Concerned for a friend with adenocarcinoma of ??? (Long mystery)

This is a mystery story. My friend is a very active and alert 84 year
old female. In late July she visited her PCP with complaint of stomach
pain usually when eating. Her belly was slightly swollen. She also
complained
of gallbladder pain. The following occurred up through last week:

- referred to gastro specialist who ordered C/t of torso
- patient referred to Onc in top local clinic that is ovarian specialist
- Ovarian Onc ordered scan which lit up ovaries, fat pad area over
stomach and a small spot "on" (not 'in") top of colon.
-dx:
(1) bc mets in ovaries (primary bc over 20 yr ago)
(2) probable new primary adenocarcinoma in "fat pad" area (?)
and immediately released patient to Onc stomach specialist.

- Stomach Onc put her on daily oral Aromasin (yes that's what I said,
I had her read it off the bottle for me and I looked it up.) for 3 months
starting 9/1/06. It helped with her stomach pain some. However after
about a month, her belly has started swelling more and she had difficulty
eating. Starting early Oct. she was started on chemo (haven't confirmed
what drug(s) yet) every 28 days. Apparently they suggested weekly
chemo but she had concern over getting to the clinic. Duh, ok honey
you can come once a month? What is this? I begged her to reconsider
weekly; that I'd personally coordinate a group of drivers for her.

We are very close church and musical friends and talk several times a
week. She is confused and now becoming angry. Her only advocate
has been a sister that doesn't seem to think this is too serious. A mutual
friend even went with to the visit with the Ovarian Onc and took notes
(even asked a few questions -- she has had a lot over serious health
issues of the last view years and has learned a lot of the lingo). What
the mutual friend took from that visit was that:
- there was no surgery planned for the ovaries
- adenocarcinoma in the stomach pad area was a spattering of cells
in fluid and they planned no biopsy. The diagnosis is undeterminable.
- No prognosis was given except to tell her:
"Oh, you're going to live a l-o-o-n-g time <goofy smile."

My take (and confusions):
- can understand switch from Ovarian Onc to Stomach Onc - more
serious primary? BUT why put her on a hormone treatment for
advanced mets bc? To possibly shrink the ovarian tumors? I
did a lot of web searches over the last month and couldn't see
that connection?
- Besides, what would be done for the stomach area issue. I can see
the improbability of a biopsy of a fluid filled area showing much and
could possibly (layman's guess) cause harm. Then WHY do anything?
- What the heck is with this: Oh, you're going to live a l-o-o-n-g time"
business? Isn't that a rather sneaky way of mincing words given the
relativity of "long time" to an octogenarian? I can't believe this
Clinic
would allow an member to present this to her this way. Finally she
insisted and was given a cassette tape of their diagnoses and treatment
protocol. Still no prognosis!
- Oh BTW, she DOES have gallstones and they hurt more too. Why didn't
they attempt to relieve or remove those? Give the woman a break!

I think they are not telling her the truth. She says she wants to hear it.
I'm at a loss as what to do. My heart tells me she can control this and
live her life pretty much as expected as she progresses in age. But my
head tells me that her natural decline, graceful as might have been may
be very quick and possibly painful. I pray there are better advocates
in her family than her sister. She is a widow with no children but many
nieces/nephews. Also I wonder how much the clinic can suck
out of her private insurance and Medicare before the tell her the truth.
I don't mean to sound so cynical as I am a sucker for the western health
profession. When I believe in the quality health professionals I put all
faith and trust in them. But this smells. Maybe not. Somebody prove
me wrong.

Marsha

Mizz Marcia Ryder wrote:

> This is a mystery story. My friend is a very active and alert 84 year
> old female. In late July she visited her PCP with complaint of stomach
> pain usually when eating. Her belly was slightly swollen. She also
> complained of gallbladder pain. The following occurred up through last week:
>
> - referred to gastro specialist who ordered C/t of torso
> - patient referred to Onc in top local clinic that is ovarian specialist
> - Ovarian Onc ordered scan which lit up ovaries, fat pad area over
> stomach and a small spot "on" (not 'in") top of colon.
> -dx:
> (1) bc mets in ovaries (primary bc over 20 yr ago)
> (2) probable new primary adenocarcinoma in "fat pad" area (?)
> and immediately released patient to Onc stomach specialist.
>
> - Stomach Onc put her on daily oral Aromasin (yes that's what I said,
> I had her read it off the bottle for me and I looked it up.) for 3 months
> starting 9/1/06. It helped with her stomach pain some. However after
> about a month, her belly has started swelling more and she had difficulty
> eating. Starting early Oct. she was started on chemo (haven't confirmed
> what drug(s) yet) every 28 days. Apparently they suggested weekly
> chemo but she had concern over getting to the clinic. Duh, ok honey
> you can come once a month? What is this? I begged her to reconsider
> weekly; that I'd personally coordinate a group of drivers for her.
> My take (and confusions):
> - can understand switch from Ovarian Onc to Stomach Onc - more
> serious primary? BUT why put her on a hormone treatment for
> advanced mets bc? To possibly shrink the ovarian tumors? I
> did a lot of web searches over the last month and couldn't see
> that connection?
> Clinic
> would allow an member to present this to her this way. Finally she
> insisted and was given a cassette tape of their diagnoses and treatment
> protocol. Still no prognosis!
> - Oh BTW, she DOES have gallstones and they hurt more too. Why didn't
> they attempt to relieve or remove those? Give the woman a break!
>
> I think they are not telling her the truth. She says she wants to hear it.
> I'm at a loss as what to do. My heart tells me she can control this and
> live her life pretty much as expected as she progresses in age. But my
> head tells me that her natural decline, graceful as might have been may
> be very quick and possibly painful. I pray there are better advocates
> in her family than her sister. She is a widow with no children but many
> nieces/nephews. Also I wonder how much the clinic can suck
> out of her private insurance and Medicare before the tell her the truth.
> I don't mean to sound so cynical as I am a sucker for the western health
> profession. When I believe in the quality health professionals I put all
> faith and trust in them. But this smells. Maybe not. Somebody prove
> me wrong.
>
> Marsha

Well Marsha, here's my read.
The ovarian involvement is not germ cell, so chemo would do little, so once a
month is fine, if it helps.
Sounds like recurrence/spread of BC and they're treating with aromasin.
Also being tried for Ovarian epithelial cell
http://www.clinicaltrials.gov/ct/show/NCT00261027
And look here
<http://www.cancerbackup.org.uk/Treatments/Hormonaltherapies/Individualhormonaltherapies/Exemestanehttp://www.cancerbackup.org.uk/Treatments/Hormonaltherapies/Individualhormonaltherapies/Exemestanehttp://www.cancerbackup.org.uk/Treatments/Hormonaltherapies/Individualhormonaltherapies/Exemestane>

"Many breast cancers rely on the hormone oestrogen to grow. In women who have
had their menopause the main source of oestrogen is through the conversion of
androgens (sex hormones produced by the adrenal glands) into oestrogens. This is
carried out by an enzyme called aromatase. The conversion process is known as
aromatisation, and happens mainly in the fatty tissues of the body. Aromasin is
a drug that blocks the process of aromatisation, which reduces the amount of
oestrogen in the body."

So they're hoping the Aromasin will help the cancer in the fat pad?
Tim (on the breast cancer newsgroup) might be able to make more sense (explain
about) of the aromasin?

Also sounds like CUP (cancer of unknown primary) adenocarcinoma

I too would like them to remove her gall bladder, but if done laproscopic,
wouldn't give answers.
And once a surgeon gets in there (open surgery) could do an exploratory and
discover lots (extensive cancer) to remove and kill her in the process or
discover no more than the gall bladder needing removing or close her back up and
do nothing, but then she's got 6 weeks of recovery from cutting through the
muscles and the fat pad....to get a closer prognosis, which might be a few
months anyway..

I could be wrong; we're in a position of not knowing. So are they apparently.
I'm sorry about your friend. It's hard to know exactly what's causing the
pain when eating. If you feel a gastro doc should remove her gallbladder,
suggest she get a 2nd opinion. But I wouldn't let someone do an "open
surgery". The problem with a surgeon is that opens the door for "picking and
pecking". Take one thing uot, solve one pain. More pain elsewhere; open her up
again there, and so and so on. Might not be fair to do to an 84 year old?

I too worry she'll have lots of pain. But I suppose it depends where the tumors
will eventually crop up. We don't want her dying from the surgery either, right?

Marsha, I'm not an expert. I'm just sharing my layperson thoughts.
If nothing else, maybe the Aromasin issue has been clarified?

She deserves the truth if "truth" can be had; maybe time will tell.
Maybe Steph can see a prognosis from what you've described.

If nothing else, please try to see that she's got her affairs in order; her
wishes if certain situations crop up.
Talk to her about the pros and cons of stents, in case they suggest some, in an
emergency painful situation. There's some posts here recently about those. You
could google the archives for them.

Also make sure she's looking into hospice (someone who's knowledgeable and able
to palliate her pain if and when required), unless she'd rather spend her final
time in hospital.

Best I can do, with your situation Sorry for snipping text.
Keep in touch and let us know how it goes.
Hugs
J

hello marsha

can agree & sounds oh so familiar, except the age !! I am 53 & for past
18months have gone thru all the the same rubbish, non diagnoses ,my
inabilty to ask the questions.
Mine all began with a non related chest xray 18month ago, where a mark
showed up, off to respiritotory specialist. no idea what I had.
after 4 ct scans 1 pir scan it was decided I should have lung biopsy.
No result/ inconclusive, what a word !! so back to surgeon, we decide
having gone this far with the (thing) as I called it, well now we should
have keyhole surgery to remove (thing) better out than in what ever it is
!!!!
so into ct scan where a hook wire was placed into the (thing) then up to
theatre where surgeon went in & pulled out the wire with (thing)
attached ?? & sent a sample of it to pathologist for diagnoses, at
this point NO-ONE had ever mentioned the C word!!!!
Well I thought it all ok now it the (thing) gone, ha.
Was sent for another ct scan 2 months later, for check up, & bugger the
whole (thing) still there !!!! and grown another 2mm!! so what exactly
did I have removed ???
So at this point am past feeling angry, just want, once & for all to get
a diagnoses & sort it out, So with that the surgeon says lets go in and
& take all the middle right lobe(that way it's out for sure)

25 May 2006 the op, & yep it came out, and sent to pathology In
melbourne, & yep it cancer the adeno type ??. but that ok it gone now
!.
so had 6 weeks to recover from op, & back for check up, then the surgeon
hits me with the chemo bit !!! (just a a precaution) he says !!!
why was none of these possiblities discussed wih me at the out-set, & should
I accept that because of the delays, my health may have been compromised
??
who knows, at this stage am into 5th of 6 cycles of chemo, have had 2 blood
trans. for aneamia, but am persevering. hopefully someone will say
soon " you cured" one can only hope & put our faith in the hands of god
and the ones god chooses to fix us !!
GOSH, this is the first time have really talked about it ?? sorry to
rabbit on, but I hope you're freind will come thru & with freinds like you
am sure she will have a quality time, what ever that may be. pls take
care & give her my best wishes. bless you all. maureen.perth.wa

"Mizz Marcia Ryder" <MizzOtis@regrets.com> wrote in message
news:3%YZg.17392$pq4.14068@tornado.ohiordc.rr.com. ..
> This is a mystery story. My friend is a very active and alert 84 year
> old female. In late July she visited her PCP with complaint of stomach
> pain usually when eating. Her belly was slightly swollen. She also
> complained
> of gallbladder pain. The following occurred up through last week:
>
> - referred to gastro specialist who ordered C/t of torso
> - patient referred to Onc in top local clinic that is ovarian specialist
> - Ovarian Onc ordered scan which lit up ovaries, fat pad area over
> stomach and a small spot "on" (not 'in") top of colon.
> -dx:
> (1) bc mets in ovaries (primary bc over 20 yr ago)
> (2) probable new primary adenocarcinoma in "fat pad" area (?)
> and immediately released patient to Onc stomach specialist.
>
> - Stomach Onc put her on daily oral Aromasin (yes that's what I said,
> I had her read it off the bottle for me and I looked it up.) for 3
> months
> starting 9/1/06. It helped with her stomach pain some. However after
> about a month, her belly has started swelling more and she had difficulty
> eating. Starting early Oct. she was started on chemo (haven't confirmed
> what drug(s) yet) every 28 days. Apparently they suggested weekly
> chemo but she had concern over getting to the clinic. Duh, ok honey
> you can come once a month? What is this? I begged her to reconsider
> weekly; that I'd personally coordinate a group of drivers for her.
>
> We are very close church and musical friends and talk several times a
> week. She is confused and now becoming angry. Her only advocate
> has been a sister that doesn't seem to think this is too serious. A
> mutual
> friend even went with to the visit with the Ovarian Onc and took notes
> (even asked a few questions -- she has had a lot over serious health
> issues of the last view years and has learned a lot of the lingo). What
> the mutual friend took from that visit was that:
> - there was no surgery planned for the ovaries
> - adenocarcinoma in the stomach pad area was a spattering of cells
> in fluid and they planned no biopsy. The diagnosis is undeterminable.
> - No prognosis was given except to tell her:
> "Oh, you're going to live a l-o-o-n-g time <goofy smile."
>
> My take (and confusions):
> - can understand switch from Ovarian Onc to Stomach Onc - more
> serious primary? BUT why put her on a hormone treatment for
> advanced mets bc? To possibly shrink the ovarian tumors? I
> did a lot of web searches over the last month and couldn't see
> that connection?
> - Besides, what would be done for the stomach area issue. I can see
> the improbability of a biopsy of a fluid filled area showing much and
> could possibly (layman's guess) cause harm. Then WHY do anything?
> - What the heck is with this: Oh, you're going to live a l-o-o-n-g time"
> business? Isn't that a rather sneaky way of mincing words given the
> relativity of "long time" to an octogenarian? I can't believe this
> Clinic
> would allow an member to present this to her this way. Finally she
> insisted and was given a cassette tape of their diagnoses and treatment
> protocol. Still no prognosis!
> - Oh BTW, she DOES have gallstones and they hurt more too. Why didn't
> they attempt to relieve or remove those? Give the woman a break!
>
> I think they are not telling her the truth. She says she wants to hear
> it.
> I'm at a loss as what to do. My heart tells me she can control this and
> live her life pretty much as expected as she progresses in age. But my
> head tells me that her natural decline, graceful as might have been may
> be very quick and possibly painful. I pray there are better advocates
> in her family than her sister. She is a widow with no children but many
> nieces/nephews. Also I wonder how much the clinic can suck
> out of her private insurance and Medicare before the tell her the truth.
> I don't mean to sound so cynical as I am a sucker for the western health
> profession. When I believe in the quality health professionals I put all
> faith and trust in them. But this smells. Maybe not. Somebody prove
> me wrong.
>
> Marsha
>
>

Sorry to hear about your friend. What is stopping her from getting a second
opinion, especially since there seems to be distrust? Who is giving her
advice her oncologist? Primary care ? Gastro?
What are they doing to treat her pain? Sounds like you are caring friend and
your friend is lucky.
Best to get health advice from people you trust and can examine the whole
situation? Any other information she gets online is only a guess due to the
limited information and lack of clinical exam.

>"alex" <wrote :
> Sorry to hear about your friend. What is stopping her from getting a
> second opinion, especially since there seems to be distrust? Who is giving
> her advice her oncologist? Primary care ? Gastro?

From the date our mutual friend went to the Onc with her, she got the scan
results to send to a surgeon we both have used and trust. He's not shy
about
the truth and shoots from the hip. But our friend was still wavering on
whether
to get a second opinion. Then she started asking me if I thought she needed
a second opinion. I feel that she could get just as wishy-washy of an
opinion
but won't know unless she tries. Still she wavers. Then recently she says
her niece things she should get a 2nd opinion and this time I'm with a firm
yes. Still, she waits.

> What are they doing to treat her pain? Sounds like you are caring friend
> and your friend is lucky.

I know that have given her pain meds but not sure what -- Oxycodone I think.
But I think she is afraid to take much (think Southern Baptist that's afraid
of
"getting hooked". I tell she can still pray even when she's stoned on legit
stuff!

> Best to get health advice from people you trust and can examine the whole
> situation? Any other information she gets online is only a guess due to
> the limited information and lack of clinical exam.
True. I'm pretty savvy with a search engine and some common sense but
I couldn't put much together. We are all worried about her. I'd love to
visit with her but with my chemo going on, I'm frankly afraid we'll give
each other the flu or something. I'll just have to keep calling her. Now's
a good time for that. Thanks, Alex.
Marsha

Mizz Marcia Ryder wrote:

> I know that have given her pain meds but not sure what -- Oxycodone I think.
> But I think she is afraid to take much (think Southern Baptist that's afraid
> of"getting hooked". I tell she can still pray even when she's stoned on legit
>
> stuff!
> True. I'm pretty savvy with a search engine and some common sense but
> I couldn't put much together. We are all worried about her. I'd love to
> visit with her but with my chemo going on, I'm frankly afraid we'll give
> each other the flu or something. I'll just have to keep calling her. Now's
> a good time for that.

And how's she doing, Marsha?
J

>"J" wrote :
> Mizz Marcia Ryder wrote:
<snipped>
>> True. I'm pretty savvy with a search engine and some common sense but
>> I couldn't put much together. We are all worried about her. I'd love to
>> visit with her but with my chemo going on, I'm frankly afraid we'll give
>> each other the flu or something. I'll just have to keep calling her.
>> Now's
>> a good time for that.
>
> And how's she doing, Marsha?
> J
Thanks for asking. I called her just as I wrote it was a good time.
Wouldn't you know; she was worried about me! What a sweetie.
She's learning to calm down a bit -- we had a slight freeze a few days
ago and she built a small fire and settled down for a winter's nap with
her Himalayan cat. She's says her stomach doesn't hurt as much when
she takes <<can't get exact med name out of her>> they prescribed for
her. After some questioning I think they've put her on Librax (sp?). Not
sure. I was on that once along with Tagamet for a pre-ulceric condition.

Mizz Marcia Ryder wrote:

> Thanks for asking. I called her just as I wrote it was a good time.
> Wouldn't you know; she was worried about me! What a sweetie.
> She's learning to calm down a bit -- we had a slight freeze a few days
> ago and she built a small fire and settled down for a winter's nap with
> her Himalayan cat. She's says her stomach doesn't hurt as much when
> she takes <<can't get exact med name out of her>> they prescribed for
> her. After some questioning I think they've put her on Librax (sp?). Not
> sure. I was on that once along with Tagamet for a pre-ulceric condition.

It's good to read that her stomach pain has improved and that she's calmed down.

Thanks for the update, Marsha.
Take care of you too !
J

Glad your friend is feeling better, one point I wanted to make before.
It is so frustrating having friends who make poor health care choices
but after giving advice there isn't much more you can do but be a
friend.
Alex

akoffman@gmail.com wrote:

> Glad your friend is feeling better, one point I wanted to make before.
> It is so frustrating having friends who make poor health care choices
> but after giving advice there isn't much more you can do but be a
> friend.

????
Her friend's 84 years old and has a reoccurence of breast cancer and CUP
and is being treated.
What's your point? She caused her breast cancer reoccurance with poor
health choices?
J

Edit:

J wrote:

> akoffman@gmail.com wrote:
>
> > Glad your friend is feeling better, one point I wanted to make before.
> > It is so frustrating having friends who make poor health care choices
> > but after giving advice there isn't much more you can do but be a
> > friend.
>
> ????
> Her friend's 84 years old and has a reoccurence of breast cancer and CUP
> and is being treated.
> What's your point? What makes you think she's making poor health care
> choices?
> J

>"maureen" wrote :
> hello marsha
>
<snipped the amazing history - you certainly persevered!>
>who knows, at this stage am into 5th of 6 cycles of chemo, have had 2
>blood trans. for aneamia, but am persevering. hopefully someone will
>say soon " you cured" one can only hope & put our faith in the hands of
>god and the ones god chooses to fix us !!

We can certainly pray that you get the "all clear"!

> GOSH, this is the first time have really talked about it ?? sorry to
> rabbit on, but I hope you're freind will come thru & with freinds like
> you am sure she will have a quality time, what ever that may be. pls
> take care & give her my best wishes. bless you all. maureen.perth.wa
>

Except for the circumstances, glad I could be the one to trigger you
to talk about it. I found that it helps to find undersanding friends
to discuss this journey.

Marsha
BTW, "rabbit on" what a curious phrase. Is that unique to Australia
or just Northern Australia?

>"J" wrote :
>> Mizz Marcia Ryder wrote:
>
>> Thanks for asking. I called her just as I wrote it was a good time.
<snipped>
> It's good to read that her stomach pain has improved and that she's calmed
> down.
>
Updating a previous post where the chemo drug was unknown.
I found out from her that it is doxil, which my research shows is
a milder version of doxorubicin. I've found various references that
seem to conflict. Some show it used for mets BC and others for
Ovarian, which is a known in her diagnosis. Seems odd that the
same drug would be used for both. Is that because a common
mets site for BC is the ovaries?

This makes me think they are indeed attacking the BC mets in the
ovaries. I suppose they are just watching the CUP in the stomach
pad area? That would explain the ovarian Onc turning her over
to the Onc that specializes in stomach cancer treatment.

Marsha

Mizz Marcia Ryder said...
> BTW, "rabbit on" what a curious phrase. Is that unique to Australia
> or just Northern Australia?
>
No, it's common in the UK as well.

Mizz Marcia Ryder wrote:

> >"J" wrote :
> >> Mizz Marcia Ryder wrote:
> >
> >> Thanks for asking. I called her just as I wrote it was a good time.
> <snipped>
> > It's good to read that her stomach pain has improved and that she's calmed
> > down.
> >
> Updating a previous post where the chemo drug was unknown.
> I found out from her that it is doxil, which my research shows is
> a milder version of doxorubicin. I've found various references that
> seem to conflict. Some show it used for mets BC and others for
> Ovarian, which is a known in her diagnosis. Seems odd that the
> same drug would be used for both. Is that because a common
> mets site for BC is the ovaries?
>
> This makes me think they are indeed attacking the BC mets in the
> ovaries. I suppose they are just watching the CUP in the stomach
> pad area? That would explain the ovarian Onc turning her over
> to the Onc that specializes in stomach cancer treatment.

Hello Marsha,
It's unlikely there'll be any "attacking" in an 84 year old.
Given what you've described earlier, there seems to be a lot happening in the
gastro area, so it makes sense to me that a Gastro onc oversee the management of
your friend's cancer. It's hard for us to know what's shape she's in and
whether surgery for the gallbladder would help or whether the cancer is
extensive in the gastro area. I expect they run scans from time to time about
that.

The management of aromasin and chemo (once a month) that you descirbed earlier
seems to correlate closely with what's described here (for her type of
situation). So in my opinion, they're covering both bases, in case it is
ovarian (primary) or gastro or breast. Anyway one looks at it, they're treating
an epilethial cell cancer.
<http://www.bccancer.bc.ca/HPI/CancerManagementGuidelines/PrimaryUnknown/Management.htm>

Just a few sections of reading would probably clarify for you.
By the way, in the main section it states "The median survival is about six
months and the proportion of patients alive at 1 year is 10-20%."

Initially you expressed concern about "how much the clinic can suck out of her
private insurance and Medicare before they tell her the truth.?"
So now you've got 2 or 3 pages on the above website that you can pass on to your
mutual friend, to make sure she's not being over-treated, over tested, but being
taken care of to the best of the ability of her doctors. If any questions arise,
that webpage is for BC, Canada, where they (most, very few complaints) get
excellent cancer care.

If there's a hospice wing in the hospital, make her aware of it.
A few people have described a bridge program, for those in active treatment but
who might also benefit from hospice input. Maybe Glo would clarify. I don't know
if it's available in every state/hospital.

Sorry I can't be more helpful, but it's hard for both of us eh? when we're not
there to ask questions and assess her situation.
Hugs
J

> ????
> Her friend's 84 years old and has a reoccurence of breast cancer and CUP
> and is being treated.
> What's your point? She caused her breast cancer reoccurance with poor
> health choices?
> J
>

That often friends and family pick the wrong provider of care ( I define
wrong as one as I would not personally choose). When a friend or family
member goes to the "wrong" provider it can make you crazy since you know the
outcome could be improved.

> Updating a previous post where the chemo drug was unknown.
> I found out from her that it is doxil, which my research shows is
> a milder version of doxorubicin. I've found various references that
> seem to conflict. Some show it used for mets BC and others for
> Ovarian, which is a known in her diagnosis. Seems odd that the
> same drug would be used for both. Is that because a common
> mets site for BC is the ovaries?
>
> This makes me think they are indeed attacking the BC mets in the
> ovaries. I suppose they are just watching the CUP in the stomach
> pad area? That would explain the ovarian Onc turning her over
> to the Onc that specializes in stomach cancer treatment.
>
> Marsha
Drugs are often used for more than one type of cancer.

The NCCN uses this drug in it's recent guidelines.

http://www.nccn.org/professionals/cms/pdf/breast.pdf

>"alex" wrote:
>>Marsha wrote:
>> Updating a previous post where the chemo drug was unknown.
>> I found out from her that it is doxil, which my research shows is
<snipped>
> Drugs are often used for more than one type of cancer.
>
> The NCCN uses this drug in it's recent guidelines.
>
> http://www.nccn.org/professionals/cms/pdf/breast.pdf

Thanks, Alex. That's a very informative document and I
can actually read it!
Marsha

>"alex" wrote :
>
>>J wrote:
>> ????
>> Her friend's 84 years old and has a reoccurence of breast cancer and CUP
>> and is being treated.
>> What's your point? She caused her breast cancer reoccurance with poor
>> health choices?
>> J
>>
>
> That often friends and family pick the wrong provider of care ( I define
> wrong as one as I would not personally choose). When a friend or family
> member goes to the "wrong" provider it can make you crazy since you know
> the outcome could be improved.
>
Actually I think *a* good oncology clinic was referred by her. It has a
great
reputation (I am seeing one of the top Oncs there - not that I'm prejudiced
or
anything, ha!) and is associated with MD Anderson. My friend got her to
get test results to sent to a surgeon because she questions why they quickly
ruled out surgery. My recommendation was for a 2nd opinion of an Onc.
There is another very reputable, but smaller clinic in Memphis that I would
have considered if my Onc had not been so highly recommended from
my surgeon as well as other patients, some of them total strangers that
hailed him through mutual friends.

So I think the Onc provider is not the question just her indecision in
seeking another opinion from an Onc.

Thank you all for trying to help. I should note that while reading a
very old post in a google search through ASC I found a link to Tim's
page which is where I learned what CUP means. Very informative
site.

Thanks for the Hugs. I'm hoping to get to see her this Sunday.
Marsha