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Medical Forum / Diseases and Disorders / Breast Cancer / December 2003help: how many times of chemical therpay is appropriate?
My mum has just finished the operation, taken off part of her right breast, before that, she got a three times of chemical therapy.-- the chemical therapy is very good: the lump reduced from 2*3cm to 1*1.5cm. And perations tells that all the lymth's test is negtive. Just 10 days after the operation, her doctor gave her the chemical therapy again, and planned it to 6 times( not include the therapy before operation), but this time, the side effect is much serious: she can not even walk for 4 days because of the pain of the right leg. I wonder what is the appropriate treatment of the chemical therapy? I am worry about the side effect could do more harm to the health of my mum. I am from China, my English is not good enough at the medical terms. I hope any kind people can understand what I mean. Thank you very much and hope your great help. It is good news that the chemotherapy before surgery ("neoadjuvant" chemo) was effective, and that the lymph nodes were negative. The number of cycles of chemotherapy varies according to the type of drugs used and how often the doses are given. A typical basic chemotherapy regime (without neoadjuvant chemo) is eight cycles, four of something like Adriamycin+Cytoxan and four of something like Taxotere, given every three weeks. Some oncologists may vary this a bit, either due to national or personal preferences or as participation in clinical trials of different regimes, or due to new guidelines being taken up. There are total lifetime dose limits for several of the drugs due to damage they do to other body tissues, as well as short term limits due to side effects such as anaemia and loss of disease immunity. The regime and doses chosen depend on the patient's body weight and any known responses to specific drugs as well as these limits. Generally the idea is to give the maximum dose allowed by short term factors, for a duration of six months. It has been shown that continuing chemotherapy beyond six months gives little benefit, is not worth the increasing side effects. I am not sure how the basic regime is usually modified when neoadjuvant chemotherapy is used, but they are still working to the same basic set of rules. Tim Jackson > My mum has just finished the operation, taken off part of her right breast, > before that, she got a three times of chemical therapy.-- the chemical [quoted text clipped - 13 lines] > any kind people can understand what I mean. Thank you very much and hope > your great help. Response to this thread received by private email > Dear sir, > > Thank you very much! I want to reply on > groups.google.com, but the IE always refused to do so. > I know it is not polite to mail directly to you but I > am really in hurry and hope you could forgive me. No problem. I think Google has been throwing a bit of a googly the last few days, so that might be your problem. Can you not get Usenet newsgroups directly through your ISP, using your email browser? > Maybe I should describe the medical treatment in more > details: [quoted text clipped - 21 lines] > just finished, what could be a appropriate way? > Your suggestion is very much appreciated. My suggestion is that this is not a direct chemo side effect but perhaps something else. Sandy's reply seemed to suggest it might something resulting from the operation rather than the chemo. He didn't mention it specifically but thrombosis springs to my mind, which might be from a combination of the inactivity and the IV. (By the way, Sandy is a retired doctor, so his opinion carries some weight for me.) If the problem is due to trouble with the blood vessel that the IV is using, then there are ways around this. The fact that they are using a leg suggests there were already vein problems, normally chemo is given through the arm as a first choice. For example they could fit one of the many sorts of central line, which is a long catheter that enters usually around the neck but extends into one of the major veins near the heart, so that the drug is infused into a much larger blood flow. Abandoning chemo at this point is not a good idea. While it may have reduced the primary cancer to a manageable size, this does not guarantee that any stray cancer cells around the body have been killed off. One of the reasons for using chemo over a long period (three to six months) is to ensure that all the cancer cells have come into a vulnerable phase of their development. If she stops now there may still be some dormant cells which have not been attacked, which will later wake up and spread the cancer. Please do take her problems and your concerns to the oncologist, or at least the oncology nurse. They can give a much better explanation in her specific circumstances than I can hope to do in my amateur way. Tim Jackson > Response to this thread received by private email > [quoted text clipped - 27 lines] > > of the right leg became hard; right leg is tumid and > > hurt, and the right leg is where the dose injected. That sounds like thrombophlebitis, an inflammation of the vein with the result that platelets*, also known as thrombocytes, stick to the inflammed area of the vein and then to each other. They can collect to form a worm-like structure that can grow to 25 cm length The danger is that the thrombus may break loose, float through the veins and through the right side of the heart, then stick in the lungs causing what is called a pulmonary embolism. That is extremely dangerous. We try to avoid using the leg veins for any intravenous injections for that reason. Treatment is usually with injections of heparin, a drug that prevents coagulation of blood, and eventually coumadin or some similar drug that also slows coagulation by a different mechanism. The risk of thrombophlebitis is increased by lack of motion, in particular moving the legs. Transpacific flights, for example, put passengers at increased risk. I was originally thinking that leg pain might be the result of a pinched nerve, resulting from laying flat in bed. That seems unlikely in the light of the additional information here. * Platelets are very tiny cell fragments. They are smaller than red cells, have no cell nucleus, and serve to prevent bleeding after an injury by sticking together and to damaged tissue so as to plug open vessels. > > Her doctor suggest her to take at least 4 cycles of > > chemotheapy after operation but my families are worry [quoted text clipped - 32 lines] > > Tim Jackson Hi, Sandy and Tim, Thank you very much on the help of my mum's symptom of the chemotherapy side effect. She asked her doctor for some medical treatment and now take the new cycle of chemotherapy. I have some new questions on the treatment: 1. Does the fomenting do help to the hard vein (though is softing now) 2. What she got is pure breastcancer, and in early Stage I, any actinotheraphy needed after the chemotherapy? One more question on newsgroup: how to register on any kind of news server and then I can paste words on it? Or where I can ask for help. I only can use google news server through web-browser, and google frequently failed.( I know how to read through news software like outlook express) Thanks a lot. > > Response to this thread received by private email > Hi, Sandy and Tim, > [quoted text clipped - 4 lines] > I have some new questions on the treatment: > 1. Does the fomenting do help to the hard vein (though is softing now) I'm sorry, I do not understand "fomenting" in this context. Could you clarify? > 2. What she got is pure breastcancer, and in early Stage I, any > actinotheraphy needed after the chemotherapy? Radiation therapy improves the long-term probability of disease-free survival, but with a small stage I tumor, it would not iprove the absolute probabilities very much. The probability is very favorable as it is. The side effects might cause some patients to prefer to do without, given the relatively small absolute benefit. Some oncologists might advise doing without for the same reason. The same is true for chemo therapy. > One more question on newsgroup: how to register on any kind of news > server and then I can paste words on it? Or where I can ask for help. > I only can use google news server through web-browser, and google > frequently failed.( I know how to read through news software like > outlook express) In Outlook, you click on View, Go To, News, then follow prompts. I don't know about Outlook Express. On my machine, starting with Outlook puts me into Outlook Express for newsgroups. > Thanks a lot. > > "Sandy L" <OCChlmsslDOC@mindspring.com (Remove occdoc to reply)> wrote in message news:<_gYAb.4138$7p2.3164@newsread2.news.atl.earthlink.net>... > > > Response to this thread received by private email Hi, Sandy, I finally found a newsgroup server that allowed me to post articles. (news.yakko.com) I was using freenews.netfront.net, which should be registered first with fees and then posting can be allowed:-) The word "fomenting" I mean is with hot wet towel put on the skin. Well, probably the word is wrong used:-( You said "The probability is very favorable as it is". Does it mean that the long-term probability of disease-free survival without radiation therapy is alreay good in the situation of my mums'? If it is, it's really good news to her, for she is always worried about any side effect of radiation therapy or chemotherapy. Her doctor suggest her to take the radiation therapy. But he can not give any believable evidence that she should take it. And he also admit that my mum's case of operation result is really good, as you said "a small stage I tumor". I guess that a happy emotion could do more helpful to her now. The understand of radiation therapy of mine: without: 10 year probability of disease-free survival is 95% with: 10 year probability of disease-free survival is 97.5%, for example. Is it right? "Sandy L" <OCChlmsslDOC@mindspring.com (Remove occdoc to reply)> ?????????? ??:uhMDb.815$wL6.178@newsread1.news.atl.earthlink.net... > > Hi, Sandy and Tim, > > [quoted text clipped - 34 lines] > news:<_gYAb.4138$7p2.3164@newsread2.news.atl.earthlink.net>... > > > > Response to this thread received by private email > Hi, Sandy, I finally found a newsgroup server that allowed me to post > articles. (news.yakko.com) I was using freenews.netfront.net, which should > be registered first with fees and then posting can be allowed:-) > > The word "fomenting" I mean is with hot wet towel put on the skin. Well, > probably the word is wrong used:-( Moist heat is part of commonly-used medical therapy. I'm not sure how effective it is, but it is not unreasonable, it may help, and it is a mainstream treatment. > You said "The probability is very favorable as it is". Does it mean that the > long-term probability of disease-free survival without radiation therapy is > already good in the situation of my mums'? Yes > If it is, it's really good news to > her, for she is always worried about any side effect of radiation therapy or [quoted text clipped - 8 lines] > with: 10 year probability of disease-free survival is 97.5%, for example. Is > it right? That is about the situation my wife was in, and the statistics she was given were similar. There was about a 50% decrease in the risk of recurrence (i.e., increase from about 95% to about 97.5% disease-free survival) with either chemo or radiation, and about a 75% decrease in the risk of recurrence (i.e., increase from 95% to about 98.75% disease-free survival). I have not independently reviewed the statistics, and her disease was diagnosed about 6 years ago, but I would think it probably hasn't changed much. > "Sandy L" <OCChlmsslDOC@mindspring.com (Remove occdoc to reply)> ?????????? > ??:uhMDb.815$wL6.178@newsread1.news.atl.earthlink.net... [quoted text clipped - 36 lines] > > news:<_gYAb.4138$7p2.3164@newsread2.news.atl.earthlink.net>... > > > > > Response to this thread received by private email > . . .she is always worried about any side effect of radiation therapy or > chemotherapy. Her doctor suggest her to take the radiation therapy. I suspect that radiation therapy (and chemo, for that matter) may be less of a problem than she might expect. Many people over-estimate the side effects based on things they have read. Popular news stories sometimes seem to exaggerate for dramatic effect. Certainly, serious side effects from radiation are possible, but they are rare. For many/most of us, it is not much worse than a localized bad sunburn. For some, the time & energy required to get to the daily treatments is the worst "side effect". Hardening or tightening of the tissue is quite common, but can usually be counteracted by stretching frequently (multiple times/day) during and after treatment. Following the doctors' after-care instructions is also important. Best wishes to your mother! Ann T. Remove 'dontsendspam' from address to reply by email > > One more question on newsgroup: how to register on any kind of news > > server and then I can paste words on it? Or where I can ask for help. [quoted text clipped - 5 lines] > don't know about Outlook Express. On my machine, starting with Outlook > puts me into Outlook Express for newsgroups. This depends on your Internet Service Provider offering a news service. Many do, and this is the 'usual' way of accessing Usenet. When you signed up for your Internet account they must have given you a server name for e-mail, to enter into Outlook Express. If they provide a news service they will also have given you the name of a news server. If you have this but cannot access it through Outlook Express, then click on Tools|Accounts|News|Add and enter your server name, and identification details for your posts (eg reply address). It should then appear in the Outlook Express window along with Inbox and the rest. Clicking on it will bring up a window allowing you to subscribe to newsgroups. Here obviously you enter "alt.support.cancer.breast" If your ISP does not offer a news service then your choices are restricted to web-based servers such as you are using, or changing ISP. Tim Jackson > My mum has just finished the operation, taken off part of her right breast, > before that, she got a three times of chemical therapy.-- the chemical [quoted text clipped - 13 lines] > any kind people can understand what I mean. Thank you very much and hope > your great help. Pain in the leg may be more related to being in a hospital bed for a few days than to chemotherapy. Routine treatment for sciatica (inflammation affecting the main nerve that runs down the back of the leg) may be needed. The cancer itself might have spread and caused pressure on the nerve, but it is unlikely that spread to that degree would occur this quickly. |
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