Answering your questions is board certified Oncologist Dr. Stephen Lemon

	Question: Hello, my daughter passed away from StgIV BC in December. She was diag. in Feb, it was very advanced. My question relates to the progesterone shots she received in 08 to help her keep a pregnancy. She still ended up with a miscarraige. Is there a poss. that the prog. either caused or advanced her cancer. It is poss. that she had the cancer for 1 to 1 1/2 yrs. Why didn't they know anything when she was pregnant. It seems that there would have been a test or something that would have shown something unusual... The only reason for these questions is my own curiosity, no reasons could be found for her cancer. She had gene testing etc and nothing.. Thank you for any info. Answer: I am sorry to hear of the loss of your daughter. I hope understanding more about breast cancer will help give you some peace in your bereavement. We know that breast cancer can be associated with hormone treatments and with pregnancy, but whether these actually cause breast cancer is uncertain. The progesterone treatment by itself probably did not cause the breast cancer, although there is not much information on progesterone treatment and breast cancer. There are studies on birth control pills that contain both estrogen and progestin and the risk of breast cancer, with some studies showing an increased risk, and other studies showing no increased risk of breast cancer. It is possible that breast cancer can be present for several years and not be detected. Breast cancer can also be present during pregnancy but not show any changes in normal pregnancy lab tests. Some studies have shown a short term increase in breast cancer risk after childbirth. Breast cancers associated with pregnancy are often aggressive cancers, but pregnancy itself probably does not cause breast cancer. So in summary, we do not completely understand the relationship between hormone treatment and breast cancer in premenopausal women, but the risks at this time appear to be low. We need to find better ways of identifying breast cancer in and around the time of pregnancy. Stephen Lemon, MD, MPH

	Question: I have a cousin and a good friend with the same type of stage 4 lung cancer. Both were diagnosed and started going through chemo with steroid treaments at approximately the same time. The cousin is a 49yr old female and the friend is a 55yr old male. Both just had scans done to see how their tumors have progressed. The friend's tumors have decreased in size by 50%. The cousin's have pretty much stayed the same. Only one tumor has decreased slightly. Why would the friend's tumors shrink and the cousin's not shrink if they are receiving the same treatment? And why is the chemo dragging the cousin down while the friend is still out and about living life like its not affecting him. Answer: This is a great question about lung cancer. Lung cancer is the leading cause of cancer death in men and women, accounting for 157,000 deaths in 2010. The main cause of lung cancer is smoking, although non-smokers can also develop lung cancer. Lung cancer is divided into small cell and non small cell subtypes. Stage 4 means the cancer has spread to another organ outside of the lung such as liver, bone, or brain. Your question asks why two people, diagnosed with the same type of lung cancer and given the same type of treatments, will have different responses to those treatments. The reason is that people and their cancers are affected differently by chemotherapy due to individual characteristics such as their gender (male or female), smoking history, metabolism, overall health, race, and other factors. Also, while two cancers might seem the same by category, they may behave very differently based on their specific genetic make-up. For example, lung cancers with mutations in the EGFR gene will respond better to the targeted agent erlotinib than to standard chemotherapy. The new field of personalized cancer treatment tries to match individual characteristics of a cancer with the best treatments for it. Unfortunately, we do not yet have a 100% reliable way to know ahead of time which lung cancer treatment is going to work the best for an individual patient, but we are working on it! Stephen J. Lemon, M.D., M.P.H.

	Question: Post chemo I seem to always be cold or often feel overly chilly. Is that a side effect of the chemotherapy or something else? My imagination? Answer: This is a good question about the side effects of chemotherapy treatment. As most patients receiving chemotherapy know, chemotherapy drugs can cause almost any side effect a person can think of! It is therefore sometimes difficult to know if a symptom is from the chemotherapy or from another cause, for both the patient and the doctor. Specific side effects of chemotherapy are related to the specific chemotherapy drug, the drug dose, its method of administration, and premedication treatment among other factors. You feel cold or chilly after treatment. This might be from pretreatment intravenous hydration or the saline (salt water) used to mix the chemotherapy drug. The hydration and saline that some chemo drugs are mixed in are often at room temperature, which is lower than body temperature, and can make a person feel chilled. Some of the newer chemotherapy "smart drugs" like Herceptin (trastuzumab) can cause chills during or after treatment. Lastly, an infection can cause chills. If a intravenous access line such as a portacath is infected with bacteria, sometimes a person will have chills after the portacath is used for treatment, indicating a infection might be present in the portacath. A portacath infection is a serious situation and needs to be evaluated and treated. It is very important to let your doctor know about your symptoms, even if they seem mild and occur after your treatment is done, so that he can evaluate the problem and correct it if necessary. Stephen J. Lemon, M.D., M.P.H.

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