Q: I was diagnosed cancer in my right breast 3 years back, which had also metastasised in vertebra and also in hip bone. My cancer was ER/PR (Estrogen receptor / Progesterone receptor) positive. I was given chemotherapy (adriamycein, cyclophosphamide two cycles and then adriamycein and taxol 6 cycles). I had also started taking tamoxifen. Chemotherapy was completed in 8 months. After that my mammography was normal. But bone scan showed multiple metastases in my vertebra and hip bone also. I was also given 12 cycles of 90 mg aredia. Next year, my mammography was normal. Till last year, I was pulling along with off and on pain in my back and also some times in shoulder. From this period I have also noticed that my right nipple is now drawn inside. My right breast had become hard in comparison to the left one after treatment, though the mammography was normal. Last year, cord compression in my vertebra was diagnosed by MRI. Tamoxifen was stopped and radiation of spine was done. After this I was prescribed with Mestrel 160 mg daily. After a couple of months, I had been having severe pain in my hip bone and mammography showed again tumor activity. Since 6 months, I am taking Chemotherapy (taxotere). I have completed four courses (each of three cycles weekly 60 mg each). My ovary (right) has been removed. Left ovary was already removed earlier. Presently there is swelling in my right arm, my axilla is normal and my veins are normal as shown by doppler sonography. The swelling in my right arm started when I took third dose of docetaxel in my righthand. Pain in hip bone is now not there. CT scan of abdomen 3 months ago showed liver metastasis and I stopped taking Mestrel. Started Femara (2.5 mg). After that I was given following chemotherapy: Nivelbine + Cisplatin; Nivelbine; Nivelbine + Cisplatin; Nivelbine. The recent CT scan showed metastasis in liver (same condition as it was before). CA-125 is 2271 u/ml while CA-15-3 is 235 u/ml. Present symptoms include swelling in right hand, right breast is heavier, right nipple slightly drawn in. Appetite and sleep are normal. The final diagnosis is breast cancer with metastasis in bones and liver. Please suggest me further treatment.

A:You are being treated alright. The principle is to use chemotherapy drugs and hormones in sequential fashion i.e., one after the other. Currently you are on femara and navelbine combination. This should be continued as long the disease is under control. Once there are signs of progressive disease, following options exist: 1. xeloda 2. caelyx 3. aromasin 4. medroxyprogestrone acetate 5. faslodex 6. herceptin, if you are her-2neu positive.