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This question was answered on Mon 19, May 2008 10:01pm by Dr Paul S, MD

Counsultation for treatment for metastatic breast cancer


    
Asked by ywlaw15@yahoo.com (Female; 42; 42yr old woman diagnosed with ductal carcinoma in situ (strongly estrogen receptor positive). Right partial mastectomy and axillary node dissection in 2002. Radiation therapy and 4 cycles of chemotherapy, followed by tamoxifen x 5 years(done in Canada). Patient stopped tamoxifen after 4.5 yrs or (4.75 yrs) and had recurrent metastatic breast cancer in Feb 2008, with involvement of neck lymph nodes and muscle, C7 and lung. ) on Mon 19, May 2008 06:34pm

After being diagnosed with recurrent metastatic breast cancer, the doctor in Canada recommended hormonal treatment, radiation and surgical removal of ovaries. The doctor also told her that it was not curable. Patient went back to Singapore from Canada. The lymphoma specialist in Singapore used a different approach. He put her on chemotherapy (fluouracil + navelbine x 4 months, neupogen & zoneta) and said it's important to use aggressive therapy to kill the cancer cells now. Is it the proper chemo combination (There is no such combination in the NCI webisite)? In addition, HER2 test has not been performed in Singapore or Canada. Is it necessary to perform this test? How can the treatment approach in Singapore be so different from the BC Cancer Institute in Canada?

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Answer by Dr Paul S, MD  on Mon 19, May 2008 10:01pm:

Hi there. Different countries have different health care systems that would result in some variation of treatment. Also, different centers and hospitals usually have different protocols of treatment based on the centers' experience and their personal clinical trials with the treatment regimens. The Navelbine+5Flurouracil regimen may not be standard in the North American hospitals, but this regimen may have been used and proven beneficial by the centers in Singapore. The European countries also have their own set of treatment regimens, but all of these are based on the same basic oncologic and chemotherapeutic principles. The canadian doctors are using a hormonal manipulation approach to the problem (I'm assuming that the cancer is hormone receptor positive) which may offer the same effectiveness as what the Singapore doctor recommends, without the complications and side effects of chemotherapy. It should be discussed with your doctors in Singapore the side effects of chemotherapy, and decide if the additional benefits is worth the risks of this form of treatment. I would agree with Her2 testing since this would open a lot of options regarding present and future treatments. I hope your treatment course will be as uneventful as possible, and that the best response can be achieved. Regards and God bless.

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Follow up:

Clarification by ywlaw15@yahoo.com on Mon 19, May 2008 10:16pm:
Dr. Paul S,

Thank you very much for your response.
The doctor in Singapore is a lymphoma specialist, not a breast cancer specialist.  Will it make a difference
in the approach to the treatement?

Thank you

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