Professor Coleman is here to answer your questions

Professor Coleman is here to answer your questions

Professor Coleman is here to answer your questions As part of Lavender Week, Breast Cancer Care would like to welcome Professor Rob Coleman, Medical Consultant Oncology at Sheffield Teaching Hospitals, as today’s Expert on Line. Professor Coleman will be on line for an hour , email the moderator on the link below if you would like to ask Professor Coleman a question.

Moderator

Breast Cancer Care

New generation of drugs Hi Professor Coleman

Forum member Lynn wants to ask this question:

My oncologist said when the next generation of drugs come out secondaries will become a chronic yet manageable disease: how true is this and how far realistically are we away from this next generation?

Reply for Lynn The new treatments in development for breast cancer target some of the biological aspects of the cancer. This means that they may well be able to control the disease for a long period of time. They’re also likely to be well tolerated treatments making them more suitable for long term use.

Should I ask for bone scan I have severe arthritis. Should I insist on a bone scan to check for any mets as i may assume any pain is the arthritis?

Hormonal treatment If a woman is on Zoladex and tamoxifen can ovarian function be restored in theory after Zoladex is stopped? Should it be? Does stopping ovarian function for two years have longer lasting effects?

Kitty

Bone Scan Usually the pain from arthritis is quite different to the pain associated with cancer. However this is something you should discuss with your breast cancer specialist who I am sure will be sensitive to your concerns.

For Kitty Hello Kitty,

Zoladex is a reversible treatment for stopping ovarian function. Usually periods restart three to six months after discontinuation. However this depends on your age and previous treatments such as chemotherapy and cannot be guaranteed.

We don’t know the optimum duration of Zoladex. Most clinicians give the drug for at least two years, sometimes as long as five. There are no data to suggest that resumption of menstrual function after a course of Zoladex is a bad thing. Indeed women who become pregnant after a diagnosis of breast cancer do just as well as those who don’t suggesting that temporary high oestrogen levels after diagnosis are not a particular problem.

Why am I so tired? Forum member Karen asks:

I am 37 years old, 2 years since diagnosis and 14 months since I finished all treatment. Triple negative tumour so no on-going treatment. My question is why am I still so tired all the time. Some days I could just sit in a corner and cry as I am so tired and yet other days its not so bad. Is this normal and will my energy levels ever return to near normal.

Thank you.

Karen

For Karen Hello Karen,

Sorry to hear you’re still feeling so tired. The symptoms you are describing are not uncommon although sound quite extreme. I suggest that you talk to your breast care nurse or specialist about your symptoms and feelings as there may be some investigations that would be appropriate. There are 101 causes of tiredness so a thorough investigation may be needed. Additionally your breast care nurse will probably have a number of interventions that she can recommend to help your symptoms.

In most women the tiredness does get better but may take a very long time and never completely resolve, we don’t know why this should be the case. Hope you’re feeling better soon.

Lobular bc Kim would like to know

Is secondary lobular breast cancer as difficult to pick up on scans as primary lobular breast cancer?
Should I be considered for oophrectomy as I have read lobular breast cancer can spread to the ovaries and I am worried this wouldn’t be picked up until it was too advanced.

AI’s Is there any advantage of one Aromatase Inhibitor compared to another?

Quite a number of pre-menopausal women on here seem to be started on Tamoxifen post treatment , some of us have been given Arimidex immediately following chemo&rads.( I was pre- meno, 48 yrs, before chemo). No blood test to confirm menopausal status- treated in a centre of excellence.Is the difference in treatment Consultant preference?
Thank-You
Cherry

For Kim Hello Kim,

As you suggest primary lobular breast cancer often does now show up very well on a mammogram. However in my experience secondaries from lobular cancer are no more difficult to identify than those from other types of breast cancer.

The pattern of spread is however quite different and as you say may include the abdominal and pelvic organs. It would be quite unusual for the disease to spread just to the ovaries alone so I personally would not recommend removal of the ovaries for the purpose you suggest. However some specialists recommend removal of the ovaries to reduce the chances of recurrence anywhere in the body so it may be worth talking this through with your breast care nurse or specialist.

For Cherry Hello Cherry,

There are no obvious advantages to one aromatase inhibitor over another although sometimes patients find side effects differ so if they are unable to tolerate one agent they may get on fine with a different member of the family.

AI’s should only be used in women who are definitely past or through the menopause. Sometimes ovarian function can recover after chemotherapy and if this occurs the AI’s are inappropriate. In our centre if there is any doubt about menopausal status we stick to Tamoxifen or give treatment to suppress the ovaries alongside the AI. Blood tests for oestrogen levels are often not very helpful and indeed sometimes misleading. I would suggest that you contact your specialist if there is any sign that your periods are resuming.
If you are having hot flushes this is probably quite reassuring that the ovaries are non functioning.

MRI scan Helen asks

I was diagnosed with bc in 2004 aged 41 and found out I have a mutation of the BRCA 2 gene 2006. should I now have MRI scan instead of mammogram?

For Helen Hello Helen,

There is no right answer to your question. It depends a little bit on your breast density as to whether mammography would be sufficient. I suggest you discuss with your breast care nurse the appropriateness of MRI in your case.

response to chemo Lolag asks
Can you tell me whether a tumour that responds poorly to chemotherapy is more likely to recur or metasticise?

For Lolag Hello,

Presumably you are referring to response to preoperative chemotherapy? The response in the tumor can be a guide to prognosis particularly if oestrogen receptor negative disease. However oestrogen receptive positive tumors often don’t change much in size but the outcome is still relatively good. You should probably talk this through with your breast care nurse who will understand the exact nature of your breast cancer.

FEC I did neoadjuvant chemo to try to shrink a 3cm, grade 3 tumour. After 3 rounds of FEC the tumour remained the same size although it was softer. I switched to Taxotere and experienced only 1.1cm of shrinkage, although this was enough to allow a WLE. I had clear margins and negative nodes. I am concerned that the chemo may have failed to destroy any ‘micromets’ that may have broken off from the original tumour.

FEC This sounds like a good result from treatment. The most important feature is that the lymph nodes were clear. I would not be unduly concerned that the modest change in the breast lump is in any way a sign that the treatment has not been useful. Additional information such as the oestrogen and HER2 receptors is needed to decide what further treatment is required and the prognosis.