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Questions for Dr. Kennedy
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cancer diagnosis
Posted by: Kris Schultz
Date: August 25, 2001 6:19 AM

My mother, having breast cancer years ago, had a routine screening. Her breast tumor marker increased from 19 to 45 in one year. She since had a CT scan, bone scan and mammogram, with no tumors, but with enlarged lymph nodes between the lung and windpipe. She doesn't want to have a biopsy due to the surgery involved. Since then her tumor marker has risen to 55. A doctor she saw said that this test is not always accurate and the enlarged nodes and tumor marker could be due to an infection. Could this be the case? Her cancer doctor gave her Femara to take and said if the tumor marker goes down then it is cancer and this would be her treatment. She doesn't want chemo or radiation.

RE: cancer diagnosis
Posted by: Ron Kennedy, M.D.
Date: August 25, 2001 2:44 PM

Femara (like Tamoxifen) is an estrogen suppressor, the newest on the market. It partially blocks the action of estrogen by blocking its cellular receptor sites. 75% of breast cancers are estrogen sensitive, that is their growth is accelerated by estrogen. So, Femara is chemotherapy and naturally will have side effects. Your mom should ask her doc about the side effects and be fully informed if she decides to take the stuff. As to an infection causing the elevation in a breast tumor marker: I do not know. If there is a specific name for that test, you could look it up on the Internet. If infection is present, it should be detectable in some way other than giving Femara, for example a white cell blood count, a blood and/or sputum culture. I don't know any doctors who are using a Femara trial to determine if there is an infection present. Tumor markers are not even close to 100% accurate, so using this as a diagnostic gauge for infection seems to me would be a real dice roll. Of course biopsy is the only way to definitely establish malignancy, but it also carries the risk of spreading the malignancy (if there is one) by breaking the capsule the body has made to contain the cancer cells and allowing them to migrate to other parts of the body. Surgery is a viable option for some cancers, namely those which have not spread, however in my opinion it should be done when the probability of cancer is extremely high and it should be done without doing a biopsy. The biopsy can be done on the tumor once it is removed. I am speaking in general terms here, of course, and I am not recommending anything for your mother as she is not my patient and I am not fully informed of her condition.

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