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Treatment for ER+/PR positive breast cancer

Q: I was diagnosed cancer in my right breast in Feb. 2000 which had also metastasised to vertebrae and the hip bone. My cancer was ER/PR positive. I was given chemotherapy (Adiramycin, Cyclophosphamide two cycles and then Adiramycein and Taxol 6 cycles). I had also started taking Tamoxifen from Feb. 2000 which was completed in October 2000. After that my mammography was normal but bone scan showed multiple metastases in my vertebrae and hip bone also. I was also given 12 cycles of 90 mg Aredia. In August 2001, my mammography was again normal. Upto February 2002, I was pulling along with off and on pain in my back and sometimes my shoulder. Since then I have also noticed that my right nipple is now drawn inside. My right breast has become hard in comparison to the left one after treatment though the mammography was normal. In March 2002, chord compression was diagnosed by MRI. Tamoxifen was stopped and radiation of spine was done in March 2002. After this I was prescribed Mestrel 160 mg daily. Now again in June 2002, I am having severe pain in my hip bone. I have the following questions: a) Should I continue with Mestrel? b) Should I go for ovary removal? My one ovary is already removed. c) After removal of ovary, which will be better for me - Mestrel or Femara. d) Please suggest me any other treatment.

A:You have ER+/PR+ breast cancer with bone metastasis. You have received AC/Taxol+Adria in 2000 followed by Tamoxifen/Aredia. On progression of bone lesions, you have recieved local RT and Mestrel. To know why the breast is hard we need an examination. For hip pain you should get bone scan and X-ray pelvis-AP. Since your pain is progressively increasing Mestrel is not working any more. Femara is given to patients who are ER+/PR+ and post menopausal and those who have had ovarian ablation (removal) six months before. We do not know your menopausal status and hence cannot advice about Femara. You should have lung/liver assessed by x-ray chest and abdominal ultra-sound. We would want to know your HEP-2 NEU status. You will be a candidate for 1) Local RT to hip, 2)Chemotherapy - oral Xeloda tablets, Navelbine, Taxotere, Herceptin (if HEr2 positive), Gemcite, CMF, 3) Medroxyprogesterone acetate, 4) Femara, if you fulfill the criteria mentioned above, 5) Ovarian ablation/Zoladex, if you are pre-menopausal.

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