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BREAST CANCER treating with TAMOXIFEN and raised ESTRADIOL.

Resolved Question:

I have completed treatment for breast cancer and I am currently taking tamoxifen. I am 40 years old. I have not had a period since December 2013. My estradiol level before beginning treatment in January 2014 was 94. My estradiol was rechecked in October 2014 and it was up to 610. My estradiol was checked again this week and it is 627.

Why is my estrogen going up? Doesn't this put me at a higher risk of recurrence?

Staging:
Breast cancer - 12/01/13
Primary Tumor (T)
Primary Tumor (T) Clinical: T2
Laterality: left
Regional Lymph Nodes (N)
Regional Lymph Nodes (N) Clinical: N1
Distant Metastasis (M)
Distant Metastasis (M) Clinical: M0
Staging Groups
Clinical Stage: IIB
Prognostic Factors
Estrogen receptor and test method (IHC, RT-PCR, other): +
Progesterone receptor and test method (IHC, RT-PCR, other): +
HER2 status and test method (IHC, FISH, CISH, RT-PCR, other): +
Histologic Grade (G)
Histologic Grade: Grade III or 3
Additional Descriptors
y clinical: No
Clinical stage was used in treatment planning: Yes
National guidelines were used in treatment planning: NCCN


Category: Oncologist

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Category: Hematologist
Dr. Prasad Eswaran is online now

Expert:  Dr. Prasad Eswaran replied 4 Days.

Hello ,
Thanks for your query at DoctorSpring.com
I understand your concern.
Since you are ER +, it would be better to stop functioning ovaries either by medicine or by surgery or Radiotherapy.
Estrogen may increase the proliferation of cancer cells as they are hormone responsive. Please let me know if you are currently menstruating.
Kind regards


Patient replied :

Thank you. I am not menstruating. My periods stopped when I started chemotherapy in January of 2014. I am taking Tamoxifen. I had a bilateral mastectomy. Can you answer my original question: Why is my estradiol level going up? From pre-treatment level of 94 to current level of 627.


Expert:  Dr. Prasad Eswaran replied 3 Days.

Usually chemotherapy 'stuns' ovaries which is followed by either permanent cessation of its functioning or slow recovery to its original level or less than that.. This depends on an individual's ovarian reserve.
Additional source of estrogen is from adipose (fat) tissue.
In your case with increasing levels, I would suspect ovarian recovery.
Since your tumor is ER +, I would suggest you to do a metastatic work up followed by surgical / medical therapy to stop ovarian function.
Hope your concern is addressed . please revert back in case of any queries.
Regards.


Patient replied :

I have read that the Tamoxifen works to block estrogen from binding to my cells and can cause an increase in "circulating estrogen". Could the increase in estrogen simply mean that the tamoxifen is doing its job, or does the increase in estrogen pose a greater risk for recurrence of my cancer?
Thank you!


Expert:  Dr. Prasad Eswaran replied 2 Days.

This is not an exact mechanism of increasing levels of estrogen. Ovaries might have recovered from chemo effects and started functioning. However kindly do relevant imaging and blood test to correlate.
At the same time, the disease should also be assessed, by scans and serum levels of tumor markers as appropriately needed.
Regards.


Dr. Prasad Eswaran
Category: Hematologist
Experience: 
Doctorate in Medicine (Fellowship in Oncology), DM,  Madras Medical College & Govt. General Hospital, Chennai, India.

Doctor of Medicine (Residency in Radiation Oncology) , MD, Christian Medical College, Vellore, Tamilnadu, India, 2004-06.

Diploma in Medical Radiology & Therapy (Residency in Radiation Oncology), D.M.R.T, Madras Medical College & Govt. General Hospital, Chennai, India, 2004-06.

Bachelor of Medicine & Bachelor of Surgery - M.B.B.S, Govt. Stanley Medical College & Hospital, Chennai, India, 1998-2004.
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