Ask the doctor - cancer

All About You online 19.03.2008

I can’t bear feeling like this I’m taking tamoxifen for breast cancer, but am getting terrible hot flushes. Is there anything I can do to relieve them?

There are several complementary therapies for treating flushes, since it is not appropriate for you to take HRT. One is red clover isoflavone, taken in doses of 60–80mg a day. Studies suggest it doesn’t increase the risk of breast cancer but there is less evidence for women who already have the disease. As it has some oestrogen-like properties, it may be worth avoiding if you have breast cancer that is oestrogen receptive. Other alternatives are dong quoi and black cohosh, but while the latter is usually safe, it has very occasionally caused severe liver problems. Prescription medications effective in treating hot flushes include SSRI tablets. Finally, the group of medicines called the Aromatase Inhibitors work similarly to tamoxifen, but do not cause as many problems with flushes. You could talk to your GP about using these as an alternative to tamoxifen.

Dr Sarah Jarvis, Good Housekeeping

Cancer affects my appetite

I have cancer and am finding it difficult to eat. What can I do?

If you experience problems with eating or drinking, or unplanned weight loss, when you have cancer, it’s important to tell your doctor. If the weight loss can be slowed or even stopped, you’re in a better position to fight the illness. Normal healthy eating rules don’t apply, and foods high in calories and protein are needed to help regain lost weight. Visit the website www.nutritionincancer.co.uk – it provides nutritional information for people with cancer. It includes recipes and suggestions for protein-rich, high-calorie snacks, plus an online forum. A free DVD can also be ordered.

Dr Sarah Brewer, Prima

Are there any warning signs of ovarian cancer?

My aunt recently died from cancer of the ovary, which wasn’t diagnosed until it had spread. Is there any way of recognising the symptoms early, so it can be picked up sooner?

Cancer of the ovary is the fourth most common cancer in women, affecting about 7,000 a year in the UK. Unfortunately, there are no routine screening tests like those for cervical or breat cancer. However, recognising the early symptoms can make all the difference to the outcome. Until recently, that was difficult as warning signs can be vague and often don’t seem to be gynaecological, but research by the University of Washington has now identified what seems to be a pattern of frequent, persistent symptoms, even in women in the very early stages of the disease. The six symptoms you need to look out for are: persistent bloating; abdominal pain; pelvic pain; increased stomach size; feeling full and difficulty in eating. If you have any of these symptoms for more than 12 days in any month, you should see your GP and explain that you’re concerned ovarian cancer may be the cause.
Dr Sarah Jarvis, Good Housekeeping

Breast cancer screening

My 44-year-old cousin has just been diagnosed with breast cancer. Will I need regular screening?

Breast cancer does sometimes run in families, but it's only likely to be a factor if a ‘first degree' relative - your mother, sister or daughter - is affected. Even then, the extra risk is small unless more than one relative is affected. So it's unlikely you need regular mammograms before the standard age of 50, unless other members of your family are affected, too. However, every woman should practice breast awareness, which means paying attention to what your breasts and nipples are normally like, so you can spot changes early. Your practice nurse or GP can give you all the details.
Dr Sarah Jarvis, Good Housekeeping

Breast cancer and goseralin

I’m 37 and have just been diagnosed with breast cancer. I’ve been told the tumour is oestrogen sensitive, which means oestrogen makes it grow, and that drug treatment to block this effect could be better than chemotherapy. Instead, I’d have monthly injections of a hormone called goseralin. I’ve been dreading chemotherapy, and this sounds too good to be true – is it?

Let's start with the benefits. If you have oestrogen receptor positive cancer (and over half of women under 50 with breast cancer do) goseralin is a really effective alternative to chemotherapy because it has similar survival rates and less serious side-effects. What's more, while chemotherapy involves repeated hospital visits, you can be given a goseralin injection just once a month by your GP or practice nurse. Of course, as with any drug, there is a downside; the side-effects are similar to menopausal problems, such as hot flushes, sweating, vaginal dryness, loss of libido and possible mood swings. These side-effects disappear after you stop treatment, however, while chemotherapy side-effects can last much longer. The main disadvantage of goseralin is that treatment takes two years - instead of six months of chemotherapy. So really, it's a question of weighing up what's most important to you, and insisting you get a say in deciding your treatment options.
Dr Sarah Jarvis, Good Housekeeping

Breast mouse

I’m 29 and have just had a lump in my breast taken out. The surgeon said it was a ‘breast mouse’ and assured me it wasn’t cancerous, but I’m still worried it might increase my risk of breast cancer.

A ‘breast mouse' is a harmless, fibrous lump, named because it ‘scuttles away' under your fingers. Obviously, all breast lumps are worrying until you know what they are. However, with a ‘breast mouse' (officially called a fibroadenoma), you don't need to be concerned. And in the long term it certainly won't increase your risk of breast cancer.
Dr Sarah Jarvis, Good Housekeeping

Tamoxifen

I was diagnosed with breast cancer four years ago, and have been taking tamoxifen ever since. I’ve been told I’ll have to stop once I’ve been on it for five years. Is it true, however, that there’s a new drug I can take after that, and does it really help?

I'm delighted to say that it's true. A drug called letrozole (Femara) has recently been licensed for post-menopausal women who have completed their course of tamoxifen. The even better news is that the license was granted after the drug, which is taken as a daily pill, was found to reduce chances of breast cancer returning by almost 40% - and since over half of the recurrences of breast cancer tend to happen after women stop taking tamoxifen, this latest drug should be a life-saving development.
Dr Sarah Jarvis, Good Housekeeping

Warning signs for ovarian cancer

Tragically, one of my friends has just been diagnosed with ovarian cancer and is terminally ill because she didn’t go to her doctor until it was too late. Obviously, I’m shaken by what’s happened. Are there are any warning signs to watch out for?

Ovarian cancer can be difficult to recognise until it's quite advanced. However, it has recently been discovered that, unbeknown to them, at least 90% of women with ovarian cancer had had warning signs before they were diagnosed. If these were more widely known, it could make a real difference to survival rates. The sort of persistent signs you should be looking out for include bloating, fullness or swelling in your abdomen; unexplained back or abdominal pain; a change in your bowel habit; excessive and ongoing tiredness; unexplained weight loss or gain or any irregular vaginal bleeding.
Dr Sarah Jarvis, Good Housekeeping

Tamoxifen & hot flushes

I was diagnosed with breast cancer two years ago, and take tamoxifen. I know it’s important to keep taking it, but it gives me ghastly hot flushes. Is there an alternative?

There have been huge advances recently in the treatment options for the 80% of postmenopausal women with breast cancer whose tumour is sensitive to oestrogen. Tamoxifen has been the drug of choice for years, and is undoubtedly very effective. However, as you've discovered, the side effects can be hard to live with. In the past couple of years, a new group of drugs, known as aromatase inhibitors, have come on the market. Like tamoxifen, they reduce your production of oestrogen - but by a different mechanism. All of them have proved to be even more effective than tamoxifen and, on the whole, are better tolerated. The first one licensed, anastrazole, can be taken if you suffer side effects and can't tolerate tamoxifen. Now one of the others, exemestane, has been licensed for use as a ‘switch' drug after two to three years on tamoxifen. Talk to your consultant about whether you might be suitable for it. Dr Sarah Jarvis, Good Housekeeping

Breast cancer scare

My lump’s not cancer, but I’m still worried I have a fibroadenoma in my breast. My GP says I don't need it removed, but will leaving it increase my risk of cancer in the future?

A fibroadenoma - a fibrous lump - is thought to occur when certain cells are unusually sensitive to the female hormone oestrogen, causing them to grow more quickly. It's common to just keep a watchful eye, as it may disappear on its own. If it's large or you're worried, you can ask for it to be removed. For most women, having a fibroadenoma does not increase the risk of breast cancer. A few women with a strong family history of breast cancer, and whose fibroadenoma shows complex cell changes, are given regular follow-ups. Talk to your GP about your concerns and, like all women, remain breast aware. You can also call the Breast Cancer Care helpline on 0808 800 6000 or visit www.breastcancercare.org.uk.
Dr Sarah Brewer, Prima

Is it worth having the cancer vaccine?

I had pre-cancerous cervical cells in my twenties and mid-forties. Should my teenage daughters have the Gardasil vaccination?

Cervical pre-cancerous abnormalities are not hereditary, as most cases are linked with certain strains of high-risk wart viruses. Condoms offer around 70 per cent protection against these viruses. The Gardasil vaccine protects against the strains associated with 70 per cent of cervical cancers, and those causing 90 per cent of genital warts. Gardasil is licensed for use in girls and boys aged nine to 15 and women aged 16 to 26. I’d strongly advise your daughters to consider having the vaccine – it has the potential to reduce the risk of cervical cancer and abnormal smear results. More information is available from the Jo’s Trust charity; visit www.jotrust.co.uk or call 01327 341965.
Dr Sarah Brewer, Prima

Are there any warning signs for lymphoma?

A friend was recently diagnosed with lymphoma, but she wasn’t her usual self for months beforehand. I’d tried to persuade her to see her GP, but she didn’t want to bother him. Are there any warning signs?

Lymphoma is a cancer of your lymph system, which helps fight infection. Early symptoms include painless, rubbery swellings in the neck, groin or armpits; night sweats; fevers; tiredness and unexplained weight loss; all-over itching; irritating cough and shortness of breath. Although symptoms are often mistaken for a cold, you should see your GP if you have more than one that doesn’t go. Catching it early can make a real difference in terms of a positive outcome.
Dr Sarah Jarvis, Good Housekeeping

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