How to manage hot flashes in menopause with breast cancer?

Question

Hello doctor,

I am 52 and was diagnosed with breast cancer three months ago — stage 2 invasive ductal carcinoma, ER-positive and HER2-negative. I had a lumpectomy and sentinel node biopsy, and one lymph node tested positive.

My oncologist recommended chemotherapy followed by radiation and then hormone therapy. I have finished four cycles of AC chemotherapy, and it has been brutal. I have lost all my hair, had constant nausea despite anti-nausea medication, mouth sores, and extreme fatigue. My white blood cell count keeps dropping, and I have had to delay treatment twice. I also gained 15 pounds from the steroids they give with chemo.

I am about to start the Taxol portion of chemotherapy, and I am scared it is going to be worse. My CA 27-29 tumor marker was elevated before surgery at 67, but it came down to 32 afterward. My radiation oncologist wants to start radiation next month. After that, I will need to take Tamoxifen for five to 10 years, which worries me because of the side effects.

I am already going through menopause and have heard that Tamoxifen can make hot flashes worse. Is there an alternative to tamoxifen for hormone-positive breast cancer? I am really struggling with all these treatments and their side effects.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

I am really sorry for what you are going through, and I truly feel for you. I understand your concerns about chemotherapy, radiotherapy, and hormonal therapy.

About chemotherapy: It can cause side effects such as hair loss, low white blood cell counts, and tiredness. But do not worry, these effects usually go away once chemotherapy is finished.

About radiotherapy: It is very important in your case because it helps prevent the cancer from coming back. The side effects are usually limited to the treated area of the breast. You might feel a bit of nausea or vomiting, but it is usually very mild, not like chemotherapy. The skin might get a little red or irritated, but this also improves quickly with soothing creams.

About Tamoxifen: Since you are worried about hot flashes, we can consider other options. Because you are near menopause, aromatase inhibitors such as Exemestane or Letrozole may be good alternatives. They are often better tolerated and have fewer side effects than Tamoxifen.

I hope you can continue your treatment journey with patience and faith. It might feel long and hard now, but you are strong, and the cancer was discovered early, which is very encouraging. With time and treatment, you will recover fully and return to your normal life.

Treatment plan:

1. Chemotherapy.

2. Surgery.

3. Radiotherapy.

4. Hormonal therapy.

Regarding follow-up: Two weeks.

I hope this helps.

Kindly follow up if you have more concerns.

Thank you.