could be of any help.

Regards

Dr Rohit Malde

[Mjmumbai in reply to roxboxfox]

Thanks a lot for ur reply sir..I recollect now that she started complaining abt breast pain before the injection..I'm suspecting probably due to the palpation during physical evaluation..before this she had shooting pain only for few seconds sometimes but after the follow up its continuous. Sas it hurts lIke an open wound..we are currently giving her NSAIDS Tds..but it doesn't make much of a difference..today she is feeling little feverish also and she thinks the size has increased(swelling??)..I'm jus surprised that a palapation led to such severe pain..il try to manage till tom morn..if it is not subsiding will try to consult a medical oncologist for emergency/pain management..

[Mjmumbai in reply to Mjmumbai]

I went for a follow up and the doctors have mentioned that it is a local disease progression..asked for repeat biopsy for assessment of the er/pr status..they hv also given her a fentanyl patch for pain relief and suggested palliative breast radiotherapy for the control of pain