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Treatment for MICROMETS in ITC before it METASTASIZE.

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Dr. Eswaran,

Thank you for all your help.

**Do you still think I have a good prognosis????**

How worried do you think I should be that I have micromets? As I said before, it just seems like the bone marrow should have a higher number of itc's, before they go off and start metastasizing. Couldn't that be true? (I know there's nothing in the literature about it)

I am really looking for some hope to hold onto. And you have been so good at that.

I really want to believe that if there are micromets either in the bone or in other organs, that the AI's can get them before they become full mets--even if I wait 6 months. And what I really really want to believe, is that the itc's are so indolent that they are probably still just sitting in the marrow.

Please help me.

Category: Oncologist

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Category: Hematologist
Dr. Prasad Eswaran is online now

Expert:  Dr. Prasad Eswaran replied 4 Days.

Hello. Thank you for posting your query at DoctorSpring.com
Yes, you have a good prognosis since your Allred score is good in spite of ITCs in bone marrow. AI can help you even if you have micromets. Try to start your AI as early as possible, after your surgical wound heals. You can be on AI during radiation. No harm.
You have an indolent disease.
Feel free to discuss further,

Patient replied :

Do you have any idea whether the itc's are spread fairly evenly throughout the bone marrow, or could, for example the spine have a much larger concentration than the pelvis?

Expert:  Dr. Prasad Eswaran replied 3 Days.

I am totally clueless for your question. This is very difficult question for which I do not have an answer.
As i told you earlier, you have a good prognosis and that is what is very important in your case.

Patient replied :

1.After chemo is over, if all the cancer (micro-mets, maybe) has not been killed, do the cells start dividing much quicker, because they are so glad to be free of the chemo? Or, is the opposite true--does it take a while for the cancer to wake up again? 2.Please consider this in the situation of of lobular cancer which divides very slowly to begin with. Maybe none of the lobular micromets would be killed, but it would suddenly take off and start growing after the chemo stops and this would turn it into a real met before the AI's could be started.
3. On a person with VERY dense (slow turnover) bones and lobular cancer (slow dividing), still have their bone scan show lobular cancer, nice and bright?

Expert:  Dr. Prasad Eswaran replied 2 Days.

1. Lobular cells require much longer time to divide.
2. When chemo is administered, there will certainly be cell kill. A major portion portion even if not dividing, will accumulate DNA changes which will be lethal in subsequent cell divisions.
3. I think we are discussing this as a repetition. If there are bone changes ( signs of bone destruction and remodeling ) it may be evident in bone scan given it's specific limitations of resolution.

Patient replied :

Thank you for your answer. 1. Let's say a ct/pet scan shows all salt and pepper on the pelvis and spine (because of dense bone). If there were an osteoblastic cancer on the pelvis, how would it look on that ct scan? Would it show up or would it be hidden?
2. What are the limits of resolution on a bone scan? Also, do you think the dense bones affect the outcome? Just your best guess.

Expert:  Dr. Prasad Eswaran replied 1 Day.

It would show up because PET Scan checks for the metabolic rate, which is high with cancer lesions, which would show up even with dense bones.
PET scan can still pick up activity in lobular cancer with dense bones.

Dr. Prasad Eswaran
Category: Hematologist
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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