Breast cancer – Symptoms and treatment
Is it true that bone marrow transplant is better than standard chemotherapy?
High-dose chemotherapy with bone marrow (or stem cell) transplant is a way of giving high doses of chemotherapy and replacing blood-forming bone marrow cells destroyed by the cancer treatment. It is actually more like a fancy blood transfusion than an organ transplant. Stem cells are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, these stem cells are thawed and given back to the patient through an intravenous infusion. These reinfused stem cells home to the bone marrow where they grow into and restore the body’s blood cells.
Though high-dose chemotherapy followed by stem cell transplant is useful in a number of cancers, studies have clearly shown that it does not work any better than standard chemotherapy in the treatment of breast cancer. Indeed, these studies showed that more breast cancer patients died of treatment side effects with this treatment than those who got standard treatment.
Since the goal of chemotherapy is to allow you to live your life, it is imperative that you do so, sometimes despite the chemotherapy itself.
Is it safe to travel while I am getting chemotherapy?
Although sticking to the chemotherapy schedule is important, the schedule is not nearly as inflexible as many people think that is. You will probably be getting chemotherapy for the rest of your life. Since the goal of chemotherapy is to allow you to live your life, it is imperative that you do so, sometimes despite the chemotherapy itself. Holidays, vacations, and family lifecycle events are part of everyone’s life. Just because you are getting chemotherapy does not mean that you need to forgo these pleasures. Tell your oncologist when they will occur, and do not be surprised when she accommodates your chemotherapy schedule around those events. Unless it becomes a regular practice, a day here or there, or an occasional extra week between cycles, will have little impact on how well the chemotherapy works; especially once you have a few treatment cycles under your belt. During your regular cycle of therapy, there are better times to travel than others. The best time to travel is once you are through the period of nadir cytopenias, just before you are due to get your next treatment. Make sure that your oncologist knows of your travel plans, and be sure to carry with you a summary of your chemotherapy treatment and latest blood counts. If you do not have access to a doctor through the friends or relatives whom you plan to visit, ask your oncologist to give you the name of a local oncologist in case you run into trouble. Of course, make sure that you take your oncologist’s telephone and fax number with you.
How does the doctor determine if I should get hormonal therapy instead of chemotherapy?
Hormonal therapy is only an option if your cancer cells have hormone receptors present. When your breast cancer was first biopsied, the pathologists tested your cancer cells to see if estrogen receptors (ER) or progesterone receptors (PR) were present. Unless this test found at least one of these hormone receptors, your cancer will not respond to hormone therapy. Breast cancers may keep the same hormonal receptor profile forever. However, from time to time, hormone receptor–positive cancers become negative.
It is unusual for a hormone receptor–negative cancer to change to hormone receptor–positive. If your doctor suspects that the hormone receptor status of your cancer may have changed, she may want to biopsy one of the metastatic spots and send it to a laboratory for estrogen and progesterone receptor tests.
If your cancer is not estrogen receptor–positive or progesterone receptor–positive or both, chemotherapy is your only option. If it is hormone receptor–positive, your doctor can use either chemotherapy or hormonal therapy to treat your cancer.
Hormone therapy is usually the first treatment used in postmenopausal women, unless their tumor is hormone receptor negative. Though it may have side effects, they are usually tolerated much better than the side effects of chemotherapy. Hormone therapy is especially useful in patients whose metastatic disease involves only bone or soft tissue. Though it is also useful in treating metastases to the vital organs (liver, lung, etc.), chemotherapy often works faster in these situations. If your cancer has recurred while you are taking adjuvant hormonal therapy, your doctor may prefer to switch to chemotherapy as the initial treatment for your metastatic cancer, especially if your cancer involves sites other than the bone or soft tissues. Another option would be to switch to a different type of hormonal therapy than you are currently using.
Chrissie’s comments:
It frustrates me that I’m only receiving hormonal therapy right now for treatment of my recently discovered metastatic disease. I want it cut out, killed with chemo, and zapped away with radiation. That makes sense to me. The doctors say that less aggressive treatment may get it into control-that is the mission now. I still think that the mission is to be cured. I need to start thinking of this disease as a chronic disease and that is hard to do.
Are there different types of hormonal therapies? How does my doctor decide which to use?
Different types of hormonal therapies are used to treat cancer in postmenopausal women than those used in premenopausal women. Aromatase inhibitors (AIs) are usually the anti-estrogen of choice in postmenopausal women. Though tamoxifen is quite effective in postmenopausal women, the AIs work better and have fewer side effects. Because they have no effect on estrogens produced by the ovaries, AIs do not work in premenopausal women. Sometimes doctors combine hormone therapy (for example, buserelin and tamoxifen). Women whose tumors are hormone receptor positive and have received anti-estrogens within the past year may still respond to second-line hormonal therapy. Examples of second-line hormonal therapy in postmenopausal women include AIs like anastrozole, letrozole, or exemestane. Fulvestrant is another useful antiestrogen. Premenopausal women with hormone receptor–positive breast cancers should undergo oophorectomy, either surgically, induced with radiation therapy, or with medicine. Tamoxifen is also an option for premenopausal women, whose cancer is hormone receptor–positive and was not treated with it in the past. Different types of hormonal
Therapies are used to treat cancer in postmenopausal women than those used in premenopausal women.
