need to find how to treat it
I am asking on behalf of my mother.
My mother is a 79-year-old woman with metastatic breast cancer involving the bones.
She was originally treated with Letrozole for approximately 4.5 years. When Letrozole was stopped, she subsequently developed significant disease progression with severe hypercalcaemia and further metastatic spread. She was restarted on Letrozole and has now remained on hormonal therapy for a further 3 years with relatively stable disease.
She also received Zoledronic Acid (Zometa) for approximately 2.5 years for bone metastases, initially monthly and later every 12 weeks. Zometa was discontinued in December 2025 because of persistent jaw/tooth pain.
Due to concern about possible medication-related osteonecrosis of the jaw (MRONJ), she underwent CT imaging and was referred to an Oral and Maxillofacial Surgery (OMFS) specialist. Following specialist review, the jaw lesion was considered more likely to represent a metastatic deposit rather than classic MRONJ.
Recent blood tests showed:
- CA15-3: 17 U/mL (normal)
- Kidney function: normal
- Liver function: normal
- Mild anaemia (Hb 112 g/L)
- Mildly elevated adjusted calcium (2.70 mmol/L)
Current symptoms
For the past several months, she has been experiencing intermittent episodes, typically in the evening, around 7pm, occurring about 2–3 times per week.
During these episodes:
- She develops pain in the lower jaw and neck.
- She then experiences severe coughing.
- The coughing is sometimes followed by hoarseness of voice.
- The pain usually lasts around 30 minutes before gradually settling.
- Between episodes she is generally comfortable.
The symptom pattern is causing significant distress and affecting her quality of life.
My questions
Although the OMFS specialist believes the jaw lesion is more likely metastatic disease, neither the oncologist nor family doctor has recommended any specific treatment for these symptoms.
Could metastatic disease involving the jaw, neck, or nearby nerves cause this type of intermittent pain and coughing?
Could irritation of the vagus nerve, recurrent laryngeal nerve, or another structure in the neck explain the combination of:
- jaw pain,
- neck pain,
- coughing, and
- temporary hoarseness?
Has anyone seen similar symptoms in a patient with metastatic breast cancer involving the jaw or head and neck region?
Any thoughts would be greatly appreciated, as she is suffering considerably despite relatively reassuring blood test results.
Comments
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Hi @xcmomno1, I am not in the exact same situation as your mother but have dealt with a mandible lesion and issues with coughing, hoarseness and laryngeal pain. My lesion turned out to be osteomyelitis (bone infection) on biopsy. That biopsy caused quite a bit of dental damage so going with the oral surgeon's suspicion based on imaging that it is a met is probably the thing to do.
The issue your mom is having could be due to letrozole which can cause dryness and irritation in the throat/larynx as well as acid reflux. It might be worth consulting an ENT who would investigate the cause and have suggestions on how to deal with her symptoms. ENTs can also refer a patient for voice therapy (the cough suppression type.)
I was already on a PPI (for silent GERD) as well as a steroid inhaler and gabapentin for radiation damage to my lungs, thyroid and laryngeal nerve. I was a bit skeptical when my pulmonologist sent me for cough voice therapy but it was actually helpful. Besides the usual recommendations (anti acid reflux diet, hydration, humidifier, raising the head of the bed) the therapist had me practice breathing/swallowing techniques for stopping the cough as soon as it starts. He also prescribed an alginate (seaweed) powder which absorbs laryngeal reflux and had me steam my throat daily to increase its moisture level.
All the best to you and your mother.
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Hi Maggie15,
Thank you very much for your thoughtful reply. Your advice has been really helpful and has given me some direction on what I should discuss with my mother's oncologist and family doctor.
I will follow up with them and explore the possibilities you mentioned, including an ENT assessment and whether reflux, dryness, or medication side effects could be contributing to her symptoms.
Thank you again for taking the time to share your experience. I truly appreciate it.
Wishing you all the best with your own health journey.
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