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

 

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Freaky Breast Cancer Friday

I was amazed when the hospital arranged an appointment for me to meet with my surgeon, Mr Osman on Friday, just two days after I got my diagnosis of the tumour. All of a sudden every thing seemed to be moving. In a few days I had gone from feeling fine, to having a battery of tests and then being told that I had a potentially fatal disease. It was too much to take in. I could not believe how fast everything was happening. Looking back, I am ashamed to say tat I simply had not recognised the discharge from my nipple nor my extreme tiredness as signs of breast cancer.

I called my friend across the road and told her. She asked me the name of my surgeon.  I had slightly misheard his name and told her it was Mr Osmond. I joked that I hoped it was Donny Osmond!donny osmond My friend disillusioned me by telling me that her surgeon was the same person, it was Mr Osman and certainly not a American entertainer! She also told me Mr.Osman is delightful and very helpful.

My appointment was for 11.30 on the Friday morning. but I was not seen until after 1pm. By this time, as I had arrived stressed, I was almost climbing the walls and had read almost all the magazines in the waiting room. It did not help that there was a man in the waiting room who chatted loudly and personally to many of the others there. Maybe it was his way of dealing with his own stress, but I found him intimidating and was glad to have my husband with me.  My Husband is a big guy, needless to say the man with the verbal diarrhea came nowhere near us. However, by the time I went into the consulting room I was up to high doe.

So to the embarrassment of my long suffering man, I asked the nurse who took me into the consulting room why my appointment had been made for 11.30 if I was not being seen until nearly 2 hours later. She explained that the clinics were very busy, but that did not answer the question as to why appointment were, apparently, made too close together if patients regularly overran their allotted time. She said I would need to take it up with Mr Osman. I agreed to do this. However, this became unnecessary, as my cancer care nurse came in to see me and calm me down. cancer care nurse I think my husband was even more glad about this than anyone, but I did get him to agree that I had not been rude and that the long wait had made a stressful situation worse.

Shortly afterwards, Mr Osman can in. He explained to me that the biopsy had shown the tumour to be malignant and that it needed to be removed. He also informed me that the tumour was found to be related to the fact that I had been taking HRT for many years. He told me I should stop taking that drug immediately.  I asked him about this because I had understood from my GP that the evidence of this was ambivalent. Maybe I had misunderstood him. Mr Osman smiled and said that the studies were not clear for those who had been taking HRT for 5 years or less. However, he said that for those who had been taking the drug for ten years or more. He noted that I fell squarely into this latter group as I had been taking HRT tablets for at least 12 years.  Mr Osman was, therefore very clear in his advice, I must stop the HRT now.

Then he asked me about when I thought my operation would take place. My friend had told me the time-lag was usually 2-3 weeks so I mentioned this to Mr Osman, but also said I appreciated this would largely depend on his schedules and work load. his kindly face broke into a wide smile. 2-3 weeks would be no problem. I returned his smile and smiled at my husband as Mr Osman went on to tell us that he had only that day negotiated an extra theatre day and he wondered if I was free on Monday.

Monday! This Monday, two days time. I gasped and grinned at my husband. I could not think of anything more pressing I had to do on Monday, or any other day. The thought of getting rid of the cancerous tumour so quickly was wonderful. I felt a bit ashamed that I had complained about the wait in the waiting room and was thrilled that the surgery would take place so quickly.

I was told to be at the hospital for 7.00am and that I would go for the various tests and scans before surgery in the afternoon.   Although the surgery s classed as day surgery, I would be required to stay in hospital overnight. I would be having a general anesthetic and the hospital wanted to keep an eye on me overnight.

We left the hospital in shock. Happy shock, but shock never the less.

Valerie Penny

Breast Cancer on Black Wednesday

Some days are better than others. Wednesday 25 April was a busy day. I spent the first half of it shuffling from one doctor to another. My first appointment was at my GP just for a regular check-up. It was then I was able to tell my GP that I had been recalled after my mammogram. He was quite cross that the hospital had not informed him. The GP also wanted to speak to me about the length of time I had been taking hormone replacement therapy (HRT). It was a long time, over 12 years. However, in light of the other appointment I had to attend later in the morning he decided not to make any changes at this point.

doctor's room

When I came back out of the surgery, I phoned my husband and he drove me on to my next medical appointment of the day. This, again was a regular appointment. It was my fortnightly visit to my psychologist. It is, perhaps, also ironic that I did not believe in depression until I was diagnosed with it over 10 years ago. Like many people, I thought it was not truly an illness, but a state of mind that could be surmounted simply by “pulling yourself together”. I cannot help but think a higher being was having a laugh when they got their own back and I have battled depression, without surmounting it, for so many years now.

However, when the psychologist asked how I felt about the possibility of a diagnosis of cancer, I still could not truly admit that it might, even now happen to me. So I put on my mask, as I so often do when faced with a problem too difficult to face, and told her that I did not know how to feel, until I knew what I had to face. It sounds sensible, but really, I simply could not release my emotions or inhibitions: not then, not yet.

When my husband and I walked from the psychology department of the hospital to the breast cancer care department we went quite slowly. Almost as if by not knowing the results of the biopsy and screening it would prevent the news from being bad.

We were not kept waiting long before I was called through to meet with the doctor and my husband came with me. None of the staff that I had seen the previous week were at the clinic that day. It was a little daunting to know I was to get the results from someone I had never met before.  However, the doctor introduced herself and the cancer nurse assigned to me was there and introduced herself too. She is Angela Watson.

It was explained to us that the biopsy had shown the tumour to be cancerous. It was explained to me that the disease had been found early and the tumour was about half the size of a baked bean. (I have always seen myself more as a “petit pois” kind of girl!) The doctor told me I would need to have surgery, a lumpectomy, (such an ugly word) to remove the tumour.  I was given an appointment to meet with the surgeon on Friday and that I would probably go for surgery in 2-3 weeks. What a lot of information.

Basic RGB

I was told the tumour was found to be HER-2 positive and that I should stop my HRT with immediate effect. HER2 is a protein found on the surface of certain cancer cells. Some breast cancers have a lot more HER2 receptors than others. In this case, the tumour is described as being HER2-positive. Tumours that are HER2-positive tend to grow more quickly than other types of breast cancer. Knowing if a cancer is HER2-positive can sometimes affect the choice of treatment. Women with HER2-positive breast cancer can benefit from a drug called trastuzumab (Herceptin). Herceptin only works in people who have high levels of the HER2 protein.

To understand HER2, it first helps to know a little about receptors and growth factors:

  • Receptors are particular proteins that are present within cells or on their surface. Other proteins or chemicals in the body can attach to these receptors to bring about change within a cell (for example, to make it reproduce or repair itself).
  • Growth factors are chemicals that attach to these receptors and stimulate cells to grow.

HER2 is a receptor found on the surface of certain cancer cells. It is made by a specific gene called the HER2/neu gene. HER2 is a receptor for a particular growth factor called human epidermal growth factor, which occurs naturally in the body. When human epidermal growth factor attaches itself to HER2 receptors on breast cancer cells, it can stimulate the cells to divide and grow.

Some breast cancer cells have a lot more HER2 receptors than others. In this case, the tumour is described as being HER2-positive. It is thought that about 1 in 5 women with breast cancer will have HER2 positive tumours. So roll on Friday and then I get to hear what the surgeon has to advise, but I am not ashamed to say, I have had better days.

Valerie Penny

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