Patient's Query
Hello doctor,
My mother was diagnosed with stage 3 breast cancer, which was removed entirely. However, two years later, she experienced metastasis that spread to the brain. Now, the cancer has spread to the liver, and she has developed jaundice.
Her bilirubin levels have increased from 7.5 to 10. Is there anything that can be done with medication? The common bile duct (CBD) is not dilated; she also has ascites, for which a combination of Spironolactone and Torasemide will be administered. Can anything be done to manage the jaundice?
Please help.
Hello,
Welcome to icliniq.com.
I can understand your concern.
I have reviewed your reports and your query. To better assist, I would like to know a few things:
What treatments has she received so far?
What is the hormonal status of the tumor?
How is her overall condition?
From what I can see, she has already received Palbociclib and Capecitabine, which suggests the tumor might be hormone receptor-positive and HER2-negative. In this case, treatment options are limited. If the tumor is triple-negative breast cancer (TNBC), we could consider a low-dose single-agent Carboplatin.
I understand this is a challenging situation. If her bilirubin levels and general condition are not optimal, chemotherapy options are limited. If you can provide a summary of her prior treatments, I will be able to offer more specific guidance. In the meantime, I recommend supportive care such as proper nutrition, pain management, and physiotherapy. These can help improve her quality of life.
I hope this helps.
Let me know if you have any other concerns.
Thank you.
Patient's Query
Hello doctor,
Thank you for the reply.
Before, my mother was given Megestrol and Ursodeoxycholic acid. She has undergone chemotherapy and radiation for both breast cancer and brain metastasis, but nothing has worked. A few days ago, she had pleural effusion and was started on HCQ (Hydroxychloroquine), which helped improve her oxygen saturation, so she no longer needs external oxygen. Recently, she became unconscious and suffered hepatic encephalopathy, so she was given Samlol, and her Megestrol and Ursodeoxycholic acid were stopped to reduce the medication load.
Now, her urine output has improved, her urine color has returned to normal, and she can open her eyes, which she could not before. The yellowishness in her eyes has also decreased. However, her reports remain concerning. She is also receiving Zoledronic acid, and today she’s being given albumin as well.
Kindly help.
Hello,
Welcome back to icliniq.com.
I read your query and can understand your concern.
What is the hormonal status of her tumor? Is it estrogen receptor (ER)-positive, progesterone receptor (PR)-positive, or human epidermal growth factor receptor 2 (HER2)-negative?
Kindly revert so I can assist you further.
Patient's Query
Hello doctor,
Thank you for the reply.
The cancer has spread to the brain, and no targeted radiation could be done, as the cancer has affected the whole body with no specific targeted zones. She has started walking with our support, unlike when the bilirubin levels started to rise and were at 4.5. I have also attached two test reports.
Kindly help.
Hello,
Welcome back to icliniq.com.
I read your query and can understand your concern.
Yes, I have reviewed the reports, but they are just liver function test (LFT) reports. Could you provide more information on how much of the liver is involved and the hormonal status of the tumor (estrogen receptor, or ER; progesterone receptor, or PR; and human epidermal growth factor receptor 2, or HER2)? At this stage, no chemotherapy options appear suitable, so the focus is on supportive medication for hepatic encephalopathy and nutritional care.
I hope I have answered your question. Let me know if I can assist you further.
Patient's Query
Hello doctor,
The disease has spread throughout the entire liver. I am currently unsure of the hormonal status, but I will check.
Kindly help.
Hello,
Welcome back to icliniq.com.
If bilirubin is elevated due to the disease spreading to the liver, it is difficult to treat, as chemotherapy will not be possible. The bilirubin levels will not decrease since they are caused by the disease. If it were due to an obstruction, drainage would have been an option.
Let me know if I can assist you further.
Patient's Query
Hello doctor,
The main thing I would like to know is how much time is left. She is speaking, aware, and able to move her legs. Her brain is fully functional, and she has started to sit, talk, and do everything. When we look at her, it does not seem like she has jaundice, even though her bilirubin levels have increased. How much time can be extended in this condition?
Kindly help.
Hello,
Welcome back to icliniq.com.
At this stage, I would not say much. A maximum of three months if all the above reports are correct. How was it confirmed that cancer has spread to the liver? is any USG (ultrasound sonography) or CT (computed tomography) done?
I hope this helps.
Kindly revert in case of further queries.
Thank you.
Patient's Query
Hello doctor,
Thank you for the reply.
An ultrasound and magnetic resonance imaging (MRI) were performed, with the MRI scan two months ago revealing metastasis in the liver. The patient also suffered from ataxia, a condition affecting coordination, originating from the brain. A computed tomography (CT) scan was also conducted.
Kindly help.
Hello,
Welcome back to icliniq.com.
Regarding extending time, I believe chemotherapy may cause more harm than benefit in the current setting. If bilirubin levels decrease with supportive care, we can consider a single-agent treatment, depending on her hormonal status. Additionally, it is important to know where she previously received treatment and where she is currently admitted to assess the continuity of care and available resources.
I hope I have answered your question.
Let me know if I can assist you further.
Regards.
Patient's Query
Hello doctor,
She is currently at home. Her breast cancer was initially treated elsewhere, and treatment for metastasis was conducted at another facility; however, there was no improvement observed during the metastatic treatment.
Kindly help.
Hello,
Welcome back to icliniq.com.
I hope your mother recovers soon.
Let me know if I can assist you further.
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Answered byDr. Pawar Satyajit Jalinder
Medically reviewed byiCliniq medical review team
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