Breast Cancer – The Side-Effects of Tamoxifen

mammogramI have had breast cancer. After the surgery, the chemotherapy and the radiotherapy, I have spent the last 5 years being treated by the drug letrozole to avoid recurrence of the disease. Last month, I had my annual check-up and mammogram and was found to be 5 years cancer free. Result! However, my tumour was HER2+ and therefore my oncologist has advised another 5 years of endocrine teatment with Tamoxifen.

I suffered from almost every side-effect of Letrozole, so it is important to me to be aware of the side effects I may have to endure while taking Tamoxifen. Everybody reacts differently to drugs and some people experience more severe side effects than others, some are really lucky and are not aware of any side effects.

The most common side effects that people have when taking Tamoxifen are much like Tamoxofen packetthe symptoms of the menopause. They include hot flushes, night sweats and sleep disturbance. Other common side effects are vaginal irritation, loss of sex drive and mood changes. Women who have regular periods are likely to find the flow may be lighter, irregular or stop altogether. However, vaginal discharge is common while taking Tamoxifen and so you should be aware of the possibility of infection,.

One of the positive side effects of Tamoxifen for women who are post-menopausal is that this drug is found to slow down the progress of osteoporosis which is thinning of the bones. Conversely, women sho are pre menopausal may be at risk of thinning bones while taking Tamoxifen.

pulmonary embolismThere are other side effects of Tamoxifen that are less common. The drug increase the risk of getting blood clots including deep vein thrombosis (DVT). This can be very serious as people with DVT are at risk of developing a pulomary embolism. Therefore people taking Tamoxifen need to be aware of blood clots and ways of helping to reduce this. Lengthy periods of inactivity can increase the risk of developing bood clots. Those who take long flights, car journeys or train trips need to be aware of the this.

My oncologist also warned me about the fact that Tamoxifen can afftect the lining of the womb and cause it to thicken. In a few cases Tamoxifen can even cause polyps, ovarian cysts or womb cancer. As my family is complete, I have told the doctors that I would look to have a hysterectomy, should that occur.

letrozole-hairA change in hair may also occur. A small number of women may find they notice an increase in downy facial hair and changes to their singing voice. Others find they suffer hair loss or thinning while taking tamoxifen. I suffered hair loss while taking Letrozole, so will be particularly alert for this side effect.

Sight may also change. Make sure to make your regular visits to your optician during treatment.

Tamoxifen can also cause changes to liver function. However, the changes to the liver are usually mild and you may not notice them. At the end f your Tamoxifen treatment your liver will probably return to normal.

Amongst the other side effects are joint pain, tiredness, difficulty concentrating, letrozole-fluidheadaches and leg cramps at nght. Some women also suffer weight increase.

My oncologist has told me that Tamoxifen usually only results in mild side effects. However, I encountered many of the side effects with Letrozole and fear Tamoxifen may be the same. They cause me distress, pain and make me self conscious. However, if Tamoxifen keeps the dreaded breast cancer at bay, I will take the tablets and live.

Valerie Penny

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Breast Cancer Treated With Tamoxofen

I am lucky, I have just been for my annual mammogram and breast cancer check up and I have learned that I am still clear of this horrible disease. It is now 5 years since I wasbreast mammogram diagnosed and treated for breast cancer. 5 years clear: wonderful. However, that does not mean I am treatment free. I have been taking Letrozole for these first five years. The side effects of that drug are many and various. I think I suffered all of them, except high blood pressure! Anyway, the oncologist says it is time to move on from Letrozole to Tamoxifen.

Tamoxifen is another form of hormone treatment, known as endocrine therapy, for those who have had breast cancer. It is only prescribed if the breast cancer had receptors within the cell that bind it to oestrogen. All breast cancers are tested for oestrogen using tissue from a biopsy or after surgery. My tumour was found to be HER2+ and, as this can stimulate cancer tumours to grow, Tamoxifen is prescribed to help stop any cancer cells from growing.

If you are found to be hormone receptor negative, then Tamoxifen will not be of any benefit to you.

Tamoxofen

Primary breast cancer, which has not spread beyond the breast and lymph glands, may be treated with Tamoxifen after surgery. The lymph glands are under your arms. Tamoxifen is used as additional treatment to reduce the risk of the cancer returning and also to reduce the risk of new cancers developing. This is called adjuvant therapy.

Occasionally, Tamoxifen may be used as the first treatment for breast cancer. This may be when surgery is not appropriate or before surgery to shrink a large breast cancer tumour. Shrinking a large tumour in this way may mean that a mastectomy (breast removal) may be avoided and a lumpectomy (removal of the tumour and surrounding tissue) may be sufficient treatment. Also, Tamoxifen may be used for breast cancer that has returned into the breast or surrounding area. It can also be used if you are diagnosed with secondary breast cancer. This is when cancer cells from the breast have spread to other parts of the body.

Tamoxofen packetIn some instances, Tamoxifen may be an option for some people who have a high risk of developing breast cancer because of family history of the disease. This is in order to reduce the risk of development of breast cancer.

 

Tamoxifen is usually taken as a tablet, but may be prescribed as a liquid for those who find swallowing difficult. The recommended dose for the majority of people is 20mg. It is best to take one at the same time each day, but, if you miss a dose, it is not necessary to take an extra tablet because there will be a high enough level of the drug in your body from the previous day.

Usually, you will be prescibed Tamoxifen for a period of between 5 and 10 years. I have been told I should take the drug for a 5 year period. So, here goes, Tamoxifen here I come!

Valerie Penny

 

Breast Cancer – Side Effects of Letrozole (Femara)

letrozoleI was diagnosed with breast cancer. After surgery, chemotherapy and radiotherapy, I was prescribed Letrozole (Femara) and must take one 2.5mg tablet each day for a perios of 5 years. Letrozole is a hormonal therapy drug. It is used to treat breast cancer in women who have been through the menopause. Letrozole has been prescribed in order to reduce the liklihood of the cancer recurring, so I am taking it. However, Letrozole does have many unpleasant side-effects and I suffer with most if them. I was not told about these. I think I should have been.

Letrozole is used after surgery and other treatments to reduce the risk of breast cancer coming back. You will usually take it for a few years. Doctors sometimes prescribe it before or after you have another type of hormonal therapy drug. Sometimes doctors give letrozole before surgery to try to reduce the size of the cancer and avoid having a mastectomy (removal of the breast). Letrozole is also used to control breast cancer that has spread to other parts of the body (secondary breast cancer)

Many breast cancers rely on the hormone oestrogen to grow. This type of breast cancer is called oestrogen receptor-positive (ER positive) breast cancer. My breast cancer fell into this category.

Hormones are substances produced naturally in the body. They act as chemical letrozole-tabletsmessengers and help control the activity of cells and organs. Hormonal therapies interfere with the way hormones are made or how they work in the body. After the menopause, oestrogen is no longer made in the ovaries. Instead it’s made in the fatty tissues of the body. This happens when an enzyme called aromatase changes other hormones into oestrogen. Letrozole is a drug called an aromatase inhibitor. It blocks this process and reduces the amount of oestrogen in the body.

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I will explain the most common side effects of letrozole here but it is sensible to tell your doctor or nurse about the side effects you have. They can prescribe drugs to help control some of them and give you advice about managing them.

Hot flushes and sweats

These are common and are often mild, but this can vary. Hot flushes and sweats may lessen after the first few months. Cutting down on nicotine, alcohol and hot drinks containing caffeine, such as tea and coffee, can help. Dress in layers, so you can remove clothes as needed. Natural fabrics, such as cotton, may feel more comfortable. If hot flushes are troublesome, tell your doctor. Low doses of certain antidepressant drugs can help to reduce flushes.

Bone thinning

Taking letrozole for a few years increases your risk of bone thinning, called osteoporosis. This can increase your risk of a broken bone (fracture). You will usually have a bone density scan to check your bone health before and during treatment. If you are at risk of osteoporosis, your doctor may prescribe drugs called bisphosphonates to protect your bones. They will also usually advise you to take calcium and vitamin D supplements. Regular walking, eating a healthy diet, not smoking and sticking to sensible drinking guidelines will also help to strengthen your bones.

Tiredness and lack of energy

You may feel tired, sleepy or feel like you have no energy when you start taking letrozole. Try to pace yourself until this improves. It is important to get the right balance of having enough rest and being physically active. Regular short walks will help you to feel less tired. If you feel sleepy, don’t drive or operate machinery.

Joint and muscle pain

You may have pain and stiffness in your joints, and sometimes in your muscles, while taking letrozole. Let your doctor or nurse know if this happens. They can prescribe painkillers and give you advice. Being physically active and maintaining a healthy weight can help reduce joint pain and keep them flexible. Let your doctor know if it doesn’t get better.

Feeling sick and indigestion or tummy pain

Any sickness is usually mild, but let your doctor or nurse know if this happens. Letrozole may also cause indigestion or tummy pain. Let them know if you have any of these symptoms. They can prescribe drugs to help.

Change in appetite

If you do not have much appetite, try eating small meals often and regularly. If problems with eating don’t get better talk to your doctor or nurse. Some women find their appetite increases. Eating healthily and being physically active will help if you have concerns about your weight, but staying active when you are tired and have joint and muscle pain can be difficult.

Hair thinningletrozole-hair

Some women notice that their hair becomes thinner while taking letrozole. This is usually mild. Your hair will get thicker after treatment finishes. I hope this is true. The hair thinning is quite embarrassing for a woman.

Skin rashes

You may get a mild skin rash . Tell your doctor or nurse if this happens. It is very important to contact your doctor straightaway if you get a severe skin rash.

Mood and behaviour changes

Some women may find they have a low mood while taking letrozole. Or you may have problems concentrating, feel anxious or have difficulty sleeping. Talk to your nurse or doctor if you have these changes so they can give you support and advice.

Headaches

If you have headaches let your doctor or nurse know. They can usually be controlled with painkillers you can buy yourself.

Feeling dizzy

Letrozole may cause dizziness. Let your doctor or nurse know if this is a problem.

Weight gain

You may put on weight when you’re taking hormonal therapy. Eating healthily and being physically active can help to keep you to a healthy weight: however, it is difficult to be physically acive when you also have the side effects of tiredness or joint and muscle pain.

Vaginal bleeding

Letrozole rarely causes vaginal bleeding. If this happens it is most likely in the first few weeks of treatment, or when you change from another hormonal therapy to letrozole. If bleeding continues for more than a few days, tell your doctor or nurse.

Raised blood pressure

Tell your doctor or nurse if you have ever had any problems with your blood pressure. Your nurse will check it regularly during your treatment. This is one of the few side-effect I do not get!

Raised cholesterol level

Your doctor may check your cholesterol levels with a blood test.

Build-up of fluidletrozole-fluid

You may get swollen feet and ankles because of fluid building up. If you notice this or any other swelling let your doctor know.

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In addition to these more common side-effects of Letrozole, there are other possible side-effects that are less common.

Vaginal dryness

Non-hormonal creams and gels or lubricants can help reduce dryness and discomfort during sex. You can buy these at a chemist or your doctor can prescribe them.

Urine infection

Let your doctor know if you have pain or discomfort when you pass urine, or if you need to go more often, or your urine is cloudy or smelly. Drink lots of fluids if you think you may have an infection.

Eye problems

Occasionally women get sore eyes or blurry vision with letrozole. Always tell your doctor or nurse if you notice any change in your vision.

Changes to your heartbeat

If you notice changes to your heartbeat, such as it speeding up, let your doctor know. If you have pain or tightness in your chest, or feel breathless at any time during or after treatment, see a doctor straightaway.

letrozole-rash***

I was told that my side-effects would settle down after a few months. That has not been the case for me, nor ofr many other women who have contacted me. Still, we keep taking the tablets. I would rather complain than have to explain to my family that the breast cancer is back.

Valerie Penny

 

 

Reduce the Risk of Breast Cancer

Since I was diagnosed with breast cancer, I have become very breast aware and am anxious that I should know how to advise my daughters so that their risk of this horrible disease is minimized. So, whatever your age, size or shape it is so important to take care of your breast mammogrambreasts. Breast cancer is the most common cancer in the UK. It affects men as well as women. So it is important to look after your breasts by being breast aware. This means getting to know how your breasts look and feel, so you know what is normal for you. You will then be more confident about noticing any unusual changes.

Before my breast cancer diagnosis, I did not check my breasts. I did not know I should. I know now this was a big mistake. Try to get used to looking at and feeling your breasts regularly. You can do this easily in the bath or shower or when you get dressed. Check all parts of your breasts, your armpits and up to your collarbone.

breast dischargeIt will not surprise you to know that before I was told I had breast cancer, I did not know what changes to look for – many of us don’t. Make sure you know what your own breasts feel like. Everyone’s look and feel different, so when yo check your breasts, be aware of any changes that are different for you.

This might be a change in size or shape; redness or a rash on the skin or around the nipple or lumps or thickening that feels different from the rest of the breast tissue. Alternatively, you might become aware of  change in skin texture such as puckeringbreast dimpling or dimpling like orange peel. I found a discharge from my right nipple, but I did not recognise this as a sign of breast cancer. Other changes might be swelling in the armpit or around your collarbone. Be aware if your nipple becomes inverted when it is not usually so or changes its position or shape in another way; you may also have constant pain in your breast or armpit.

If you notice any change in your breasts go to see your GP as soon as possible. Most changes are benign, but if you are struck by breast cancer, give the doctors a chance to help you by going to see them as early as possible.

My breast cancer was discovered as the result of a breast screening appointment arranged by my GP. Breast screening, or mammography as it is known, is an X-ray examination of the breasts. For me, it helped to detect breast cancer before I was aware of any signs or symptoms. The sooner the breast cancer is detected and diagnosed, the more effective treatment will be and the more likely you are to have a more satisfactory outcome.

Valerie Penny

Osteoporosis and Breast Cancer

Osteoporosis literally means porous bones. The result is that the bones can become thin or snap. Osteoporosis cannot be cured and often is not found until after bones break. It affects half of women over 50 and one in five men in that age range and some people who receive treatment for breast cancer are at an increased risk of ostoeporosis, however, treatments are available to try to keep bones strong and less likely to break.

Women who have not gone through the menopause before they are treated for breast cancer have an increased risk of osteoporosis. Indeed, chemotherapy can cause an early menopause and a rapid, significant reduction in bone density and result in osteoporosis.Even women who have been through the menopause may be at increased risk of osteoporosis because of the hormone therapies they take for breast cancer.

balanced her 2.jpgI am being treated with letrozole for my breast cancer. My tumour was of the fast growing HER2 positive variety. The letrozole is one of the drugs that reduces the amount of oestrogen circulating in my body and this could result in osteoporosis. I have my bone density checked with a bone density scan and, so far, I do not show signs of osteoporosis. Generally speaking, people with a good bone density before getting treatment for breast cancer are less likely to develop osteoporosis while taking an aromatase inhibitor such as letrozole.

I have been careful to put some simple lifestyle choices to help keep my bones strong and healthy. I ensure that, although I am vegetarian, I have a well-balanced diet. Although dietbalanced-diet changes will not cure bone defects, it may stop them osteoporosis getting worse. Eating meals that incorporate a wide variety of foods including fruit and vegetables, carbohydrates, milk and dairy products and proteins help achieve this. As a general rule it is recommended that we eat at least five portions of fruit and vegetables a day. You would be amazed how many people, including vegetarians, do not manage this! I have also significantly reduced my alcohol intake and the amount of fizzy drinks I take.

Calcium is a vital mineral for teeth and bones. It gives them strength and rigidity. Most of the calcium found in our bodies is in our bones. Dairy produce is our main source of calcium. People  can usually get enough calium through a healthy diet that includes dairy products. If your diet did not include dairy produce you would need to ensure you got calium from another source such as a calcium supplement.

I also have to bear in mind that vitamin D is needed to help my body absorb calcium. The best source of vitamin D is sunlight. Human bodies use the sunshine to make vitamin D in the skin. The vitamin D is fat-soluble and the body stores it for use in the winter months. balanced sunWe only need to be out in the sun for about quarter of an hour a day during the summer months to give most people enough vitamin D for the whole year. So a walk, some gardening or a round of golf should make sure we get enough vitamin D. In addition to that, margarine, egg yolks and oily fish also contain vitamin D.

Regular weight-bearing exercise is also important to put force through the bones. This helps stimulate growth and strength and keep bones strong and healthy. Such exercise includes skipping, aerobics, tennis, and dancing are good bone building activities, even a brisk walk can be of benefit to bones. I try to do some exercise at least three times a week in order to combat the cancer-related fatigue I suffer and the potential for weight gain that my medication induces. I really try very hard to make sure that I do not add osteoporosis to my list of worries.

Valerie Penny

 

Radiotherapy after Breast Cancer

My Uncle suffered from colon cancer and had told me that radiotherapy was not nearly as difficult to bear as chemotherapy. However, when I came to receive radiotherapy for my breast cancer, I came to disagree with him. Radiotherapy treatment is planned and delivered by specially trained professionals called therapy radiographers. It is given by a machine called a linear accererator. Breast cancer patients are usually treated for between 3 to 6 weeks.

The treatment only lasts a few seconds, but to get prepared and settled on the machinery, the period each patient is in the room is about 10 minutes. I needed four weeks treatment. It is given on week days, every week day except for public holidays, for the stated period, so I had to go for treatment 5 days a week for four weeks.

The treatment, at least at first, is painless. Still, reasons that I did not agree with my uncle were that the journey to the hospital that delivers the treatment is an hour’s drive from where I live, and an hour’s drive back. Given that and the wait for treatment at the beatsonhospital could mean a 3-4 four round trip. That was terribly tiring. Also, the treat ment is given in a large room that contains nothing but a chair to place my cloths on, a screen for the radiographers to stand behind as they deliver treatment and the machine, itself.

Patients are not treated by the same radiographers each day and students, male or female, may be amongst the team. I should have been asked if I was willing to have a student present , but I never was. Like many who suffer from breast cancer, I come from a generation that is not used to displaying my body to other people, especially much younger men. I was simply told to take off the clothes on my top half and come over to the machine. It was embarrassing and demeaning. I was just given a piece of paper towel to cover my modesty. Needless to say, that did not work!

The way this treatment was delivered was embarrassing and demeaning. The journey to get the treatment was long and tiring. During treatment I had to lie in a specific position so that the radiotherapy could be delivered most accurately. The radiographers dimmed the lights for a short time while they positioned the machine. They then stood behind the b machinescreen while the treatment was delivered.Once or twice the treament given was slightly different in that it was a boost to my scar area. However, the method of delivery and the lack of attention to personal sensitivities was the same as ever.

The treatment results in a cumulative effect to the cancer and side effects. At first, I felt no different after treatment. It was only after two weeks or so that I bagan to feel side effects and so terribly tired, weary, as a result of the treatment. It also caused burning on and in the flesh around my breast. The hospital provded aqueous cream to soothe that.

I needed the radiotherapy to help beat the cancer, but it was difficult to bear.

Valerie Penny

FEC Chemotherapy for Breast Cancer

When I was diagnosed with breast cancer, apart from being completely taken aback that something like this could happen to me, I got detailed advice from the oncologist about the type of treatment I would need.

fecI was told that after surgery to remove the tumours, the oncologist told me that I would receive chemotherapy and then  radiotherapy. The chemotherapy I received was called FEC. This is a combination of three chemotherapy drugs 5 fluorouracil, epirubican and cyclophosphamide. FEC takes its name from the initial of these three drugs.It is normally used to treat people with primary breast cancer that has not spread to other parts of the body. Chemotherapy destroys cancer cells by interfering with their ability to divide and grow.

All cells in our bodies continually divide and grow. This enables growth and repair of body tissue. Cancer cells are different because they grow by dividing in a disorderly and uncontrolled way. Different chemotherapy drugs work in different ways and attack the cancer cells at different stages of their growth. This is why a combination of drugs is often more effective than just one drug.

I was given my FEC intravenously. I had a Hickman line fitted because the veins in my hands did not allow easy acces for the cancer nurses.  All my medication was given through my Hickman line. I did not like having it, but it was useful. I was given the FEC as an out patient, every three weeks for 18 weeks. This meant I could go home on the same day after treatment, that was nice, but the days were long and tiring. The time involved is not just that required to give the drugs, but also waiting time, blood tests and time for the drugs to be prepared.fec tired

I suffered side effects with FEC. The common side effects include bone marrow suppression.Bone marrow suppression or myelotoxicity is the decrease in production of cells responsible for providing immunity, carrying oxygen and those responsible for normal blood clotting. Bone marrow suppression is a serious side effect of chemotherapy. The decrease in blood cell counts does not occur right at the start of chemotherapy because the drugs do not destroy the cells already in the bloodstream. However, the drugs affect new blood cells that are being made by the bone marrow. The suppression of bone marrow activity causes a deficiency of blood cells. This condition can rapidly lead to life-threatening infection, as the body cannot respond to invading bacteria and viruses.It can also leading to anaemia due to a lack of red blood cells and spontaneous severe bleeding due to deficiency of platelets. This resulted in me suffering from severe tiredness and exhaustion. It is difficult to describe the depth of the feelings of exhaustion. I also had several spontaneous nose bleeds.

Other side effects include nausea and vomiting. The hospital supplied medication to minimise this. I was instructed to take the medication at specified times after my treatment. However, the most visual side effect of chemotherapy is hair loss. I did try an ice-cap to reduce that, but to no avail. It did not work.

fec baldWhen people think of hair loss, they, and women in particular think of the loss of hair on their head. Certainly that does go. The result is a cold head in winter! However, all of the hair on my body was lost. This included the hair on my limbs and inside my nose. The good news was that I did not need to shave my legs for a year, the bad news is that it meant there were no hairs to stop my nose from running. Always carry a handkerchief!

I was not going to bother buying a wig. However, my cancer nurse advised that I should. This was partly because it might make the sight of me during my illness less difficult for my children and my elderly mother. She also pointed out that it would keep my head warmer, especially in winter. She was right on both counts.

Cancer affects not just the person who is diagnosed, but all the people who love them: their friends and family. I hope you never suffer such a diagnosis, but if you do, bear in mind the agony of those around you.

Valerie Penny

 

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