Cancer cells in Sternum
Hello everybody, I am new to this forum and this is my first post.
I would like to know if anyone have any experance with breast cancer that has spread to the sternum (chest bone). Specifically, if a removal or partial removal and reconstruction can/should be done?
I know that once cancer has spread, it could be anywhere in the body and therefor an overall treatment such as chemo is most effective. My wife cancer was detected 2 years ago with metastasis to the sternum(no where else other than the sternum). After her first line of treatment (7 round of Chemo CEF, radiation and hormone), no new spread, but cancer in sternum remain active. She was then given 18 rounds of Taxotere over one year and Zomata, and has started another hormone theraphy.
After ended Taxotere treatment, still no new spread, but still the cancer in the sternum is active. A result of a PET/CT scanning resived today 2 months after ended Taxotere treatment, suspect that the active cells in the sternum might cause a lymph node behind the sternum to swollen.
We can't help but wonder that we might be cancer free now if the sternum was removed from the beginning. Our operation doctor mentioned plastic surgury for removal and reconstruction of the sternum for two years ago when she operated the lump from my wife's breast. But our Ocology doctor says its useless once spread. Now we are trying to get informations and are seriously considering it.
Thanks for any help.
I'm praying for your wife's full recovery and your continued advocacy. My wife was diagnosed with stage iv in December with mets in spine, skull, ribs and hip, among other places. She is making a miraculous recovery!
As per her bone issues, chemo, CAF and radiation seems to have been enough. It's interesting that the cancer in sternum is not or has not been responding. Also, has it improved or is it getting worse, same?
Frankly, I would get second/third opinion from another oncologist on this. If these cells prove to be more resistance/aggressive, and it's the only place that the scans have detected them, I sure as heck would seriously ask my oncologist what harm would there be to remove the sternum and go through reconstructive surgery.
Also, hearing your oncologist say that once it's spread surgery is useless when the scans reveal active cells in the sternum only and after repeated treatment bothers me.
Take care of your wife and be the type of advocate that takes your wife's health as priority one. In other words, don't take the oncologist's dismissal as the final word.
NameNiels, I am very sorry about your wife's advanced cancer. I do not know the specific answer to your question. In general, if a cancer can be removed surgically, it should. But this is not the case for metastatic tumors. In most cases of metastatic tumors, the best option is chemotherapy since the cancer cells can be anywhere. But, again, there are some exceptions to that general rule. If the metastatic tumor is causing pain or is an imminent threat to life AND can be safely removed, then surgery is again a viable option.
I know, this is not a very clear answer but the question is more complex that you might think. Keep working with her own medical team to find out what is best for your wife.
You and your wife are in my thoughts and prayers.
Thanks for the replies so far. To add to the first post I've written above:
Allthough the cancer cells in my wife's sternum still is active, the doctor is certain that the chemo must have worked since she have no other sites of spread since first detected 3 years ago.
But I cannot understand why it cannot fight the cells in the sternum when it can fight the cells in the blood and keeping them from further spread.
It has only been 2 months since Taxotere treatment ended and her lymph nodes behind the sternum has been enlarged allready according to the PET/CT scan done last week. Now we are very worried that it is a sign that her stable condition for the last 3 years might come to an end. That's why, looking back makes me angry that we might have prevented this if the sternum was removed from the beginning. But just as Jim says, once the cancer has spread it could be anywhere, and with that same reason the doctors says remove/reconstruct of the Sternum will be useless. But looking back, this might just have worked and our situation now would have been different.
We are living in Denmark, Europe, and the doctors here are not so aggressive as what I've heard in countries such as the US, and we would like to find a location in the US that can/willing to do the removal/reconstruction of the Sternum if the doctors here refuses to do it. If anybody knows of such please let us know.
Our doctors want to put my wife back on Chemo (Xeloda). If this makes the swollen node goes away, and she continues to remain spread free other than the Sternum, then we will go for the removal of the sternum and do a plastic surgury reconstruction.
I am so very tired of the cancer. It is out to get the womens in my life. My wife's breast cancer was detected just 9 months after my mother's deth, also from cancer!
I completely understand the issue of metastasis. I am not suggesting that "just" removing the sternum will be the answer to removing all of the cancer, rather, if it is the only area that the cancer is detected and it seems to be more stubborn to treatment after all this time, I am uncertain as to why it is not removed so that "it" does not create additional problems. After re-reading your post it seems that the treatment has prevented spread, but not reduced cancer in sternum. You said that a surgeon had suggested removal and reconstruction. Is your wife's oncologist the final word? Can you get approval from another physician (oncologist)?
It seems to me that US doctors are more aggressive about cancer, but that's not always a good thing. And like many other places, not all US hospitals or doctors are are knowledgeable or "aggressive" in their treatment plans. But in your case, if you cannot find anyone there, why not search in nearby countries? UK? Or is it easier just to go to the US? What about insurance? Will you be able to pay for a procedure abroad? Things to consider...
There are plenty of high quality cancer centers/hospitals that would likely do it. But make certain that you have a means to pay for it. I would contact the American Embassy or hospitals themselves. In fact, why not contact your health ministry and find how to go about seeking international health assistance/facilities.
I keep your wife, yourself and family in my prayers.
NameNiels, I can hear how tired this cancer is making you . Your wife is not in an easy situation. If she can come to the US, she should probably go to one of the major cities with state of the art medical centers such as Boston, New Your, or Houston. However, you will have to pay a lot. I am truly sorry about your wife's difficulty in getting treatment.
In response to mymaria:
I must admit that there are a few bright sides in our situation, compare to many other in same situation as ours in that the Danish government health care take care of all midical expences. But when confronted with seeking help in other countries, our doctors allways say that the Danish health system is amoung the best in the world. And also that there are more approved drugs in the EU than in the US.
One bad thing is that we are assign to a an oncologist who pretty much ditermind the stradigy for the treatment. They fail badly with in the case of my mother, so I think it is worth to do some thinking for ourselves and take more chances.
But they disagree on removing the Sternum, though strangly enough our operation doctor thinks that it might be a good idea. But our oncologist will not stop us if we want to go for it.
They say that it is a bad place to operate, and in Denmark with only 5 million people there are not many such operations to create an experence doctor in the area. If we want to do so, it should be a specialist, and that's what we are trying to look for right now. I am also looking for a specialist in Europe at the same time. Thanks for listenning.
Hi Niels - try Germany - they are very efficient! There is a clinic in Deggendorf which has performed this operation and may be helpful. See this abstract about it: http://cat.inist.fr/?aModele=afficheN&cpsidt=17287265
I'm not certain how the whole EU relationship works when it comes to citizens seeking medical health in other EU countries, but I would certainly try countries like Germany (as Vee suggested), or France. I have no doubt that Denmark has "one of the best...", but that certainly does not mean that it has the specialists that one needs.
About health insurance...that is the ever-perpetuation debate in our country. Universal health coverage or no. Many more Americans and beginning to see that universal health insurance should at least be seriously debated and with over 40-50+ million "working" Americans w/o health insurance at all, it should be debated.
It comes down to cost in my opinion. It's insane how our country fails to ask the primary question as to why health insurance is so precarious in our country- COST. Why does everything cost so much? When you get charged $12 for a single aspirin in a hospital, there is something seriously wrong! In the end, the USA has "the best medical expertise as a whole in the world." Not always something to be proud of considering we get clobbered by the costs that it brings with it...
Anyway, i don't want to digress from your needs.
Have you spoken seriously with the surgeon? How does she/he feel about such a procedure? Confident? Has a plan? Any experience with such surgery? Otherwise, definitely seek outside expertise if you choose to.