Resolved question:
Thank you for all your answers.
My doctor reminded me today, that my most likely way to metastatic cancer, is that I have isolated tumor cells in my bone marrow (2-3 percent). They are just single cells. No "bone marrow cancer" or bone cancer yet.
The idea has been that the chemo will kill or make most of them dormant, and then the AI's will make the rest go to sleep (ALLRED=8).
But, here's what I'm worried about--I'm going to have to wait 4 months to start the AI's while I have a mastectomy and radiation. My doctor will NOT let me take the AI's until I am done with both of those, because he thinks the AI's interfere with radiation.
Do you think the lobular itc's will just sit there and do nothing for 4 months, or am I risking getting bone marrow or bone cancer by waiting those 4 months, without taking AI's?
The one consultation I had at Stanford University--that doctor thought the itc's would move pretty slowly. What do you know about this?
Submitted:
4 Days
Category:
Oncologist
Hello.
Thank you for your query at DoctorSpring.com.
This is the same that I intended to convey to you. Absence of systemic therapy during surgery is OKAY. AIs can be started after radiation. The old concept has changed now.
I hope Stanford doctors have also reassured you about your good prognosis because of your good ALLRED score.
Feel free to discuss further.
Kind regards.
How worried do YOU think I should be about the itc's metastasizing to the bone marrow.? Is this truly likely? I am so afraid I will get metastasis from the itc's BEFORE I even start the AI's. I guess the real question is, how aggressive are these itc's likely to be?
I think my big worry is that with my immunity lowered from chemo and radiation, the itc's will be able to move right in. What do you think of that?
You are right now on chemotherapy which can have an impact (kill or suppress) on the ITCs. They are cancer cells which can grow. I agree with it but with good ER positivity, I can say that they need not be aggressive. ER positive tumors are generally indolent ones. 4 months is a normal gap for all patients undergoing chemo surgery and radiation.
THe recent concept is that AI can be started with radiation. No harm. However, physicians differ in their own opinions. Many Oncologists worldwide follow the well recognized NCCN guidelines for patiens which states that concurrent or sequential administration of endocrine therapy is acceptable. SEE PAGE BINV 6, LEGEND - W in the following link:
https://drive.google.com/file/d/0B-8ZMSsBayxJNUpGSjZZNWtJeXhvdnhiQUI5b2RIRmpnbWYw/edit?usp=sharing
Please revert back if any queries.
Kind regards.
How long do you think indolent lobular estrogen postivie itc's could go without becoming bone or bone marrow cancer? Do you think six months? A year? Because, depending on how the mastectomy heals, I may need to wait longer for the radiation, and then the whole thing would take longer than 4 months.
I've heard it might even be years before these itc's start dividing--but I don't know if this can be possible.
ER positive tumors may take even decades to come back.
Did you see the reference I sent you with previous mail? AI can be started with along with radiation. You may start it after the surgical wound heals.
Regards.
I showed the reference to my doctor. He says he believes AI's stop the radiation from working. But, thank you so much for sending the link.
How long do you think a a very ER positive ITC or lymph node can avoid spreading IF THE AI'S HAVE NOT BEEN STARTED YET??? As I said, I'm worried I might have to wait even 6 months, if the mastectomy heals badly.
Just to remind you, even though I have Classic Lobular Cancer, which is supposed to divide slowly--it IS Grade 2--so that might speed it up.
If I were your doc, I would definitely start on AI as early as possible. However, opinions vary. If at all disease recurs, it would take a long time. So please be assured. I hope your Oncologists also would have suggested the same.
Regards.