HealthCareMagic is now Ask A Doctor - 24x7 | https://www.askadoctor24x7.com

What Do These Following Lab Reports Indicate?

Posted on Fri, 19 May 2017

Question: Hello, What is the newest treatment option for breast cancer patient with bone metastasis (cancer size 8x 3 x 3.5cm on MRI) so far? Thanks.

Answered by Dr. Deepak Sundriyal (1 hour later)

Brief Answer:
Hello dear. A PET-CT is also required

Detailed Answer:
Hello dear.

I have gone through the all the reports in details. So it's a stage 4 breast cancer now and a PET-CT scan will also be required to look for other areas where tumor has spread. If it is only in the bones, then hormonal therapy like Fulvestrant plus CDK inhibitor drug Palbociclib will be the best agent.

Also, bisphosphonate drug has to be given to prevent fracture at mets site and focal radiation to the site may also be required.

Thanks and regards
Feel free to ask further

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Deepak Sundriyal (1 hour later)

Thanks for your quick response, Dr. Sundriyal.

Do you think if chemo would be necessary for the case?
PET-CT scan should be done before treatment starts or after treatment start or doesn't matter (because the tumor grow fast). Timing is the key.

Thanks again.

By the way, if gene profiling test for the bone biopsy tissue is required or not to guild drug/target treatment?
Thanks.

Answered by Dr. Deepak Sundriyal (27 minutes later)

Brief Answer:
Hello. Petct is required before the start of treatment.

Detailed Answer:
Hello dear. A petct is required before treatment begins. Gene express profiling is not required. If there is bone only disease, then chemo can be spared and only hormonal therapy will have excellent results.
Thanks and regards

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Deepak Sundriyal (3 hours later)

Thank you very much for your help.
I have a question, why two times X-ray and one time bone scan could not find any bone lesion/cancer met even the size is up to 8.3cm? Thanks again.

Answered by Dr. Deepak Sundriyal (0 minute later)

Brief Answer:
Hello. Xray has a poor sensitivity

Detailed Answer:
Hello dear. Xrays have very poor sensitivity for bony lesions. Bone scan if done at the same time as of mri should pick the lesion. However, some tumors may behave differently and an mri can pick a lesion early. In the course.
Thanks and regards

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Deepak Sundriyal (23 hours later)

Hi, Doctor Sundriyal,
Based on this case, could you share your experience for survival rate/prognosis per your experience/expectation? Your patient's best result?.
What diet or other life style issue you may suggest?
Thank you so much!

Thanks, Dr. Sundriyal,
Your information is very important and helpful.
So, what is the mechanism to avoid underground roots?
How do you think if the sweet potatoes, potatoes and taro are all belong to the category of underground roots? Please advise, thanks again.

Answered by Dr. Deepak Sundriyal (24 hours later)

Brief Answer:
Hello. If properly cooked, then can be eaten

Detailed Answer:
Hello dear. We ask to avoid roots as any underground vegetable is unhygienic and can have bacterias even if properly washed. However, if properly cooked or boiled, then can be eaten. I would like to know the er pr and her2 reports of tumor as these reports influence the survival. If er comes out to be postive and her2 negative, then survival. Can be upto many years say, 5 years or even more.
Thanks

Brief Answer:
Hello. I need er pr and her2 reports

Detailed Answer:
Hello dear. I would like to know the er pr and her2 reports of tumor as these reports influence the survival. If er comes out to be postive and her2 negative, then survival. Can be upto many years say, 5 years or even more. Regular aerobic exercises and home cooked food helps patients. Eat a lot of fresh fruits but avoid underground roots like beet root radhish, carrot etc.
Thanks and regards

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Deepak Sundriyal (11 hours later)

Hi, Dr. Sundriyal,
Thanks for your note.
I just spoke to local pathologic lab regarding ER,PR and Her2 tests and was told these tests were not included since the bone biopsy samples contained less cancer cells for the testing. However, these tests were done and showed ER+, PR+ and Her2- in 2008, the tests used surgical/tissue from the lumpectomy.

By the way, we will request the PET-CT when we see an oncologist next week. If PET-CT does show mets in other place, the treatment would include chemo? And what chemo drug is best/effective to choose from?
Your experience is very crucial to patient, thanks so much again.

Answered by Dr. Deepak Sundriyal (2 hours later)

Brief Answer:
A repeat ER or Her2 status is must

Detailed Answer:
Hello.

A repeat ER, Her2 check on metastatic tumor is a must as tumor tends to change these receptors and hence treatment gets changed.

If at all we have to choose chemo if PET-scan shows other areas of disease, any agent can be used but I'd prefer to use Abraxane due to its safety profile.

Thanks and regards

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

Above answer was peer-reviewed by : Dr. Arnab Banerjee