possible that an enlarged node is not cancerous?

zayb

About 74 months ago I was diagnosed with early stage tnbc upper left, mostly dcis with microinvasions (felt way bigger than it was). No lymphatic invasion, no vascular invasion, node negative. I had the full work up with scans, including PET, MRI, ct before chemotherapy. I had a left mastectomy, dd ac+t and radiation. No abnormalities in any scan except a lipoma in my colon which I already knew about. About 7 months after finishing treatment I had a "prophylactic" mastectomy on the right (5 years ago now). Never an abnormal right mammo. Dcis was found in more than one quadrant but it was still very small, microscopic. I had good margins, especially chest wall. I had a pathology review at Penn. Recommendation was no further treatment. Since I was triple negative previously no hormonal therapy.

Recently, I felt an irregularity on the right side by my muscle. I had had a rash at my "crease" a few days before finding the abnormality. I had expanders placed after my second mastectomy. Radiated side = really bad capular contracture. I ruptured my right expander from constantly palpating it and had lacerations to the inside of my pectoral muscle. I had my expanders removed more than 3 years ago but the excess skin wasn't removed on the right so it always hangs over my scar and sweats a lot in the summer. The rash only lasted a few days but I had really inflamed skin. I noticed the irregularity a few days after the rash. I went in and was able to get an ultrasound right away. The Dr. Had to look real time because he couldn't tell from still pictures what it was. Finally he decided it was a lymph node and said it was 2x3 cm! They didn't scan all my nodes, but he said he could only see a single enlarged node. Nothing else seems to be evident in my physical exam. No other palpable nodes, nothing on the chest wall either side, etc etc.

I was always told that physical exams (chest wall, etc.) would pick up recurrences after dcis, which is what I had on the right side. Is it possible to have a node this large that isn't cancer? I am convinced it is my interpectoral node since it is hard to feel or feels smaller than it is. It was palpable in the physical exam but the rad onc thought it was only about a centimeter. I read that interpectoral recurrences are rare in the absence of any other evident recurrence and haven't found any cases as a first place of recurrence after dcis. I don't think it is related to the tnbc I had more than 6 years ago on the other side. I know skin rashes can cause problems but the size of the node freaks me out. I had palpated it quite a bit (for about 18 hours) before the exam which may have had some effect on it. I cannot stop probing the areas where my breasts were, which is how I ruptured my expander (I really press very hard at things), and don't wear a prosthesis so I can probe all the time. The radiologist said the node was abnormal (2 x 3 ) but he could not tell what was making it that way. I have a biopsy scheduled next week.

vlnrph

An enlargement can be due to infection, not malignancy. Your 'heat rash' may have been a sign of fungal growth in that warm moist area. Excessive palpation of the area could introduce other micro-organisms like staphylococcus which are found on the skin. Would I sound like a mother if I said "stop poking at that"!?

Seriously, with your history of triple negative cancer, I can understand the concern.

Try to distract yourself this weekend and until the biopsy, doing something fun that also keeps your hands busy and away from your armpit. Go to a pottery workshop and learn how to work a wheel. You won't be putting fingers full of clay where they don't belong and will create an interesting souvenier at the same time...

Tomboy

Made me laugh too! Good luck to you, dear Kayb. *Edited to say good luck to zayb!

zayb

I know I shouldn't be constantly touching it, and that this is a problem in itself. I don't know what if any effect this can have over a period of many years. I broke the skin with my nails scraping on the rash. I also scraped my gum near a chipped tooth that I pick on and it has become infected. It is pretty miserable. I had always directed my anxiety into different kinds of health worries, but now that I have had a real health worry oping with feeling anxious has become pretty unbearable and usually involves picking and prodding. I have something else scheduled for this upcoming week that has been scheduled for some time and that I am anxious about. Now I can't figure out what I should be anxious about and pretty much can't do anything, even though there are a lot of things I am suppose to be doing.

vlnrph

I agree with the idea of trying a low dose of lorazepam, at least until some of these issues resolve.

How about using the nervous energy that might remain to smooth lotion all over yourself? It would be similar to the detrimental skin/body contact you are doing but it would be more therapeutic and even promote healing.

Also, cut your nails really short so you don't scratch by accident at night when drifting into sleep

zayb

Well I had my biopsy today and am not feeling very hopeful. The node was slightly smaller, by a few millimeters in each direction, but nothing significant. It also is less palpable. As far as I know no other enlarged nodes were visible. They have someone from cytology check to make sure there is enough tissue. Can they tell if there are cancerous cells when they do this? I am Still can't figure out how I have one enlarged node 5 years after dcis on this side. My understanding is that there is no imaging done because a local recurrence is easy to identify....

bevin

keep us posted, praying its non cancerous!

vlnrph

Oh dear, another weekend of waiting! Did you ask about getting an anti-anxiety prescription?

I would try not to worry too much. The fact that they sampled the node instead of removing it might mean that it is less suspicious than you think. If it is decreasing in size maybe it is done with the work of catching infectious organisms (cancer will usually keep growing): be sure to get a copy of the pathology report when it comes out.

My medical microbiology classes were decades ago so don't quote me but the lab needs enough tissue in order to slice & dice onto various slides. Then they use staining or process in different ways which help visualize whatever is lurking. There could be dead bacteria, normal cell structures, various other things. Hopefully all benign.

zayb

I did get ativan, and I also went through with the other scheduled event on Wednesday that I was very anxious about (unrelated to breast cancer) and that turned out well.

I am pretty confused about the lymph node though. I can no longer feel it, the area where i could feel it is soft now with no definition. So it seems back to status quo to me. I suspect it is a large node normally because even though it is still there I can no longer feel it because it is softer now. From the way it feels now (like they always feel) i would never even consider going in to the doctor. It is 1 mm shorter in length and about 4mm more narrow. They said those were insignificant decreases in size. But there are some abnormal features, it isn't 100% normal architechurally. Not sure what to make of this. It seems like a good thing that it is not palpable anymore, but we'll see. My mouth infection is nearly gone. I have a little section over my tooth (where the infection started) that is a bit swollen, but the rest of my face (up to my eye) and my gums to the jaw and my inside and outside cheek are back to normal.

I appreciate the ativan though it is making me a bit sleepy!

zayb

I haven't taken an Ativan yet today, but am planning to soon, followed by a morning chaser. Hoping to hear in the morning. The doctor was going to give me 1 pill until the nurses there explained that 1 pill was unlikely to tide me through the weekend. I am nervous. I did have an infection, but am not sure how this fits into the whole equation! The doctor told me it wasn't 100% architecturally normal ... really does this mean anything? Just something to mull over for me... something to obsess about .... does this mean 95% normal/5 % abnormal...how ambiguous...just what I was looking for, an obscure statement I can't even begin to figure out.

zayb

No news is no news. My husband was going to call today, but i asked him not to. They said they would call me as soon as they got the results....

I don't want to call, but maybe my husband will call in the morning.

zayb

bad news

farmerlucy

oh zayb - I'm so sorry. Damn cancer

zayb

I am having an excisional biopsy tomorrow. It is estrogen receptive, no problem or her 2 yet. The surgeon couldn't feel it. If it hasn't traveled tentative plan is radiation and anti-hormonals.

zayb

Meant no progesterone results yet.

farmerlucy

Unbelievable zayb. This stuff is insidious. Hanging with you

zayb

It is sh*tty. Will find out more in the next week. I am having the node and surrounding tissue removed tomorrow by the same surgeon who did the two mastectomies. I saw the rad onc (who gave me the news), then the surgeon and the medical oncologist today. It is low grade and 90% estrogen receptive, her 2 negative. I switched to Xanax. Thank you, surgeon.

vlnrph

So sorry to learn of this development but it's good to be getting it all out right away. Hope the procedure today was uneventful and caused minimal discomfort. Glad to know they let you have enough lorazepam for the past weekend. Alprazolam is also helpful for many people and perhaps results in less daytime sedation.

Interesting that this lesion is ER+ when you were triple negative previously. This is an advantage because now there is the possibility of using anti-estrogen therapy like tamoxifen or aromatase inhibitors as you pointed out.

Has anyone talked about seeing a genetic counselor since this is basically bilateral as well as different/new pathology? Don't think about it until those more immediate concerns are under control. Even without family history, your presentation would fit the criteria my insurance company suggests to qualify for testing. There is more out there to look for than BRCA now: something to consider when you're ready...

614

Good luck Zayb

zayb

I do have family history. My mother and both her sisters (but her sisters were not diagnosed until they were older). I have already had genetic testing. I did the regular test, then the BART. I clearly have some genetic predisposition. I have a cousin who was diagnosed with extensive dcis shortly after my initial diagnosis. My tnbc was extensive dcis with multi-focal invasive components. My other mastectomy had various grade dcis but still very small, microscopic for the most part. Interestingly enough this invasive cancer looks to be similar to the lowest grade, most hormone sensitive dcis I had which was also 90% estrogen receptive. I did have some small comedo necrosis and high grade dcis but this isn't what became invasive. Some positive notes: although they will never say breast cancer is cured, they now believe my earlier invasive tnbc (over 6 years ago) is likely gone. They said to call Tuesday for pathology, but the node was only 1 x 1.5 cm and soft and squishy as the surgeon said. I knew it was becoming less palpable. There was scar tissue right next to the node, wasn't really expecting this but also not a huge surprise, so this must have been making the node look bigger on ultrasound. The scar tissue must have been what I was able to feel, I guess. The surgeon saw two other normal sized, normal looking nodes and assumes there may be some others as well in the "fat pad" he removed. Of course, the pathology will clarify things. But, I can't help but think a 1 x 1.5 soft node is better than a 2 x 3 palpable node. Please?

The medical oncologist said there are a few more genetic mutations (not brca 1 or 2) that have been identified since I was last diagnosed. Anyone heard of these? I will be getting these tests.

My mother died of breast cancer. I have a 9 year old daughter. I feel like I am in the middle, understanding the terror my own mother must have felt, but willing to do pretty much anything to spare my daughter from my own experience. I know I am pretty obsessive with my poking prodding, but hopefully it wasn't completely without reason!

KBeee

sorry you are facing this again. I know how hard it is to hear the news again

patriciahurtado

zayb I'm sorry!! It sucks!!!

I don't understand why can it just go away forever. I am BRCA1 and BRCA2. Now I'm just waiting!!!

Well I had my implants place in 2 months ago. Now I have 2cm lump under my armpit. I also felt a small lump right above the lump. One is hard the other one feels like a small pearl inside my skin. I don't know what to do. I went to my Oncologist and she send me for a pet scan which my insurance did not approve. My plastic surgeon wants to remove it. The doctor that had removed my tumor is no longer my doctor she moved to another. State. Now I'm not sure who to see. I'm also waiting on my oncologist to see if they approve a CT scan. I'm sick of thinking I'm sick again.