Patient: Description: Hello Dr. Cheng! I have invasive ductal carcinoma of the right breast, and the tumor is located in the inner upper quadrant of the right breast. Five and a half years after surgery. The surgery was done twice. First, I had a minor outpatient surgery because I was young (just 30 years old) and the lump was small (about 0.8*0.8cm), but I insisted on cutting it before I was accepted for the minor outpatient surgery. During the surgery, the lump was too small to be found after the anesthetic was administered, and the lump was accidentally shattered during clamping. After 11 days, I underwent a simplified radical surgery and did not undergo radiotherapy after the surgery. Immunohistochemistry was: ER+,PR+,erb-B2:+~++. He was on oral triamcinolone for five years after surgery. In the middle and late October, I noticed a transient pain in the right side of my chest, which I thought was caused by a cold and cough, and it was slightly relieved by oral cough syrup in late December. However, I was worried about myself and had a PET-CT done on Jan. 14. The results were: abnormally high FDG metabolism in the right anterior chest wall medial pleura and corresponding chest wall, which was considered as metastasis. Dr. Cheng, how should I be treated in this case so that the tumor will be killed as soon as possible? The doctor on my side suggested me to use “double-degree” endocrine therapy. But I think this treatment is too slow, and it takes at least two months for the tumor to go away, during which I am worried about the metastasis in other areas. I am still so young and I don’t want to delay it like this. Please help me, Dr. Cheng! Thank you! Patient: Biochemical test report: 1 Carcinoembryonic antigen CEA (luminescence):2.6 ng/ml,reference value is 0.1-10.0 2. CA153 (chemiluminescence): 4 U/ml, reference value is 1-35 Doctor: I agree with your doctor’s treatment opinion can be considered double German program. Reasons: 1. You have been treated for 5.5 years from now, suggesting that tumor progression is still slow and endocrine therapy should be effective. 2. For premenopausal patients, you can consider drug ovarian transplantation + new endocrine therapy drugs. 3. At present, you actually do not have symptoms due to this metastasis, so there is time to use endocrine therapy, and this treatment has little side effects. I understand your concern that endocrine therapy is ineffective and delayed. Then, in fact, chemotherapy is also effective, and the efficacy of chemotherapy is not necessarily better than endocrine therapy for receptor-positive patients. Therefore, I suggest to try the easier treatment first. If it doesn’t work, it’s not too late to switch to chemotherapy. If you have the condition to do PET, I think you can review the PET after 3-4 months to see if the SUV value of the lesion has decreased. If it decreases, it still indicates that the treatment is effective. In addition, it is recommended that: 1. If possible, the original tumor section should be rechecked for Her2 and detected by FISH. If it is positive, you can consider adding targeted therapy. 2. Contact with thoracic surgery to see if there is a possibility of biopsy by puncture or any minimally invasive method to clarify if it is metastasis. Patient: Hello, Dr. Cheng! Thank you very much for giving me such a detailed and serious reply! Because I was busy choosing a hospital and treatment, I didn’t reply to you in time, please forgive me. Eight months have passed, during which I had chemotherapy and radiotherapy. I had six cycles of chemotherapy, Pyridoxine + Docetaxel, CT showed a significant thinning of the thickened part of the pleura, I don’t know the exact result because I didn’t do PET again. 25 times of radiotherapy were given to the pleural lesions, and ordinary electron radiation was given to the clavicle, I don’t know the exact dose. In the radiation therapy at the same time to start double German in the Norelide, June 25 began, once every four weeks, so far has been five times. The hormone levels are as follows: estradiol 14, the reference value of menopausal level is less than 20, follicle stimulating hormone 3.96, the reference value of menopausal level is 16.74-113.59. Because the follicle stimulating hormone is very far from menopause, the doctor said that I should wait and check the hormone levels again, and then take Reninde after reaching menopause. I am now worried that if the follicle stimulation one keeps failing, I won’t be able to use Ryninde, so will it delay my treatment? I would like to ask Dr. Cheng again, in my case, do I have to wait for both hormone levels to reach menopause before I can use Ryninde? (Different hospitals in my area say different things, and some say they only refer to estradiol levels.) If I can’t reach them, can I reach them by removing my ovaries? Thank you, Dr. Cheng! Patient: I didn’t do a biopsy, I just had the original wax block re-cut for immunohistochemistry and FSH, results: ER:+, PR:++, TOPO:-, K67:-, HER2:-. Doctor: I think it’s ok to take Rynintex. There are different opinions about the hormone measurement values, and there is no definite conclusion yet. Of course, if you have your ovaries removed, you can definitely take these endocrine therapy drugs. Patient: Thank you, Dr. Cheng, for being so prompt and patient with an unfamiliar patient, and for asking me to join the patient association. I wish you all the best!