Dr. Susan B. LeGrand

You should see a dermatologist immediately. This could very well be melanoma and needs to be removed

Susan LeGrand MD

She has ductal carcinoma in situ which means the disease is confined to the duct based on current knowledge i.e. the path report. She needs to have it surgically removed and tested to make sure there is no invasive disease that would require different therapy. DCIS is not really cancer it is a pre-cancer that left alone can become invasive disease, It still needs to be treated appropriately-surgery,+/- radiation depending on pathology. Is it estrogen positive:?

Based on what you have described it sounds like hospice would be appropriate. They can help better with his pain control as that is part of their responsibility. He should he on a sustained release medication such as SR morphine or ER morphine in addition to the oxycodone. Doses should be enough to relieve his pain. As to future symptoms, pain can certainly escalate and would need to be addressed by the hospice. The most difficult to manage if it occurs is confusion. If his liver fails there may be significant confusion that would require medications. The other thing you will notice is he will eat less and less and get more and more fatigue and then not get out of bed at all. You cannot help his nutritional status so let him eat what he wants no matter how little.

The two therapies are quite different. Chemotherapy is given to impact disease in any location in the body (does not always get to the brain) so it is a systemic treatment with the hope of prolonging life. Radiation is focused on a single area, therefore local therapy, with the hope of improving symptoms. Therefore with the goal of improving pain control, preventing fracture and treating local complications of the cancer. Sometimes in pancreatic cancer a combination of chemotherapy and radiation will be used with the goal of shrinking the tumor enough to have a surgical procedure.

It depends on what medications you are getting. Fatigue is the most common side effect and gradually improves. There are side effects day 1 of treatment and then sometimes for several days after again depending on which drugs.

There is a lot of scientific evidence that CBD oil is not effective in cancer and I evidence that THC has any value nor is there any reason they should. If you do not have metastatic disease then tumor markers have no role and should not be monitored. They are not specific enough to predict recurrence. There is good evidence that no scans/labs should be done unless there is a symptom to monitor. This is something the American Society of Clinical Oncology strongly discourages.

There is no particular role for medical marijuana managing the cancer itself. CBD oil information on the Internet that it impacts on cancer survival but this is not true. There is also something called RSO oil the gentleman who sells it feels it cured his cancer. there is no cancer based research that can to manage improvement in cancer with medical marijuana Medical marijuana can be of use is the management of nausea and appetite. For more than 20 years there has been a product called dronabinol which was a legal THC initially approved for help in managing chemotherapy induced nausea. Better anti-nausea drugs came subsequently and this has not been used for this indication since then. In palliative medicine we sometimes use dronabinol for the nausea and the appetite stimulation. I work at the Cleveland clinic and we are not allowed to recommend medical marijuana since the data is so poor and it is not FDA approved for any indication.

Susan B. LeGrand MD, FACP, FAAHPM

The two things have different purposes. Radiation works with surgery to control the disease in the breast. It is recommended in certain tumors of large size and/or positive lymph nodes. If she has a lot lumpectomy then radiation is needed. Chemotherapy or hormone therapy is there to try and prevent or postpone any spread of the cancer to other organs. Whether it is the right thing to do depends on several issue
1) how big was the cancer
2) were lymph nodes involved
3) what type of breast cancer is it. Different types need different therapies.
4) was there an Oncotype done? If so what I as the number result

So many things to consider. Surgery +/- radiation is for local control in the breast and on the chest. Chemotherapy and/ or hormone therapy is for the rest of the body

Most Chemotherapy given after or before surgery for breast cancer does cause hair loss. There is a cold cap available but does not work if one of the drugs is adriamycin.

Difficult to calculate without additional information. If she was hormone positive, then there remains a (low) risk of relapse forever. Hormone-positive breast cancer has a consistent late relapse rate. If she had hormone-negative disease, then the likelihood or relapse is nil.

If you are having regular periods and chemotherapy is this far out, then there should not be a problem. There is no evidence that remote chemotherapy negatively impacts fetal health. Getting pregnant might be a little harder.

Everything you did was to prevent cancer from coming back but it is not a guarantee. While the tumor was in your breast, it had a chance to send cells to other places like bone and lung. The chemotherapy you did was to kill these cells, but some may be dormant and escape the treatment. So there is a chance it could come back. How much risk depends on factors such as the size of the tumor and whether lymph nodes were involved. You are at a slightly higher risk to get cancer in the other breast. If this occurred, it would not be a spread from the first cancer, but a new tumor that you would approach like this one biopsy, surgery, maybe chemo, etc. Hope this helps.