Why has my breast cancer relapsed and spread to my bones?

Question

Hello doctor,

I had breast cancer five years ago. I thought I was cured, but now it has come back and spread to my bones. I have severe bone pain in my back, ribs, and hips. I am on chemotherapy again, I am exhausted, losing weight, and I am terrified I am dying.

What does metastatic mean?
Is this stage four?
Is it curable, or am I just buying time?
How long do I have left?
What are my treatment options?
What chemotherapy works for metastatic breast cancer?
What are immunotherapy options? What are the side effects?
What can I do for bone pain? Are pain pills enough?
What about opioids? Are they addictive?
What is radiation for bone metastases?
Does it help with pain?
How do I maintain quality of life?
What is palliative care?
Do I need an oncologist and a pain specialist?
Is there any hope, or should I get my affairs in order?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I understand the amount of pain, stress, and fear you have about the cancer coming back again and appearing in the bone. But I want to reassure you that we can have full control over all of this. The situation is simple, do not be afraid, it is not as you imagine. Even if the disease has returned, we have many solutions and many options.

Firstly, if your disease is hormone-positive, then at this stage we prefer to use immuno-targeted hormonal therapy, such as Everolimus and Exemestane. If it is PARP-positive, we will use a PARP (poly ADP ribose polymerase) inhibitor. We will use Ribociclib and Palbociclib. We have a lot of immunotherapy and targeted therapy options that allow us to control the spread of the disease again.

As for Herceptin (Trastuzumab), we use it if your tumor is HER2-positive. Regarding the bone pain, we prefer to give localized therapy in the areas affected by pain to reduce the spread from those sites. We give Denosumab, which is a treatment specifically targeted to the bone; it strengthens the bone structure and reduces cancer spread within the bones. We also give calcium and vitamin D supplements.

As for the pain itself, I recommend that you see a pain specialist. They will assess your pain scale and provide the appropriate pain treatment, ranging from mild nonsteroidal anti-inflammatory drugs (NSAIDS) up to weak opioids, or even strong opioids. At this stage, we must pay attention to nutrition. Of course, there will be a nutrition plan; we will have small, frequent meals and ensure proper hydration.

We also need emotional support from the family. You are strong enough to get through this stage. This stage is not as difficult as you imagine. The situation is simple, and we have many clinical trials. You can join any clinical trial and may receive targeted therapy for free, and there could also be financial support available. Do not worry, there are many cases that have been treated, have become stable, and have been able to live through this stage very well.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.