Urgent - Need Support PET Scan

[Prasath_sas]

Hello All, My mom had finished her radiation treatment on april 8, 2017.After that she underwent chemotheraphy on May 12.Now our oncologist had suggested for PET scan on 12 June,to check the response of disease.Whats the actually timeline to do PET scan after chemotheraphy or radiation? I am afraid that it will show any false positives like inflammation.,etc

[made2b2gether]

Prasant, it won't show a false positive. If your doctor has requested a PetScan, then do it. If your mother is a diabetic, then your doctor ought to check her sugar levels and consider the best timing of the Petct, cased on sugar levels. The Petct will give the doctor a good idea if more treatment is required, or what type of treatment is necessary, if there is any visible residua disease left. The concept is called PCR (Pathological Complete Response - means all cancer visible on scans is gone) or Residual Disease is present. If there is some visible activity or tumor activity left over, depending on her type of breast cancer, he will prescribe more treatment and this is a good thing. Your doctor is being vigilant and very careful with your dear mother, and that is a good thing. If you mother did not take out her breasts surgically yet, (and she did neo-adjuvant chemo), then an Ultrasound / Sonogram of the affected breast, in addition to the Petct will be good (do both). Talk to your doctor, and no, there will be no false positive as you have stated. Your doctor is doing the right thing. Follow his advise in timely fashion.

[kontak TeamBCI in reply to made2b2gether]

Prasath - It will not show any false results. Doctors want to see and compare the effects of chemo. Do as Doctors have told

[Prasath_sas in reply to made2b2gether]

Thanks for your reply,Please find below full details regarding my mom's diagonsis

My mom had been diagnose with breast cancer in 2011, lumpetocomy was done at that time and done with 6 cycles of chemotheraphy(Cyclophosphamide,5-FU and Adrim), Now again in 2017 recurrence happened in chest wall with mets to 1st and 4th rib and strenum.She undergone a surgery and now had concurrent chemoradiation(4 mild doses of CMF + 30 radiations(3DCRT).Also she had completed one cycle of chemo(taxol + carboplatin)

We had went for pet scan last week which showed the below findings

Lesions in ribs was totally cleared in this PET Scan( previously it was present in 1st and 4th rib (max suv - 5.8), increased uptake in left sternum suv - 6( previosuly the suv is 3.5), Doctor prescribed to take femare(letrozole 2.5 mg) and monthly once bone injection , but he was telling only the survival rate will be 2 to 3 years.. And he told No chemo required..kindly advise whether we are going in right path or is there any other advanced treatments available

[made2b2gether]

Hi Prasath_sas. I am not a doctor and I am merely a husband and a caretaker. My wife had tnbc (triple negative breast cancer) in 2014 and she was treated, whereby I gathered some bits and pieces of knowledge to help my wife. So please understand that I am not a medical professional and I do not know the vital details as I am no doctor.

Please note that breast cancer is a complex and varied disease process and there is no one type of treatment. There is standardized treatment by type of breast cancer , and then further individualized treatment regimens, that can be based on genetics, patient family history, and also based on careful watching and checking the response to certain medications that doctors prescribe. So there is no One Answer for this. So the need to see someone really specialized in breast cancer is your first priority. I write this because the treatment prescribed in 2011 does not seem Standard and complete! This really concerns me about the doctors recommendations in 2011 (and possibly even the doctor you are seeing now - is he/she the same doctor? And also is the treatment at a larger medical facility with a doctor with expertise in breast cancer care?).

But based on what you've written above, I will comment. In 2011, when your mother was diagnosed with breast cancer, was the cancer at the time hormone-receptor-positive breast cancer? Such as driven by Er or Pr (Estrogen or Progesterone)? I ask because she is now being given bone injections of a specific kind (?), and is also being prescribed femara (letrozole 2.5 mg). Check if the dose of Femara is correct, because you say monthly above - I assume you mean the bone injection is monthly. My guess (as a layman is that the Femara - Letrozole dose should be a daily dose - but you should verify and ask).

If so, why was she not given any hormone suppressing medicines (or was she?)? The chemo alone is not standard therapy and is very questionable. Did she get Hormone Suppressing therapy post, or during chemo when diagnosed in 2011? Please first answer that. Did she take a pill, everyday for a number of years after being diagnosed?

When diagnosed in 2011, was your mothers cancer driven by Estrogen (ER+), Progesterone (PR+), HER 2, a combination of the previously mentioned drivers, or did the doctor say that it was TNBC (Triple Negative Breast Cancer)? This is important to know, as the exact diagnosis determines standard care and treatment.

And based on the now recurrence and biopsy result, what is the type of breast cancer and recommended treatment for your mothers (her age and health all considered)?

There is a lot of information on these websites;

breastcancer.org/symptoms/d...

breastcancer.org/

lbbc.org/i-am-living-with-m...

I am questioning your doctors prescribed treatment in 2011! It does not seem right, but you can ask sumeet_shah on this forum, as he is a Medical Professional, and he is a good man!

Glad you did the Petct. Our last conversation was telling you that it would not give false results. Good you went ahead and did it.

Now, your doctor telling you that she has 2-3 years. He is not GOD. Only GOD decides how many years we have. She could have 1 year. She could have 10 good years or more. Please go to a top medical University Hospital in a big City in India (Mumbai, Delhi, Pune, Hyderabad, Bangalore, Chennai, or a City closest to your Hometown), and talk to specialized and experienced breast cancer doctor on treatment options for your mother. Share her full patient history, and repeat the biopsy, and the petct if necessary!

Ask them if along with targeted hormone suppressing therapy and bone injections, ask the doctors if any other treatments are recommended for your mothers case. Your mothers age will also plan a role to judge if chemo is even a viable option. But it does not hurt to ASK! Ask questions! Also, with the correct line of treatment, work with the Oncologist and a Palliative Care specialist to manage your mothers pain. This will help a lot. So also get introduced to a doctor specialized on Oncology and Palliative Care (specially pain management to do with Cancer).

Take the entire history with you to a larger hospital for a 2nd Opinion (you must). If your mother was not given hormone suppressing therapy the first time (in 2011), then what is to say that the correct line of therapy won't help her this time. She may greatly benefit.

I cannot make you optimistic because I am also a layman and I too am not GOD, and fact is I do not know, but the most important thing is, 1) Based on your mothers specific type of breast cancer, first get the correct and right treatment. Ask questions of the doctor. Read online. And everything your doctor says may not be right (especially on life expectancy). Remember, you need to talk to a top breast care specialist and then take their best advise on treatment, and then do your very best and also be realistic.

But also keep in mind, a doctor saying 2-3 years does not mean that your mother has that much time left (they talk with data on averages). But first you have to ensure he / she is doing everything the doctor must do medically and in terms of treatment before making such broad claims about life expectancy and expected survival. Now, Please first focus on getting her the right treatment, the right care, a good Second Opinion from another doctor at a good hospital in your City. Then look after her well and give her plenty of affection and love. You don't know this, but she could be happy, well and alive for much longer than anyone expected. Important thing is the right diagnosis, the right treatment for that diagnosis, and a lot of love, care and affection, Now, when she is alive!

Take care and please get that 2nd Opinion. Ask around on the forum for good breast care doctors, and specifically, a letter of introduction in your City.

Please take care.

[Prasath_sas]

Hello Sir,

Thanks for your valuable time and your sugesstion.Please find below the missing information

2011 :

In 2011 when she was first diagnosed with BC, she underwent a surgery mastetocomy to remove breast and after that she undergone 6 cycles of chemo(FAC).No hormone receptor test was done at that time and after chemo she was taking vitamin tablets only for 5 years.Biopsy results came as : Invasive lobular carcinoma, grade II, micrometastatic deposit in one lymph node.surgery&treatment was done by general surgeon

2017 :

In jan 2017 we went for a normal check up and it showed lesion in chest wall.we had a surgery at that time to remove the lesion, the biposy report came as : invasive breast carcinoma of no special type, grade II, Tumor is involving skeletal muscle and margin of excision , vascular and perinueral invasion is present. Hormone receptor status : ER + 8/8 , PR 4/8 and HER -

So we changed to multi-speciality hospital where the oncologist had advised for a pet scan, we took a pet scan on 08.02.2017 and it showed lesions in ribs and sternum.So oncologist first preferred for concurrent chemoradiation for 30 days(3DRT + 4 mild doses of CMF).After that she took one cycle of chemo(taxol and carboplatin).She was not able to tolerate the chemo dosage and i got a contact from another multispeciality hospital where the oncologist had done DM and practised in famous cancer research insititute.

So we had switched to new oncologist and he ordered for pet scan and results shown as cancer was gone from ribs and present in sternum only.he advised to take famara(letrozole 2,5 mg) one tablet per day and one bone injection per month.

@Sumeth_shah : sir can you pls advise whether she needs more chemo or any other treatments