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PaulaRyanMDPhD
(Physician
- Oncology - Hematology/Oncology
(Verified)
)
| Communities: Breast Cancer | Thank You's: 1 |
| Member Since: Jan. 2012 | Questions: 9 |
| Answers: 17 |
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Professional Statement
As a medical oncologist specializing in breast cancer, my goal is to provide each patient with individualized, compassionate, state of the art care. Prior to joining the Women’s Cancer Program at Fox Chase Cancer Center, I practiced for ten years in the breast oncology group at the Massachusetts General Hospital Cancer Center and the Dana Farber/Harvard Cancer Center, specializing in the care of breast malignancies and the clinical management of patients with specific inherited gene mutations, which place them at high risk for cancer.
I treat patients with all stages of breast cancer, with a focus on the management of patients with breast cancers that are locally advanced and metastatic. I have a particular interest in coordinating the management of patients with complex care. I feel the best care for patients with breast cancer is achieved with a multidisciplinary team that works together to develop an individualized, comprehensive treatment plan conducted in a supportive environment for our patients and their loved ones. The Women’s Cancer Center at Fox Chase provides the ideal environment to achieve this goal—bringing together expert faculty in one central location to provide not only the best clinical care but also cutting edge research in women’s cancers.
I am also devoted to clinical research in breast cancer and in particular the development of novel treatment strategies and agents for the treatment of metastatic breast cancer. There is an exciting collection of new drugs that target specific genetic abnormalities and I am leading several multi-center clinical trials that offer the hope of improving the outcome of women with breast cancer. I also have extensive experience with treating patients with preoperative therapy in close collaboration with surgical colleagues to reduce the need for mastectomy.
I treat patients with all stages of breast cancer, with a focus on the management of patients with breast cancers that are locally advanced and metastatic. I have a particular interest in coordinating the management of patients with complex care. I feel the best care for patients with breast cancer is achieved with a multidisciplinary team that works together to develop an individualized, comprehensive treatment plan conducted in a supportive environment for our patients and their loved ones. The Women’s Cancer Center at Fox Chase provides the ideal environment to achieve this goal—bringing together expert faculty in one central location to provide not only the best clinical care but also cutting edge research in women’s cancers.
I am also devoted to clinical research in breast cancer and in particular the development of novel treatment strategies and agents for the treatment of metastatic breast cancer. There is an exciting collection of new drugs that target specific genetic abnormalities and I am leading several multi-center clinical trials that offer the hope of improving the outcome of women with breast cancer. I also have extensive experience with treating patients with preoperative therapy in close collaboration with surgical colleagues to reduce the need for mastectomy.
Professional Info
Credential:
MD
Primary specialty:
Oncology - Hematology/Oncology
Medical school:
University of Rochester Medical Center
Residency:
Duke University Medical Center
Fellowship:
Duke University Medical Center
Board certifications:
American Board of Internal Medicine, Medical Oncology
Professional memberships:
American Society of Clinical Oncology Cancer and Leukemia Group B (CALGB)
Areas of expertise:
Breast Cancer, locally advanced and metastatic breast cancer, inherited predisposition to breast cancer
Research interests:
Novel targeted therapies, endocrine-resistant breast cancer, triple negative breast cancer
Awards and publications:
Leadership Development for Physicians and Scientists, Harvard Medical
School, 2006;
Edna L. Alizio Cancer Research Achiever’s Award, Massachusetts General Hospital, 2003;
John and Carol Barry Cancer Research Award, Massachusetts General Hospital, 2001
School, 2006;
Edna L. Alizio Cancer Research Achiever’s Award, Massachusetts General Hospital, 2003;
John and Carol Barry Cancer Research Award, Massachusetts General Hospital, 2001
Hospital affiliation:
Fox Chase Cancer Center
Practice address:
333 Cottman Avenue
Philadelphia, PA
19111-2497
Practice phone number:
888-369-2427
Webpage:
http://www.fccc.edu/index.html
PaulaRyanMDPhD Activities
Eribulin is a newer drug (FDA approved for metastatic breast cancer in 2010) that is effective in individuals who have been previously treated with chemotherapy. In a study, known as the EMBRACE trial, women were assigned to receive eribulin or to the treatment chosen by their doctors as predicted to have the best effect. There was a significant survival benefit of about 2.5 months in favor of the eribulin. The drug, derived from sea sponges, works by targeting a scaffolding protein (microtubule) within a cell and interferes with the construction of the scaffolding and stops the cancer cell from dividing.
Eribulin is a newer drug (FDA approved for metastatic breast cancer in 2010) that is effective in individuals who have been previously treated with chemotherapy. In a study, known as the EMBRACE trial, women were assigned to receive eribulin or to the treatment chosen by their doctors as predicted to have the best effect. There was a significant survival benefit of about 2.5 months in favor of the eribulin. The drug, derived from sea sponges, works by targeting a scaffolding protein (microtubule) within a cell and interferes with the construction of the scaffolding and stops the cancer cell from dividing.
New answer by PaulaRyanMDPhD (Physician - Oncology - Hematology/Oncology (Verified)) in topic(s) Metastatic Breast Cancer Medications, Breast Cancer Treatments, Eribulin (Halaven) Mechanism Of Action, Breast Cancer, Breast Cancer Drug Efficacy, Metastatic Breast Cancer, Eribulin (Halaven) Drug Efficacy, Medications, Breast Cancer Medications, Eribulin (Halaven), Secondary Breast Cancer Treatments, Metastatic Breast Cancer Treatments
1
Answer |
9 days ago
Breast cancer has a tendency to spread to certain locations in the body more so than others, for example, the lung, pleura (lining of the lung), bones, liver and central nervous system. Thus if an individual reports a cough, cough that is blood-tinged, shortness of breath at rest or when exerting oneself, bone pain that is localized, unusual and not relieved with typical remedies, abdominal pain, unusual/persistent headaches, weakness, imbalance, unexplained weight loss--these may be problems for which further testing may be advised.
Breast cancer has a tendency to spread to certain locations in the body more so than others, for example, the lung, pleura (lining of the lung), bones, liver and central nervous system. Thus if an individual reports a cough, cough that is blood-tinged, shortness of breath at rest or when exerting oneself, bone pain that is localized, unusual and not relieved with typical remedies, abdominal pain, unusual/persistent headaches, weakness, imbalance, unexplained weight loss--these may be problems for which further testing may be advised.
New answer by PaulaRyanMDPhD (Physician - Oncology - Hematology/Oncology (Verified)) in topic(s) Breast Cancer, Metastatic Breast Cancer Chief Complaints, Metastatic Breast Cancer, Metastatic Breast Cancer Symptoms, Metastatic Cancer Symptoms
1
Answer |
9 days ago
There are occasions when the location of metastatic disease does direct treatment decisions, but more commonly we base our medical treatment decision on the particular subtype of breast cancer. For example, if the breast cancer is the subtype that is estrogen receptor positive (ER+) and/or progesterone receptor positive (PR+) and is HER2 negative, then we would likely recommend an anti-estrogen (endocrine) therapy such as tamoxifen or an aromatase inhibitor. On the other hand, tumors that are "triple negative" (ER-/PR-/HER2-) are treated with chemotherapy and tumors that are HER2 positive will usually be treated with trastuzumab (Herceptin) and chemotherapy. If there is cancer that has spread to a vital organ (liver, lung) that is causing an individual to have worrisome symptoms or problems then we may advise chemotherapy to achieve control of the cancer more quickly. If cancer has spread to the brain, however, or other parts of the central nervous system then radiation therapy is typically the mainstay of treatment. Also, radiation can be used at sites of bone involvement to help with pain control and is used in conjunction with other medical therapies in this setting.
There are occasions when the location of metastatic disease does direct treatment decisions, but more commonly we base our medical treatment decision on the particular subtype of breast cancer. For example, if the breast cancer is the subtype that is estrogen receptor positive (ER+) and/or progesterone receptor positive (PR+) and is HER2 negative, then we would likely recommend an anti-estrogen (endocrine) therapy such as tamoxifen or an aromatase inhibitor. On the other hand, tumors that are "triple negative" (ER-/PR-/HER2-) are treated with chemotherapy and tumors that are HER2 positive will usually be treated with trastuzumab (Herceptin) and chemotherapy. If there is cancer that has spread to a vital organ (liver, lung) that is causing an individual to have worrisome symptoms or problems then we may advise chemotherapy to achieve control of the cancer more quickly. If cancer has spread to the brain, however, or other parts of the central nervous system then radiation therapy is typically the mainstay of treatment. Also, radiation can be used at sites of bone involvement to help with pain control and is used in conjunction with other medical therapies in this setting.
New answer by PaulaRyanMDPhD (Physician - Oncology - Hematology/Oncology (Verified))
1
Answer |
9 days ago
Rarely is it necessary to test for breast cancer in other parts of the body in women newly diagnosed with early stage breast cancer. Indeed, routine staging is not indicated for early stage breast cancer in the absence of symptoms. If a woman presents with breast cancer and has signs or symptoms that are concerning for possible spread of cancer elsewhere then that may lead to diagnostic tests (for example, a bone scan is advised if a woman has localized bone pain or if there is an abnormal elevation of alkaline phosphatase on lab studies; alkaline phosphatase comes from bone and/or liver). A CT or MRI looking at the abdomen and pelvis is indicated if alkaline phosphatase is elevated, liver function tests are abnormal or if there are abdominal symptoms or abnormal findings on physical examination of the abdomen or pelvis. A chest CT is advised if there are pulmonary symptoms present (for example, worrisome cough, shortness of breath). Patients who present with Stage III breast cancer (large tumor in breast and/or lymph nodes or skin involvement) are often advised to have additional tests including a CT of the chest/abdomen/pelvis or MRI and a bone scan. After completion of treatment for early stage breast cancer and in follow-up, testing for cancer spread is only done if there are signs or symptoms of a problem.
Rarely is it necessary to test for breast cancer in other parts of the body in women newly diagnosed with early stage breast cancer. Indeed, routine staging is not indicated for early stage breast cancer in the absence of symptoms. If a woman presents with breast cancer and has signs or symptoms that are concerning for possible spread of cancer elsewhere then that may lead to diagnostic tests (for example, a bone scan is advised if a woman has localized bone pain or if there is an abnormal elevation of alkaline phosphatase on lab studies; alkaline phosphatase comes from bone and/or liver). A CT or MRI looking at the abdomen and pelvis is indicated if alkaline phosphatase is elevated, liver function tests are abnormal or if there are abdominal symptoms or abnormal findings on physical examination of the abdomen or pelvis. A chest CT is advised if there are pulmonary symptoms present (for example, worrisome cough, shortness of breath). Patients who present with Stage III breast cancer (large tumor in breast and/or lymph nodes or skin involvement) are often advised to have additional tests including a CT of the chest/abdomen/pelvis or MRI and a bone scan. After completion of treatment for early stage breast cancer and in follow-up, testing for cancer spread is only done if there are signs or symptoms of a problem.
New answer by PaulaRyanMDPhD (Physician - Oncology - Hematology/Oncology (Verified))
1
Answer |
9 days ago
The standard recommendation is for five years of aromatase therapy based on our present knowledge and the results of numerous large clinical trials that compared aromatase inhibitors to tamoxifen. It is also an acceptable strategy to initiate therapy with tamoxifen and switch to an aromatase inhibitor after 2 to 3 years to complete a total of five years of therapy. Based on evidence from a large clinical trial, it is also acceptable to switch to tamoxifen from an aromatase inhibitor; this is an option for individuals who are experiencing difficult side effects with aromatase inhibitors.
The standard recommendation is for five years of aromatase therapy based on our present knowledge and the results of numerous large clinical trials that compared aromatase inhibitors to tamoxifen. It is also an acceptable strategy to initiate therapy with tamoxifen and switch to an aromatase inhibitor after 2 to 3 years to complete a total of five years of therapy. Based on evidence from a large clinical trial, it is also acceptable to switch to tamoxifen from an aromatase inhibitor; this is an option for individuals who are experiencing difficult side effects with aromatase inhibitors.
New answer by PaulaRyanMDPhD (Physician - Oncology - Hematology/Oncology (Verified)) in topic(s) Medication Side Effects, Breast Cancer Treatments, Breast Cancer, Side Effect Management, Hormonal Therapy Medications, Hormonal Therapy, Aromatase Inhibitors, Medications, Breast Cancer Medications, Breast Cancer Side Effects
1
Answer |
1 month ago
This may vary depending on the individual and their risk for bone density loss or fracture. It is important when starting an aromatase inhibitor that you have a baseline bone mineral density study (referred to as a DEXA scan) and a clinical assessment for other potential risk factors for osteoporosis (defined as a T score < 2.5 on a DEXA scan by the World Health Organization). These risks include older age, previous fracture, low body weight, current tobacco use, and excessive alcohol consumption, among others. I encourage all women starting an aromatase inhibitor to adopt lifestyle changes that promote not only bone health but overall health as well. These include increasing physical activity (including weight bearing exercise), stopping smoking, and taking calcium and vitamin D supplements. Some individuals starting an aromatase inhibitor may be advised to take drug therapy with bisphosphonates if they have osteoporosis or a history of a fracture or osteopenia (http://www.medterms.com/script/main/art.asp?articlekey=8048)(T-score between -1 and -2.5 on a DEXA scan) with other risk factors. There is no consensus on the optimal strategy for monitoring but every two years is a common strategy.
This may vary depending on the individual and their risk for bone density loss or fracture. It is important when starting an aromatase inhibitor that you have a baseline bone mineral density study (referred to as a DEXA scan) and a clinical assessment for other potential risk factors for osteoporosis (defined as a T score < 2.5 on a DEXA scan by the World Health Organization). These risks include older age, previous fracture, low body weight, current tobacco use, and excessive alcohol consumption, among others. I encourage all women starting an aromatase inhibitor to adopt lifestyle changes that promote not only bone health but overall health as well. These include increasing physical activity (including weight bearing exercise), stopping smoking, and taking calcium and vitamin D supplements. Some individuals starting an aromatase inhibitor may be advised to take drug therapy with bisphosphonates if they have osteoporosis or a history of a fracture or osteopenia (http://www.medterms.com/script/main/art.asp?articlekey=8048)(T-score between -1 and -2.5 on a DEXA scan) with other risk factors. There is no consensus on the optimal strategy for monitoring but every two years is a common strategy.
New answer by PaulaRyanMDPhD (Physician - Oncology - Hematology/Oncology (Verified)) in topic(s) Medication Side Effects, Aromatase Inhibitor Side Effects, Breast Cancer Tests, Breast Cancer, Aromatase Inhibitors, Hormonal Therapy, Medications, Breast Cancer Medications, Side Effects, Bone Density
1
Answer |
1 month ago
Aromatase inhibitors lower estrogen levels in your body and this estrogen deficiency leads to increased bone turnover and bone loss. This side effect, however, does not reflect whether the medication is working for your breast cancer. Estrogen is known to stimulate hormone receptor positive breast tumor cells and aromatase inhibitors are very effective at lowering estrogen levels and thereby removing this growth signal and resulting in tumor cell death. Thus, the lowering of estrogen is a critical reason why these drugs work so well to treat hormone receptor positive breast cancer but may have, at the same time, a negative impact on bone health.
Aromatase inhibitors lower estrogen levels in your body and this estrogen deficiency leads to increased bone turnover and bone loss. This side effect, however, does not reflect whether the medication is working for your breast cancer. Estrogen is known to stimulate hormone receptor positive breast tumor cells and aromatase inhibitors are very effective at lowering estrogen levels and thereby removing this growth signal and resulting in tumor cell death. Thus, the lowering of estrogen is a critical reason why these drugs work so well to treat hormone receptor positive breast cancer but may have, at the same time, a negative impact on bone health.
New answer by PaulaRyanMDPhD (Physician - Oncology - Hematology/Oncology (Verified)) in topic(s) Medication Side Effects, Breast Cancer, Bone Loss, Aromatase Inhibitors, Medications, Breast Cancer Medications, Side Effects, Aromatase Inhibitors Side Effects
1
Answer |
1 month ago
The role of hormonal therapy for risk reduction should be carefully considered and discussed with experts in breast cancer risk assessment and management in a shared decision-making environment. Guidelines from expert groups recommend that the risks and benefits of breast cancer prevention be discussed with premenopausal and postmenopausal women who are at high risk for the disease.
Women at high risk may include some women over the age of 60; women with certain high-risk conditions found on breast biopsy, such as lobular carcinoma in situ (LCIS) or atypical ductal or lobular hyperplasia; women between the ages of 35 and 59 years who have a calculated five-year risk of developing breast cancer of 1.7 percent or higher, according to a system called the Gail model. The Gail model uses a woman's current age, age at first menstrual period, age at first live birth, the number of first-degree relatives with breast cancer, and the number and pathologic findings of any breast biopsies to estimate the probability of breast cancer over time. This model, and others, is used by health professionals to calculate an individual’s risk and the results should be interpreted with an expert in breast cancer risk assessment. It is also important to remember that the presence of breast cancer risk factors does not mean that cancer is inevitable as many women with risk factors never develop breast cancer.
Another very important issue is that the Gail model does not consider the risk of cancer associated with inherited breast cancer-predisposing genes such as BRCA1 and BRCA2. If an individual has a strong family history that suggests the possibility of an inherited predisposition to breast cancer, then that individual should be referred for genetic counseling. Other components of a risk/benefit assessment and counseling include a careful discussion of the side effects of hormonal therapy, options for participation in clinical research and healthy lifestyle changes. The role of hormonal therapy for risk reduction should be carefully considered and discussed with experts in breast cancer risk assessment and management in a shared decision-making environment. Guidelines from expert groups recommend that the risks and benefits of breast cancer prevention be discussed with premenopausal and postmenopausal women who are at high risk for the disease.
Women at high risk may include some women over the age of 60; women with certain high-risk conditions found on breast biopsy, such as lobular carcinoma in situ (LCIS) or atypical ductal or lobular hyperplasia; women between the ages of 35 and 59 years who have a calculated five-year risk of developing breast cancer of 1.7 percent or higher, according to a system called the Gail model. The Gail model uses a woman's current age, age at first menstrual period, age at first live birth, the number of first-degree relatives with breast cancer, and the number and pathologic findings of any breast biopsies to estimate the probability of breast cancer over time. This model, and others, is used by health professionals to calculate an individual’s risk and the results should be interpreted with an expert in breast cancer risk assessment. It is also important to remember that the presence of breast cancer risk factors does not mean that cancer is inevitable as many women with risk factors never develop breast cancer.
Another very important issue is that the Gail model does not consider the risk of cancer associated with inherited breast cancer-predisposing genes such as BRCA1 and BRCA2. If an individual has a strong family history that suggests the possibility of an inherited predisposition to breast cancer, then that individual should be referred for genetic counseling. Other components of a risk/benefit assessment and counseling include a careful discussion of the side effects of hormonal therapy, options for participation in clinical research and healthy lifestyle changes.
Women at high risk may include some women over the age of 60; women with certain high-risk conditions found on breast biopsy, such as lobular carcinoma in situ (LCIS) or atypical ductal or lobular hyperplasia; women between the ages of 35 and 59 years who have a calculated five-year risk of developing breast cancer of 1.7 percent or higher, according to a system called the Gail model. The Gail model uses a woman's current age, age at first menstrual period, age at first live birth, the number of first-degree relatives with breast cancer, and the number and pathologic findings of any breast biopsies to estimate the probability of breast cancer over time. This model, and others, is used by health professionals to calculate an individual’s risk and the results should be interpreted with an expert in breast cancer risk assessment. It is also important to remember that the presence of breast cancer risk factors does not mean that cancer is inevitable as many women with risk factors never develop breast cancer.
Another very important issue is that the Gail model does not consider the risk of cancer associated with inherited breast cancer-predisposing genes such as BRCA1 and BRCA2. If an individual has a strong family history that suggests the possibility of an inherited predisposition to breast cancer, then that individual should be referred for genetic counseling. Other components of a risk/benefit assessment and counseling include a careful discussion of the side effects of hormonal therapy, options for participation in clinical research and healthy lifestyle changes. The role of hormonal therapy for risk reduction should be carefully considered and discussed with experts in breast cancer risk assessment and management in a shared decision-making environment. Guidelines from expert groups recommend that the risks and benefits of breast cancer prevention be discussed with premenopausal and postmenopausal women who are at high risk for the disease.
Women at high risk may include some women over the age of 60; women with certain high-risk conditions found on breast biopsy, such as lobular carcinoma in situ (LCIS) or atypical ductal or lobular hyperplasia; women between the ages of 35 and 59 years who have a calculated five-year risk of developing breast cancer of 1.7 percent or higher, according to a system called the Gail model. The Gail model uses a woman's current age, age at first menstrual period, age at first live birth, the number of first-degree relatives with breast cancer, and the number and pathologic findings of any breast biopsies to estimate the probability of breast cancer over time. This model, and others, is used by health professionals to calculate an individual’s risk and the results should be interpreted with an expert in breast cancer risk assessment. It is also important to remember that the presence of breast cancer risk factors does not mean that cancer is inevitable as many women with risk factors never develop breast cancer.
Another very important issue is that the Gail model does not consider the risk of cancer associated with inherited breast cancer-predisposing genes such as BRCA1 and BRCA2. If an individual has a strong family history that suggests the possibility of an inherited predisposition to breast cancer, then that individual should be referred for genetic counseling. Other components of a risk/benefit assessment and counseling include a careful discussion of the side effects of hormonal therapy, options for participation in clinical research and healthy lifestyle changes.
New answer by PaulaRyanMDPhD (Physician - Oncology - Hematology/Oncology (Verified)) in topic(s) Cancer Risk Reduction, Breast Cancer, Hormonal Therapy, Breast Cancer High Risk, Breast Cancer Risk Reduction, Cancer Risk Assessment, Medications, Breast Cancer Medications, Breast Cancer Risk Assessment
1
Answer |
1 month ago
Initiation of hormonal therapy is commonly begun after the completion of chemotherapy (and after completion of radiation therapy if you receive both). In terms of actual timing, hormonal therapy will typically begin approximately four to six weeks following completion of chemotherapy. A preference for sequential timing of chemotherapy and hormonal therapy, i.e., adjuvant chemotherapy followed by hormonal therapy, was suggested by a clinical trial, in which sequential versus concurrent chemo/hormonal therapy were directly compared and sequential treatment had superior outcomes for disease free and overall survival.
I would add that there are limited clinical data and no consensus on the use of concurrent hormonal therapy and radiation therapy, thus some medical oncologists advise overlap of hormonal therapy with radiation and others advise waiting until radiation is complete. I generally advise waiting until radiation is complete. Initiation of hormonal therapy is commonly begun after the completion of chemotherapy (and after completion of radiation therapy if you receive both). In terms of actual timing, hormonal therapy will typically begin approximately four to six weeks following completion of chemotherapy. A preference for sequential timing of chemotherapy and hormonal therapy, i.e., adjuvant chemotherapy followed by hormonal therapy, was suggested by a clinical trial, in which sequential versus concurrent chemo/hormonal therapy were directly compared and sequential treatment had superior outcomes for disease free and overall survival.
I would add that there are limited clinical data and no consensus on the use of concurrent hormonal therapy and radiation therapy, thus some medical oncologists advise overlap of hormonal therapy with radiation and others advise waiting until radiation is complete. I generally advise waiting until radiation is complete.
I would add that there are limited clinical data and no consensus on the use of concurrent hormonal therapy and radiation therapy, thus some medical oncologists advise overlap of hormonal therapy with radiation and others advise waiting until radiation is complete. I generally advise waiting until radiation is complete. Initiation of hormonal therapy is commonly begun after the completion of chemotherapy (and after completion of radiation therapy if you receive both). In terms of actual timing, hormonal therapy will typically begin approximately four to six weeks following completion of chemotherapy. A preference for sequential timing of chemotherapy and hormonal therapy, i.e., adjuvant chemotherapy followed by hormonal therapy, was suggested by a clinical trial, in which sequential versus concurrent chemo/hormonal therapy were directly compared and sequential treatment had superior outcomes for disease free and overall survival.
I would add that there are limited clinical data and no consensus on the use of concurrent hormonal therapy and radiation therapy, thus some medical oncologists advise overlap of hormonal therapy with radiation and others advise waiting until radiation is complete. I generally advise waiting until radiation is complete.
New answer by PaulaRyanMDPhD (Physician - Oncology - Hematology/Oncology (Verified)) in topic(s) What To Expect, Cancer Treatment Process, Hormonal Therapy, Aromatase Inhibitors, Medications, Breast Cancer Treatment Process, Breast Cancer Medications, Breast Cancer What To Expect, Tamoxifen
1
Answer |
1 month ago
If you have metastatic breast cancer and chemotherapy is part of your treatment plan, your doctor may use different tests to determine how well the chemotherapy is working and how you're handling the chemotherapy. These tests may include CT scans, bone scan, MRI, X-rays, laboratory studies, among others. If these tests show that the cancer is growing or that the cancer is showing up in new areas then that may signal a time when the chemotherapy needs to change. Chemotherapy may also change if it is causing too many side effects and problems for you.
If you have metastatic breast cancer and chemotherapy is part of your treatment plan, your doctor may use different tests to determine how well the chemotherapy is working and how you're handling the chemotherapy. These tests may include CT scans, bone scan, MRI, X-rays, laboratory studies, among others. If these tests show that the cancer is growing or that the cancer is showing up in new areas then that may signal a time when the chemotherapy needs to change. Chemotherapy may also change if it is causing too many side effects and problems for you.
New answer by PaulaRyanMDPhD (Physician - Oncology - Hematology/Oncology (Verified)) in topic(s) Breast Cancer Complications, Chemotherapy Treatment Complications, Breast Cancer, Breast Cancer Treatment Options, Metastatic Breast Cancer, Breast Cancer Treatment, Medications, Breast Cancer Medications, Metastatic Cancer, Chemotherapy
1
Answer |
3 months ago
We consider reducing the dose of chemotherapy when there are either laboratory studies that are outside a safe range or when side effects become too troublesome for our patients. Chemotherapy may be reduced, for example, for low blood counts. Also, it may be reduced in the setting of abnormal liver or kidney function tests. Sometimes reducing the dose is not safe enough and your doctor may have to hold the treatment for a week or more. Often reducing or holding a dose of chemotherapy will allow you to be treated safely at a future date.
We consider reducing the dose of chemotherapy when there are either laboratory studies that are outside a safe range or when side effects become too troublesome for our patients. Chemotherapy may be reduced, for example, for low blood counts. Also, it may be reduced in the setting of abnormal liver or kidney function tests. Sometimes reducing the dose is not safe enough and your doctor may have to hold the treatment for a week or more. Often reducing or holding a dose of chemotherapy will allow you to be treated safely at a future date.
New answer by PaulaRyanMDPhD (Physician - Oncology - Hematology/Oncology (Verified)) in topic(s) Breast Cancer, Breast Cancer Treatment Options, Metastatic Breast Cancer, Chemotherapy Options, Medications, Medication Options, Chemotherapy Treatment Options, Chemotherapy Tolerance, Chemotherapy Complications, Chemotherapy
1
Answer |
3 months ago
During chemotherapy we hope to see an improvement in symptoms, if you are having any, within days or weeks of treatment. We expect to see changes on scans (for example, CT scans, X-rays, bone scans) within weeks of beginning treatment. Most often, we would recommend looking at scans within 6-8 weeks after starting chemotherapy. Sometimes the interval is related to how often you have the chemotherapy. For example, if your treatment is every 3 weeks then you may have scans at 6 or 9 weeks and if the chemotherapy is every 4 weeks then you may have scans in 8 or 12 week intervals. If the drug is working then we would expect to see tumors shrinking or staying the same size. If the drug is not working as well as we would like then we may see tumors getting larger or new tumors showing up on the scans.
During chemotherapy we hope to see an improvement in symptoms, if you are having any, within days or weeks of treatment. We expect to see changes on scans (for example, CT scans, X-rays, bone scans) within weeks of beginning treatment. Most often, we would recommend looking at scans within 6-8 weeks after starting chemotherapy. Sometimes the interval is related to how often you have the chemotherapy. For example, if your treatment is every 3 weeks then you may have scans at 6 or 9 weeks and if the chemotherapy is every 4 weeks then you may have scans in 8 or 12 week intervals. If the drug is working then we would expect to see tumors shrinking or staying the same size. If the drug is not working as well as we would like then we may see tumors getting larger or new tumors showing up on the scans.
New answer by PaulaRyanMDPhD (Physician - Oncology - Hematology/Oncology (Verified)) in topic(s) Chemotherapy Treatment Process, Chemotherapy Treatment Measurement, Breast Cancer Tests, Treatment Progress, Breast Cancer, Metastatic Breast Cancer, Breast Cancer Treatment Process, Chemotherapy Treatment Progress, Chemotherapy
1
Answer |
3 months ago
The mouse mammary tumor virus-like sequences (MMTV-LS) has been studied as a possible cause of human breast cancer. Molecular laboratory techniques are the most definitive for establishing a viral presence in human tissues. Despite many published laboratory studies on this subject many have had problems with methodology or design and they remain preliminary in establishing a significant association with breast cancer. Studies are ongoing.
The mouse mammary tumor virus-like sequences (MMTV-LS) has been studied as a possible cause of human breast cancer. Molecular laboratory techniques are the most definitive for establishing a viral presence in human tissues. Despite many published laboratory studies on this subject many have had problems with methodology or design and they remain preliminary in establishing a significant association with breast cancer. Studies are ongoing.
New answer by PaulaRyanMDPhD (Physician - Oncology - Hematology/Oncology (Verified)) in topic(s) Breast Cancer, Mouse Mammory Tumor Virus, Human Mammary Tumor Virus, Breast Cancer Research
1
Answer |
3 months ago
In general, most chemotherapy medicines can be used to treat metastatic breast cancer until side effects become a problem or the medicine stops being effective. Breast cancer that has metastasized will often require continual treatment whereas treatment in the non-metastatic setting typically has a defined number or duration of treatments. For example, in the non-metastatic setting, a usual care plan includes surgery with or without radiation therapy, and some type of systemic (drug) therapy, with the drug therapy specified as a certain number of cycles (if chemotherapy) or a certain duration of treatment (for example, tamoxifen for 5 years). In metastatic breast cancer, the goal of medicines is to destroy or damage tumor cells and to shrink tumors or keep tumors stable and in order to do that we have to keep patients on treatment most of the time. Sometimes when the cancer is stable we can provide our patients with some time off or drug holiday but most of the time we have to consider some type of systemic therapy.
In general, most chemotherapy medicines can be used to treat metastatic breast cancer until side effects become a problem or the medicine stops being effective. Breast cancer that has metastasized will often require continual treatment whereas treatment in the non-metastatic setting typically has a defined number or duration of treatments. For example, in the non-metastatic setting, a usual care plan includes surgery with or without radiation therapy, and some type of systemic (drug) therapy, with the drug therapy specified as a certain number of cycles (if chemotherapy) or a certain duration of treatment (for example, tamoxifen for 5 years). In metastatic breast cancer, the goal of medicines is to destroy or damage tumor cells and to shrink tumors or keep tumors stable and in order to do that we have to keep patients on treatment most of the time. Sometimes when the cancer is stable we can provide our patients with some time off or drug holiday but most of the time we have to consider some type of systemic therapy.
New answer by PaulaRyanMDPhD (Physician - Oncology - Hematology/Oncology (Verified)) in topic(s) Breast Cancer, Breast Cancer Treatment Options, Metastatic Breast Cancer, Treatment Options, Metastasis, Metastatic Cancer
1
Answer |
3 months ago
Both oral and IV chemotherapy can be highly effective strategies for the treatment of breast cancer and which drug your doctor recommends may be related to the timing of treatment, what prior treatment you may have had, what type of breast cancer you have and patient preference. For metastatic breast cancer, one widely used drug is oral capecitabine (Xeloda). Another oral drug we use frequently for metastatic HER2+ tumors is a drug called lapatinib (Tycerb). The vast majority of the drugs we use are IV and many of them have been used for years; others are newer IV drugs (eribulin, ixabepilone, for example) and all have proven effectiveness. Sometimes, practical reasons may dictate whether oral or IV medications are used. If someone has a problem swallowing or taking pills then we use IV drugs and if someone has a preference for taking pills for convenience then we certainly take that into consideration.
Both oral and IV chemotherapy can be highly effective strategies for the treatment of breast cancer and which drug your doctor recommends may be related to the timing of treatment, what prior treatment you may have had, what type of breast cancer you have and patient preference. For metastatic breast cancer, one widely used drug is oral capecitabine (Xeloda). Another oral drug we use frequently for metastatic HER2+ tumors is a drug called lapatinib (Tycerb). The vast majority of the drugs we use are IV and many of them have been used for years; others are newer IV drugs (eribulin, ixabepilone, for example) and all have proven effectiveness. Sometimes, practical reasons may dictate whether oral or IV medications are used. If someone has a problem swallowing or taking pills then we use IV drugs and if someone has a preference for taking pills for convenience then we certainly take that into consideration.
New answer by PaulaRyanMDPhD (Physician - Oncology - Hematology/Oncology (Verified)) in topic(s) IV Chemotherapy, Oral Chemotherapy, Medications, Chemotherapy Experiences, Cancer Medications, Chemotherapy
1
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3 months ago
In my opinion available scientific evidence does not suggest a benefit to chelation treatment for patients with cancer and safety is an important factor to consider. Some laboratory studies have suggested that agents that chelate copper or iron may affect cancer cells or the formation of tumor blood vessels but there is no robust evidence for clinical benefit with chelation. Chelation therapy also may have safety concerns. Chelation therapy may produce toxic effects, including kidney damage, irregular heart beat, nausea, vomiting, diarrhea, and temporary lowering of blood pressure. Since the therapy removes minerals from the body, there is a risk of developing low calcium levels (hypocalcemia). The possible interactions between chelation therapy and chemotherapy and other prescription or over-the counter medications are not well known.
In my opinion available scientific evidence does not suggest a benefit to chelation treatment for patients with cancer and safety is an important factor to consider. Some laboratory studies have suggested that agents that chelate copper or iron may affect cancer cells or the formation of tumor blood vessels but there is no robust evidence for clinical benefit with chelation. Chelation therapy also may have safety concerns. Chelation therapy may produce toxic effects, including kidney damage, irregular heart beat, nausea, vomiting, diarrhea, and temporary lowering of blood pressure. Since the therapy removes minerals from the body, there is a risk of developing low calcium levels (hypocalcemia). The possible interactions between chelation therapy and chemotherapy and other prescription or over-the counter medications are not well known.
New answer by PaulaRyanMDPhD (Physician - Oncology - Hematology/Oncology (Verified)) in topic(s) Breast Cancer, Chelation, Chemotherapy
1
Answer |
3 months ago
These are some practical suggestions for treating dry mouth: sip water or sugar-free drinks often and avoid drinks that cause dry mouth, such as caffeine-containing drinks (coffee, tea, some sodas) alcohol and commercial mouthwashes. Chew sugar-free gums or candies to stimulate saliva flow. Avoid tobacco, as this has a drying effect on the mouth. It may be helpful to avoid spicy and salty foods. You may want to put fruits and vegetables in a blender to soften and smooth them. Use a cool mist humidifier at night. Use a soft-bristle toothbrush and rinse your mouth before and after eating with plain water or a mild mouth rinse (1 quart water, mixed with 1 teaspoon salt and 1 teaspoon baking soda). Regularly floss your teeth. Biotene and Oasis are mouthwash products that may help with dry mouth.
These are some practical suggestions for treating dry mouth: sip water or sugar-free drinks often and avoid drinks that cause dry mouth, such as caffeine-containing drinks (coffee, tea, some sodas) alcohol and commercial mouthwashes. Chew sugar-free gums or candies to stimulate saliva flow. Avoid tobacco, as this has a drying effect on the mouth. It may be helpful to avoid spicy and salty foods. You may want to put fruits and vegetables in a blender to soften and smooth them. Use a cool mist humidifier at night. Use a soft-bristle toothbrush and rinse your mouth before and after eating with plain water or a mild mouth rinse (1 quart water, mixed with 1 teaspoon salt and 1 teaspoon baking soda). Regularly floss your teeth. Biotene and Oasis are mouthwash products that may help with dry mouth.
New answer by PaulaRyanMDPhD (Physician - Oncology - Hematology/Oncology (Verified)) in topic(s) Medication Side Effects, Dry Mouth, Side Effects, Synthetic Saliva
1
Answer |
3 months ago
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