I have cancer and heart disease. How to manage this?

Question

Hi doctor,

I was diagnosed with breast cancer two years ago in both breasts. The worst was stage 3 IDC. I had a double mastectomy, chemotherapy, and hormone blockers for 18 months. Due to the blockers affecting my heart (I have heart disease), I had to stop taking them. I recently had a lumpectomy on my scar tissue, which was found to be cancerous; invasive lobular breast carcinoma. I had a scan, which was clear. My histology showed high estrogen and progesterone receptors. My cardiologist says that I must just monitor this, as due to the fact that I cannot take hormone blockers, she is not going to treat further. Is this standard treatment, or should I get a second opinion?

Please help.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

Based on what you have shared, you have a complex situation. You were diagnosed with stage 3 invasive ductal carcinoma in both breasts two years back and underwent a double mastectomy, chemotherapy, and hormone therapy.

Recently, you developed a recurrence in scar tissue, diagnosed as invasive lobular carcinoma that is strongly estrogen and progesterone receptor positive, human epidermal growth factor receptor 2 (HER-2) negative, and imaging shows no distant spread (attachment removed to protect the patient's identity).

Typically, treatment for a hormone receptor-positive local recurrence after surgery would include complete excision, possibly radiation to the area if not previously treated, and systemic therapy with hormone blockers to reduce the risk of further recurrence. In your case, because hormone therapy is contraindicated due to heart disease, your cardiologist has advised monitoring only.

While close observation may be reasonable given your heart limitations and the small, completely excised tumor, monitoring alone is not generally considered standard treatment for hormone receptor-positive recurrence, as hormone therapy is usually the mainstay to prevent further recurrence.

There may be alternative options worth exploring, such as carefully supervised hormone therapy with adjusted dosing, radiation therapy to the recurrence site, or participation in clinical trials or targeted therapies. Given the complexity and the potential impact on your prognosis, seeking a second opinion from a breast oncology specialist experienced in managing patients with cardiac limitations and recurrent breast cancer would be strongly advisable to ensure all safe and effective treatment options have been considered.

If you want, I can also explain what radiation or other non-hormonal treatments could be considered in your situation.

I hope this helps answer your query.

Thank you.