Questions on Node biopsy

cjwynn1994

Hello, everyone I need some advise please! I was just dx on 10/9/09 with ILC. When I went to my next dr. appt. I expected to get the results of the MRI, but instead was told that a node showed some signs. My Doctor wanted to do a ultrasound their in her office right then. She then thought it was best to do a biopsy on the node, again right then.

Now I'm suppose to have a PET done this week to see where else the invader has went to. I thought when you get your dx, you have your surgery,chemo,? radiation. She thinks it would be best to get me to my oncologist and start the chemo before the mastectomy. Is this the usual? Do things happen this fast? I mean from what I have read, they do the biopsy on the nodes during the mastectomy. Please help!! My head is splitting!

lrsreyes

In my case the path report after my mastectomy ( 5/08 )  determined my stage & number of positive lymph nodes. I had a 7.5 cm tumor & 15+/30 lymph nodes grade 1, mitotic rate of 1. I had 4 AC & 4 taxol , 28 rads, femara 12/08, zometa 6/ 09. During my last visit 9/09 my onco said that I am doing well. I had little side effects with all the treatments, no pain , active & sleeping well. Good luck with your treatments.

lrsreyes

My onco ordered MRI, pet scan, bone scan, muga scan after mastectomy & before my chemo

cjwynn1994

 Thank you for answering. See that is what I don't understand.She took a needle biopsy of the node on Friday and ordered the PET this week. Is it normal to do the chemo first, to try and control  the spread? I just really am lost:( All this has happened since the 9th of Oct.

Gitane

Oh Cindy!  I'll share what I did.  Others will be along, too.  I had an MRI and a PET/CT scan before decisions were made.  I also had a Sentinel Node Biopsy before chemo so that they had an idea of what the stage was. This is not an unusual sequence for ILC.  After all the information from the scans and SNB was gathered, I had chemotherapy before a mastectomy.  I did chemo first because I wanted to know if the chemo worked not because I was aiming for a lumpectomy.  

It may help to schedule another meeting to go over everything again.  Believe me we all are overwhelmed at first and need to ask the same thing over and over.  The doctors are used to that.  Be sure you ask lots of questions.  Get answers you understand, even if it means going line by line over the pathologists report, the PET report, and the MRI report.  Take a small recorder with you so you can refer back to what was said, I did that.  If you don't understand something later, call them back and ask your questions.  You deserve to understand what is happening to you.

I agree with your surgeon; it's good to meet with the oncologist before making any decisions.  You may even want to take copies of your pathology reports on your biopsies, the CDs of your PET and MRI and get the opinions of another surgeon, another oncologist, and if you are considering reconstruction, a plastic surgeon or two.  Some of us even have our slides from our biopsies read by another pathologist.  All this information really helps you clarify what's happening to you and what your choices are.  You don't have to rush.  You don't want to feel rushed.  

Deep breath.  We are here! Come see us and bring your thoughts and questions.  Also, remember we all are incredibly emotional and afraid when we are diagnosed.  We know how hard the whole process is.  HUGS.  G. 

lrsreyes

You have a lot of knowledge with ILC but first I noticed that you did not point out her METS diagnosis which I think is not correct at this point. When I was first diagnosed with breast cancer I was shocked because I do not know anybody close who had breast cancer. ( Asians have very low cancer rates) much less lobular cancer. Since I have stage IIIC ILC I have convinced myself that with Femara, Zometa, complementary therapies, grade I , mitotic rate of 1 I will survive this disease. You are 4 years out so you have a lot more confidence while I just have to think of the positive side.

unklezwifeonty

Dear Cindy,

Take a few deep breaths. Then ask yourself and your surgeon whether the procedure can be done next day or the day after. In other words, don't let the surgeon push you into an immediate decision. Take the time to go find an independent medical oncologist at a reputed teaching hospital. Then find another independent surgeon who does only breast work. You need second opinions before starting treatment.

While early detection offers the best chances, a few weeks will NOT make a difference. Also, not sure what you mean by "mets" in your diagnosis line?

Before the treatment plan is decided, the following tests are helpful:

Mammo

Ultrasound

MRI

PET-CT

Biopsy of the tumor

BRCA

Ask for copies of all test reports and images as you get the tests done. Ask the ordering doctor to explain each and every phrase in the reports.

cjwynn1994

You all are the absolute best!  Well I did start with a cyst that was on the side of my r breast about a year and a half ago. My GP thought it was nothing, but he did swab it. Then ordered a Mammo followed by a Ultrasound. His opinion was recheck in 6 months.

Then another 6 months.On my next one the radiologist said," Well it might be something, but We will just bring u back again. This time I said NOWAY! I want a biopsy!

On my first meeting with the breast surgeon I assumed it would be to make a appointment to come back and actually do the procedure, but she thought she wanted to go and then and do the Ultrasound, in which case she stated that we really needed to do the biopsy now! It was ILC. Then they scheduled for my MRI. When I went in friday to get the results thats when the node thing came up that was spotted on the MRI, Thats when she said do the biopsy. I get the results back tomorrow.

Thats when she said the importance of doing the PET now, so that the oncologist nows how to procedure with the chemo. Followed by the mastectomy

I just couldn't figure out why she did the needle biopsy on the node. In stead of waiting and doing it with the mastectomy

I will let all of you know more tomorrow.

unklezwifeonty

Dear Cindy,

I too think the "needle biopsy" on the node was unusual. But it is done.

For tomorrow be prepared with written questions and ask for copies of reports and ask her to review the reports with you to __your satisfaction__. Do not agree to any _procedure_ that she asks you to do tomorrow itself (imaging tests are ok). If she wants to schedule you for surgery, take the date but also make it clear that you will do surgery after getting an independent second opinion. Take the surgeon's suggested other surgeons and oncologists contact info but do not get the second opinion from these surgeons or oncologists.

Sorry for being a cynic but many of us have been thru' this process. No one can think with a clear head in a surgeon's office when faced with cancer. The surgeons know this and use this advantage to keep you hooked. They lose about 50% of the patients who go for second opinions.

Good luck.

dlb823

Cindy ~  I agree with the others who are suggesting that you get a second opinion.  A couple of things about your diagnosis to date do sound out of the ordinary.  For example, neoadjuvant chemo is becoming more common, but used most often to try to shrink a lesion to possibly be able to have a lumpectomy instead of a mastectomy -- OR if you have an extremely aggressive form of bc, neither of which scenario appears to exactly fit with your situation as you've described it.  And you're right about nodes usually being removed and examined during a mastectomy or lumpectomy -- not biopsied.

Also, I didn't quite understand if you've had an MRI.  Was that how they found an enlarged lymph node?  Did they tell you if your breasts are clear with the exception of the lesion they already knew about?

In one of your posts above, you mentioned meeting with the breast surgeon.  Is she a surgeon who only does breast surgery/care?  If not, that's the preferable choice over a general surgeon who has to worry about and keep up with the latest on a wide range of conditions requiring surgery.    Deanna  

cjwynn1994

Deanna- Thanks so much for answering!

Now to answer your questions. I have had an MRI done on 10/19/09, and it did in fact show a questionable lymph node. She then said that, she had felt something during the examination the previous week.

Also, my surgeon specializes in strictly breast surgery. I have checked into her background with high marks. It just seems to me i am only getting half the story. In fact today I called them to ask what grade my cancer was because nobody had told me.

My PET Scan is scheduled for Wednesday 10/28/09, and I Have an Appointment on Friday 10/30/09 with the  Plastic Surgeon.

Tomorrow I get the results on the lymph node biopsy. I will keep you all informed. Thank you all so much for listening and caring!!

unklezwifeonty

Dear Cindy,

You will do fine. Remember you need to keep managing your care.....

Survivor07

My Dx was a whirlwind--but that whirlwind saved my life. In my doctors office on a Wednesday and started chemo the next week.  He said if I had surgery first, then I would have to wait until I was healed to start chemo. Waiting for chemo would allow the "hidden" cells (if there were any) to grow. Surgeon and Oncologist decided to "kick ass" with the chemo first.  Had MRI, ultrasound, Muga Scan, PET scan, all within a week.  This is the 2nd time I've had breast cancer and am fortunate in the fact that I trust my doctors completely!  Am doing better now but wouldn't be here without the good doctors.

concernedsis

Cjwynn

Your profile says mets - but you are describing a local mass and a questionable lymph node? Having a positive node does not mean you necessarily have mets. Is there something I missed?

Chemo 1st would be to clean the nodes, reduce the size of the tumor and allow the docs to see response to chemo  - it would be to treat your whole cancer while surgery would treat the local breast cancer. 

looking for mets varies by center - sis had a bone scan, CT chest abd and pelvis prechemo and had her PET after chemo. 

Go to a cancer center if you can and find a medical oncologist you can trust to run the show

Good luck!

unklezwifeonty

Dear Cindy,

Any update? By the way I revisited the recently updated NCCN guidelines today and have some news for you.

Contrary to what I said earlier, Core Needle or Fine Needle biopsy of nodes is ok in certain cases, eg when the cancer is believed to be invasive not in situ and pre-operative chemo is indicated and the lymph nodes do not look suspicious from clinical exams.

Please let us know how you decided to procced and what's the diagnosis so far?

hrf

I had a needle biopsy on a node and that gave us the information regarding the tumour. The lobular tumour in the breast did not show up with mammogram or u/s. The mri showed an area of enhancement.

I hear more people starting chemo before surgery in order to determine if the chemo works.

Good luck.