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Took Medicine For Metastatic Disease. Can Anybody Have Malignant Tumours In The Liver And Granulomatous Lymphadeniis In The Lungs?

Posted on Wed, 28 Nov 2012

Question: I had mastectomy in the left breast in 2006. In 2010 I was diagonised with matastasis in the liver, lungs and pubic bone. I have taken abraxene, xeloda, gemzar, vinorylabine I was diagonised wih two lesions in the btrain in April2012 for which i took cyberknife treatment. I took 6 cycles of docetaxol and carboplatin. On Pet scan it was found that in the liver SUV is nil but the largest tumour still remains to be 16 cm x 18 cm. I have one new lesion in the brain. In the lungs two new nodules have come up. I got a bronchoscopy aided biopsy done in the lungs. The results showed that it was chronic granulomatous lymphadenitis. The Doc said that the brain met could be becuase of that. Can anybody have malignant tumours in the liver and granulomatous lymphadeniis in the lungs? He has given me steriods 60 mg (Omnacortil). Will this take care of the liver also? What about the mets in the pubic bone which has not changed much in the past 2 1/4 years? Pls let me know

Answered by Dr. Indranil Ghosh (1 hour later)

Hi

Thanks for writing in.

I have noted your history. It appears that you have tried many systemic therapies for metastatic disease. The disease responds to chemo but again increases after some time necessitating a change in therapy.

As new lesion in the brain has come back, probably the response to docetaxel-carboplatin is lost. Though the new lung lesions may be because of granuloma (as per biopsy), the brain lesion is unlikely to be because of that. Was MRI brain (with spectroscopy) done? That can throw some light on the brain lesion.

Steroid is not going to take care of the metastases anywhere. It can only be of help in reducing fluid around brain mets or lung granuloma which is not due to Tuberculosis. I am not sure whether tuberculosis has been ruled out. It can flare up with steroids.

The bone metastases usually do not change much on scans; their activity may go down only.

Hope I have answered you query. I will be available for further follow-up queries, if any.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Indranil Ghosh (47 hours later)

Hello Doc, I was told that MRI with spectroscopy will not yield correct results in case of metastatic tumours. It will hold good only if one has original site of cancer in the brain. Is that true? Yes, Tuberculosis has been ruled out .
For the new lesion in the brain Doc has told me to wait for another 15 days as he says the lesion can be seen in only two sections but I am apprehensive as it has grown in the past three months from 5mm to 11 mm.So does that mean I will not have to take steriods for the lungs granuloma, radiation for the brain and some new chemotheraphy for the liver, Lungs & bones. In that case could you suggest what are the options available to me in chemotheraphy. I am a triple negative case. Is it possible that on going for a liver biopsy ther may be changes of me being at least ER , PR Or Her2 positive (any one of them). I was ER & PR positive in 2006.(In 2010 ER-Positive weak,PGR negative & HER2Neu negative) Thank you.

Answered by Dr. Indranil Ghosh (3 hours later)

Keeping in mind the entire picture I would consider low dose oral chemotherapy with endoxan, methotrexate as your treatment. Brain RT I would hold on at this moment. Steroids also seem unnecessary to me at this point. However, your oncologist is the best judge of the scenario.
Did you ever receive hormonal therapy and if so, what was the response? if there was ever any response to hormonal therapy then it may be considered again.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Indranil Ghosh (14 hours later)

I was taking nalvodex (tamoxifen) from 2006 Sept to 2010. The fourth year scan revealed metastasis in the liver, bone and lungs. So I guess hormonal therapy does not work for me. I have taken Xeloda earlier. Do you suggest I take that again as a low dose chemotherapy or is there any other oral chemotherapy drug? What are endoxan and methotrexate? are they chemotheraphy drugs or oral drugs?

Answered by Dr. Indranil Ghosh (1 hour later)

My answers to your queries..

1. As nolvadex kept it under control for so many years, I think you should try some other hormonal therapy. There is a fair chance of response
I would do FSH, LH, estradiol, if these are in post-menopausal range then start arimidex tablet. Or else zoladex injection+arimidex.

2. Methotrexate and endoxan are oral chemotherapy drugs and if given in a low dose continuous schedule benefits many patients (this strategy is known as metronomic therapy).

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Indranil Ghosh (23 hours later)

I got my menopause in 2006 Sept. After that they did a test and found out that it was menopause. To do FSH, LH, estradiol will I have to go in for a biopsy or blood test?

Answered by Dr. Indranil Ghosh (1 hour later)

FSH, LH, estradiol are blood tests to confirm menopause. If it has been confirmed already, then you can start arimidex alone.

Note: For further queries related to kidney problems Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar