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Ask Dr. D. Love Your Own Question

Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 17510
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I need some advice, I have cancer 3 years now, have

Customer Question

I need some advice, I have breast cancer 3 years now, have had radiation, oral chemo and shots, my concern is my liver ,in April of this year I studied the blood results, all seemed to be in range except my Ferritin count, it was almost 1900,i was taking iron pills so stopped them and tried to watch what i ate. my ferritin went down to 1100. when i brought this up to my ong. she said not to worry about it, then i started to research it myself on the computer, didn't sound so good, so i spoke to my GP and he said listen to the ong. but my side and back hurt most of the time. I spoke to my GP again and he sent me to another ong. and she said basically the same thing, now my ong. wants me to take tomosifin, oh I stopped all chemo, and my last blood work showed my ferritin is 1600, my ? is what will the tomoxifin do to my liver? and what is it doing to my other organs, I don't need any other problems. I have cancer in my bones,in various parts of my body. I was taking hydrocodon w/acetaminophen 5-500, but I also stopped that, seem to being doing O.K. without it, can you help me to decide if i should take the tomoxifin or is it going to be bad for my liver. thank you mary XXXXX XXXXX
P.S. i .am 79, but am able to function, my Grandson has been helping me the last 3 yrs.
Submitted: 3 years ago.
Category: Medical
Expert:  Dr. D. Love replied 3 years ago.
It will help if you could provide some additional information:
Were the other liver blood tests checked and normal?
Did they also check an iron saturation?
If so, what was the iron saturation?

Customer: replied 3 years ago.

Do you mean tests I had done before or within the same test. the liver count in the same test Dr. said was o.k.


 


I don't know what you mean by iron saturation , all I know is when i first saw it it was 1800 + almost 1900 , went down to 1100 now the last test was1600

Expert:  Dr. D. Love replied 3 years ago.
To assess iron metabolism, there is usually several tests that are done. In addition to the ferritin, there is an iron saturation, which measures the serum iron, the iron binding capacity, and the iron saturation (as a percentage) is calculated. Were these other tests done?

Customer: replied 3 years ago.

I looked at my test results:Iron Sat %37,


TIBC292


 


UIBC184


 


IRON108


 


ferritin1668


 


ca27-29949.0


 


B12 -54


 


Reticulocyte count 4.1


 


folate serum>19.9

Customer: replied 3 years ago.

also;


Diagnoses: Primary V10.3 Personal Hxof breast malignancy Mets:liver-


Secondary 198.5 second mal Neoplasm bone and bone marrow -stable


secondary275.3 other hemochromatosis- to early to tell


 


secondary 288.5 leukocytopenia, unspecified- stable


 


"285.8 Anemia nec. -stable


 


" 197.7 Second Mal Neoplasm liver, specified as secondary too early to tell

Expert:  Dr. D. Love replied 3 years ago.
Yes, this is it.

TIBC is the total iron binding capacity. The iron saturation is 108/292 = 37%.

The reason that this is important is in the interpretation of the ferritin. The ferritin interpretation is complicated by the fact that the ferritin can be increased as a non-specific response to major illness. This is common to several proteins in the body, which are collecting referred to as acute phase reactants or acute phase proteins. When looking at an elevated ferritin, determining whether it is elevated because it is an acute phase reactant or because there is excessive iron in your system, the iron saturation will clarify the picture. If the iron saturation is elevated, then that would indicate that the ferritin is increased because of excessive iron in your system. But if the iron saturation is normal (as in your case), then the elevated ferritin is because of an acute phase reaction.

As for the tamoxifen, it is true that there is a low risk of the tamoxifen affecting the liver. In clinical studies, mild abnormalities in liver tests occur in about 1-2% of persons receiving the drug. More severe reaction also have been rarely reported, but these are quite rare. In a person with metastatic cancer, there would be a greater risk of an adverse effect on the liver because of spread of the cancer to the liver. The fact that the ferritin is elevated does not alter the risk, since the elevated ferritin is due to an acute phase reaction, as noted above. Therefore, from the perspective of liver function in the future, there would be greater risk to the liver if the tamoxifen is not taken.

After I had typed all of this, I see that you added that you already have liver metastases, so there definitely would be benefit in taking the tamoxifen in trying to prevent worsening liver function from the effect of the metastases.

As for the potential effect of tamoxifen on other organs, the primary risk is related to the formation of blood clots, which can occur in veins and be manifested as deep venous thrombophlebitis (DVT, blood clots in the deep veins of the legs or pelvis) or pulmonary embolus (part of the vein blood clot breaks off and travels to the lungs. The blood clots also can form in the arterial system, which can be manifested as a stroke. These are the primary serious warning that need to be considered with the use of tamoxifen. There are multiple studies that show that the benefits of tamoxifen in women with metastatic cancer outweigh the risks, so doctors will still frequently recommend the use of tamoxifen.

Therefore, the current recommendations are that the tamoxifen would provide more benefit than risk, so would be appropriate to take.

If you have any further questions, please let me know.

Customer: replied 3 years ago.

Thank you so much for your explanation, I wish my Drs, would have explained this to me,You have helped me .


.By the way are you related to Dr. Love who treated president Roosevelt, for I knew him as a a young girl. What a wonderful person he was. He had a home on Long Island , N.Y. East Hampton,where I grew up.

Expert:  Dr. D. Love replied 3 years ago.
You're welcome. I'm glad I could be of service.

I am not related to him as far as I know.

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