Join Us

We are 224,270 members in 83 forums discussing 163,473 topics.

Help with Abbreviations

Topic: Aunt has Lesion on Liver

Forum: Stage IV/Metastatic Breast Cancer, Open to All To Contribute —

Topics here are started by members with a Stage IV/Metastatic Breast Cancer diagnosis, but open to all members to contribute to discussions. Please note that there is a separate forum, Stage IV/Metastatic Breast Cancer ONLY, where topics are open only to those members.

Posted on: Aug 10, 2021 03:06PM

morrigan_2575 wrote:

hi all

Hope you can provide some guidance. My aunt has BC about 23 years ago, 16 years ago she had her second BC. First time it was in the left breast, lumpectomy+radiation and 5 years of Tamoxifen. Second time it was in her right breast, she did another lumpectomy+radiation and Anastrozole for 5 years.

She went to her Oncologist in June for routine blood work and her protein was high. He sent her for a CT Scan and they found a lesion on her Liver. They were supposed to do a biopsy but the Dr said her lesion was too close to her Diaphragm and he couldn't do a needle biopsy. She's 83 and has a blockage years ago so they don't want to do surgery in order to biopsy the lesion.

So the Oncologist decided to just put her on Anastrozole and monitor her Bloodwork. Does that sound right to you? I feel like they're a little to Blasé about it. I also don't want to upset or worry her unnecessarily

Dx 1/20/2020, DCIS/IDC, Right, 4cm, Stage IIA, Grade 2, ER+/PR+, HER2+ (IHC) Chemotherapy 2/5/2020 Carboplatin (Paraplatin), Taxotere (docetaxel) Targeted Therapy 2/5/2020 Herceptin (trastuzumab) Targeted Therapy 2/5/2020 Perjeta (pertuzumab) Dx 6/19/2020, DCIS/IDC, Right, <1cm, Stage IA, Grade 2, 1/3 nodes, ER+/PR+, HER2+ Surgery 6/19/2020 Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Targeted Therapy 7/6/2020 Kadcyla (T-DM1, ado-trastuzumab) Radiation Therapy 8/10/2020 Whole-breast: Breast, Lymph nodes, Chest wall
Log in to post a reply

Page 1 of 1 (6 results)

Posts 1 - 6 (6 total)

Log in to post a reply

Aug 10, 2021 03:58PM moth wrote:

Hi, I hope some ER+ people chime in. You might want to ask about this on the liver mets thread https://community.breastcancer.org/forum/8/topics/...

I think I see anastrazole combined with fulvestrant more commonly than on its own, but her age & ability to withstand treatments might be guiding some of the treatment recommendations. I will pm you a screenshot of the NCCN guidelines for ER+ metastatic

How aggressively does your aunt want to treat this? does she understand that this a terminal disease?


I take weekends off

Initial dx at 50. Seriously?? “Sometimes the future changes quickly and completely and we’re left with only the choice of what to do next." blog: Never Tell Me the Odds

Dx 12/2017, IDC, Left, 1cm, Stage IA, Grade 3, 0/5 nodes, ER-/PR-, HER2- (IHC) Surgery 12/12/2017 Lumpectomy: Left; Lymph node removal: Sentinel Chemotherapy 2/13/2018 AC + T (Taxol) Radiation Therapy 8/13/2018 Whole-breast: Breast Dx 2/2020, IDC, Stage IV, metastasized to liver/lungs, Grade 3, ER-/PR-, HER2- Chemotherapy 3/18/2020 Taxol (paclitaxel) Immunotherapy 3/18/2020 Tecentriq (atezolizumab) Chemotherapy 11/25/2020 Abraxane (albumin-bound or nab-paclitaxel) Radiation Therapy 12/8/2020 External Dx 12/9/2020, IDC, Right, Stage IV, metastasized to lungs, Grade 3, ER+/PR-, HER2- (IHC) Hormonal Therapy 12/15/2020 Femara (letrozole) Dx 1/28/2021, IDC, Left, Stage IV, metastasized to bone Radiation Therapy 3/2/2021 External: Bone
Log in to post a reply

Aug 10, 2021 04:33PM morrigan_2575 wrote:

"How aggressively does your aunt want to treat this? does she understand that this a terminal disease?"

I don't think she does. When she asked her Oncologist what the worst case was, he told her she'd have to go on 2 pills (didn't say which) but, that she'd be around for awhile.

I was thinking about it after posting and, I'm sure her age plays a roll in how they treat her. There is the concern of quality vs quantity. I honestly don't even know what choices I would make at her age.

Thanks for the PM!

Dx 1/20/2020, DCIS/IDC, Right, 4cm, Stage IIA, Grade 2, ER+/PR+, HER2+ (IHC) Chemotherapy 2/5/2020 Carboplatin (Paraplatin), Taxotere (docetaxel) Targeted Therapy 2/5/2020 Herceptin (trastuzumab) Targeted Therapy 2/5/2020 Perjeta (pertuzumab) Dx 6/19/2020, DCIS/IDC, Right, <1cm, Stage IA, Grade 2, 1/3 nodes, ER+/PR+, HER2+ Surgery 6/19/2020 Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Targeted Therapy 7/6/2020 Kadcyla (T-DM1, ado-trastuzumab) Radiation Therapy 8/10/2020 Whole-breast: Breast, Lymph nodes, Chest wall
Log in to post a reply

Aug 10, 2021 07:27PM ShetlandPony wrote:

Hi, morrigan. So your aunt took tamoxifen for 5 years, then got 2 more years apparently cancer-free. Then a new breast cancer was found, she took anastrazole for 5 years, then got 11 more years apparently cancer-free. Is that right? It sounds like these cancers have not been particularly aggressive, though one of them is persistent. I'm guessing that this slowness would make an oncologist lean toward choosing easier treatment over aggressive treatment. And low-key treatment could keep the cancer at bay long enough for your aunt's natural lifetime, without subjecting her to more side effects. I think the two-pill option would be an anti estrogen such as anastrazole plus a targeted therapy like Ibrance. This targeted therapy could double the progression-free survival time. So this is where your aunt and her oncologist need to talk about how her health is otherwise, what is her own individual life expectancy. Do the ladies in her family live into their 90s and is she in great health otherwise? Or is she rather frail? Is she willing to put up with a lot for a better chance at seeing that next grandchild? Age alone should not determine the course of action. It has to be individualized. I would ask if the recommended treatment would be the same if your aunt was age 53. If not, why? In her position I might seek a consultation with a geriatric oncologist. It could probably be done via telehealth and you could attend.

It makes sense to me that the doctor would not order a biopsy that is too risky. I think monitoring ought to be not only with blood tests (liver enzymes) but also with scans (CT, MRI, or PET), typically every three months. I would ask why use tamoxifen or anastrazole again since eventually one of those failed; how about aromasin? (These are all anti-estrogens but not exactly alike.) Fulvestrant/faslodex is another one, but it is some pretty big injections that I hate to think of giving to an older lady, so I would be inclined to try the others one first. Again, your aunt has to say what she is up for, what her goals and values are. (Choosing quality over quantity is not "giving up".)

It sounds like you are a good ally -- sensitive to your aunt's feelings, looking out for her, without wanting to take over. Help her make sure she has a smart, compassionate doctor who is in her corner, and you have done a lot.

2011 Stage I ITCs sn, premenopausal, Oncotype 16. 2014 Stage IV mets breast,liver. TaxolNEAD. Ibrance+letrozole 2yrs. Fas+afinitor nope. XelodaNEAD 2yrs. Eribulin,Doxil nope. SUMMIT FaslodexHerceptinNeratinib for Her2mut NEAD Dx 2011, ILC, 1cm, Stage IA, Grade 1, 0/1 nodes, ER+/PR+, HER2- Dx 2014, ILC, 2cm, Stage IV, metastasized to liver/other, Grade 2, ER+/PR+, HER2- Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Radiation Therapy Whole-breast: Breast Surgery Lumpectomy
Log in to post a reply

Aug 10, 2021 07:47PM SeeQ wrote:

morrigan - I think first line treatment is usually an AI (the anastrozole) and a CDK 4/6 inhibitor (Verzenio/Ibrance/Kisqali). I'm not sure if your aunt's age or other health conditions could affect the decision process. The insurance approval process for the CDK inhibitor could take several days - could it be that they're working on that and starting the anastrozole in the mean time? I started the anastrozole first, and Verzenio about a week later.

Diagnosed de novo Stage IV; numerous liver mets; single small breast tumor identified 4 weeks later Dx 6/2/2020, IDC, 6cm+, Stage IV, metastasized to liver, ER+/PR+, HER2- (IHC) Hormonal Therapy 7/3/2020 Arimidex (anastrozole) Targeted Therapy 7/10/2020 Verzenio
Log in to post a reply

Aug 11, 2021 03:59AM - edited Aug 11, 2021 04:01AM by morrigan_2575

@ShetlandPony - Thanks for your reply that's good information. Yes, that's pretty much her situation of on/off cancer times.

She's in pretty good health for 83, lives alone, still drives, no real issues. My mom and 2 aunts are the only ones alive of 8 siblings. My eldest living aunt is 95, my mom is 84 and my aunt is 83. I think we all assumed (at this point) that my mom and aunt would live into their 90s like their sister.

I think I might have to get out my mindset with treating cancer (throw everything at it) to something more realistic for her age.

@SeeQ - thanks for the info, I didn't realize that AI+ CDK Inhibitor was the first line action. For some reason I thought they'd start with Chemo again. I will check with her on the other pills Ibrance or Verzenio to see if he plans to include them. I'll also tell her to request Scans every 3 months, that blood work isn't enough.


Thanks everyone who replied, I was thinking they're not being aggressive enough but, most likely that was my own issue/fear.







Dx 1/20/2020, DCIS/IDC, Right, 4cm, Stage IIA, Grade 2, ER+/PR+, HER2+ (IHC) Chemotherapy 2/5/2020 Carboplatin (Paraplatin), Taxotere (docetaxel) Targeted Therapy 2/5/2020 Herceptin (trastuzumab) Targeted Therapy 2/5/2020 Perjeta (pertuzumab) Dx 6/19/2020, DCIS/IDC, Right, <1cm, Stage IA, Grade 2, 1/3 nodes, ER+/PR+, HER2+ Surgery 6/19/2020 Mastectomy: Left, Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Targeted Therapy 7/6/2020 Kadcyla (T-DM1, ado-trastuzumab) Radiation Therapy 8/10/2020 Whole-breast: Breast, Lymph nodes, Chest wall
Log in to post a reply

Aug 11, 2021 06:30AM - edited Aug 11, 2021 06:33AM by ShetlandPony

A general principle with ER positive Her2 negative liver mets is to start with hormonal therapy, often with Ibrance, Kisqali or Verzenio, unless the mets are so large or numerous as to put the patient in imminent danger, in which case chemo would be used first to get things under control. And even in this case it would not typically be the big double or triple combo one might use for early stage. Stage iv is a marathon, not a sprint.

2011 Stage I ITCs sn, premenopausal, Oncotype 16. 2014 Stage IV mets breast,liver. TaxolNEAD. Ibrance+letrozole 2yrs. Fas+afinitor nope. XelodaNEAD 2yrs. Eribulin,Doxil nope. SUMMIT FaslodexHerceptinNeratinib for Her2mut NEAD Dx 2011, ILC, 1cm, Stage IA, Grade 1, 0/1 nodes, ER+/PR+, HER2- Dx 2014, ILC, 2cm, Stage IV, metastasized to liver/other, Grade 2, ER+/PR+, HER2- Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Radiation Therapy Whole-breast: Breast Surgery Lumpectomy

Page 1 of 1 (6 results)