I am 56, female with breast ductal carcinoma. What to do?

Question

Hi doctor,

I am a 56-year-old woman recently diagnosed with ER-positive, PR-positive, HER2-negative breast cancer, and I am feeling overwhelmed because I also have type 2 diabetes and mild hypertension at the same time.

My latest biopsy showed a grade 2 invasive ductal carcinoma measuring 1.2 inches, and my oncotype DX score came back as 27, which my doctor said is intermediate-to-high risk. My fasting blood sugar has been around 168 mg/dL, and my HbA1c is 8.1%, which worries me because I have heard that poor sugar control can affect cancer treatment outcomes.

My blood pressure is also fluctuating around 148/92 mmHg, even though I am already on medication. My recent PET-CT showed no distant metastasis, but there was a suspicious axillary lymph node measuring 1.4 cm with SUV 4.2. I am not sure how my diabetes medications, like Metformin or insulin, will interact with chemotherapy, especially if I need drugs like docetaxel or doxorubicin.

My calcium level was 10.9 mg/dL, and my doctor said it is slightly high, so I am worried if this has anything to do with bone spread. I am also feeling very tired lately, and my hemoglobin dropped to 10.6 g/dL.

Could you please help me understand how these conditions together may affect my treatment plan and what steps I should take next?

Please advise.

Answer 1

Hi

Welcome to icliniq.com.

I understand your concern.

I am very sorry that you are going through the shock of the cancer diagnosis. But the good thing is, first of all, that we are in stage two, and this means we can control the disease well, prevent it from coming back, and also prevent its spread. The second very good thing is that it is hormone-positive, progesterone receptor (PR) positive. This means it responds very well to hormonal therapy, and we can control it for a very long time.

Initially, for chemotherapy, you will receive six cycles of chemotherapy. It does not interfere with insulin or hypertension at all. We just need to manage the diabetes because during chemotherapy, there may be nausea and vomiting, and of course, fatigue, and your energy will decrease a little, so we need to manage blood sugar regularly all the time. But you will continue your usual diabetes treatment, normally with insulin and Metformin exactly as usual.

The nausea, vomiting, diarrhea, and gastrointestinal upset usually happen during the first three to four days after chemotherapy, then they go away, and everything becomes completely fine. And after we finish the whole treatment course, all the side effects are reversible, and everything goes back to how it was before. Your life becomes very stable again and completely fine like before.

Regarding the side effects during chemotherapy, as I mentioned, they are all reversible; even the hair loss also grows back again like before. During the radiotherapy period, you will need radiotherapy to the breast and to the axilla. In this period, we also need to control the blood sugar so that the wound can heal properly. And of course, we need to care for the skin area where we are giving the radiotherapy. During this period, insulin is very important.

And during the surgery period as well, it is important that we take insulin doses so that proper, complete healing can happen. After that, you will continue on hormonal therapy, and this does not affect the blood pressure or the blood sugar at all; it has no effect on them.

With it, we need to maintain proper calcium levels, vitamin D, and our supplements. It is very important during the treatment period that we pay attention to our nutrition: taking small, frequent meals, staying well hydrated, and eating fruits and vegetables. These things are very important during treatment.

I hope my answer is clear to you, and if you need any details at any time, I am here and at your service.

Thank you.