Lymph node and something else?

zayb

For the pasttwo months, I have been undergoing evaluation for a suspicious node found on ultrasound. I have already had one surgery that removed 4 nodes, one grossly enlarged, that were all cancer free. It turns out the original surgeon removed the wrong nodes and that the suspicious node is a level one node slightly lower in the chain, right beside where my breast would have been. No one can feel the node, oddly enough because it is flat. Has anyone ever heard of a node shaped this way? From their description it sounds like it is shaped something like the bottom of a hotdog bun, over three times longer than it is deep, and narrower than it is long. It was diagnosed as breast cancer by FNA biopsy (that I had before the surgery). The surgeon couldn't see anything abnormal, besides the one grossly enlarged noncancerous node and scar tissue. I am wondering if it could be a node and a cyst or something else like that to account for its odd shape. They said it had a normal vascular pattern, but that it is big (around 3 centimeters long). And even though it is right on the side axilla area, no doctors have been able to palpate it. The first place I went to said it was recurrent and used my previous invasive BC code. I had triple negative breast cancer 6.5 years ago on the other side. A little over five years ago, I had a "prophylactic" mastectomy on the other side and had microscopic dcis in three quadrants but also had good surgical margins. The new place I am going to (University of Pennsylvania) who also reviewed all my pathologies said this is a new primary, unrelated to my previous cancers. It is 90% er+ and 10% PR+ (which sounds weird to me too) and it is not high grade. They think it is isolated, especially because the lymph nodes a bit higher up in the chain were negative for cancer, but they cannot palpate any local cancer. I asked about ILC because it is flat (the node) but they said they think that if I had a local recurrence of ILC they would be able to feel it since I have had a mastectomy. I am having another surgery on October 7, no cherry picking this time, they will take every node they can find. I guess I will know then, but was just wondering if a lymph node could be in or beside a cyst or some other thing that would show up on ultrasound to account for the odd shape.

KBeee

They can never be 100% sure on shape and such from ultrasound, but surgery will definitely give a more definitive answer. Keep us posted.

zayb

So, I had my surgery last week. Haven't heard anything yet, and I don't feel like looking at my patient portal. Surgery was pretty uneventful. The surgeon actually found the node this time at least. It was very near the other, noncancerous node I had removed before. The node was shaped like a kidney bean, which I guess is consistent with the ultrasound image of long and flat. Resident said it was easily dissected and firm, not sure if there is any difference between firm and hard. No other obvious abnormalities. I asked if it was possible that I had a microscopic local breast cancer, but the surgeon said an enlarged cancerous node is unlikely for a microscopic cancer....so, what does this mean? I assume it would even be more unlikely in the absence of any local cancer, which is my situation. So, my release papers said malignant neoplasm of the breast, based on the FNA biopsy I had done at the other hospital. Is this usual even though it was a lymph node (does this count as breast?)? Original pathology showed strongly er+ 90% and weakly PR+ 10%, and her2 negativ Are the er/PR percentages typical? My dcis on the right was er+ 90% was also highly PR + at 80+%. The difference in the percentages seemed odd to me. I am still having a hard time getting a handle on this. When I was diagnosed with triple negative bc on the other side (left) 6.5 years ago it was all really obvious. My skin was red, it hurt and was really hard, even though I had no lymph node involvement and no lymphovascular invasion. This most recent thing (right) was not palpable and I haven't had a breast on that side for over 5 years. It is funny. I found out the radiologist gave it a birads 4, which i thought was pretty good given my history, said it looked abnormal/enlarged but he couldn't tell from ultrsound what made it enlarged so it needed to be biopsied. As far as I know, it doesn't match any of the microscopic in situ cancer that I had on the right side, so I can't figure out where it came from in the absence of a local recurrence/primary. The oncologist said it is really unusual to have it only in a node after a mastectomy for dcis. Oh well. At least it has been removed, hoping this is a good thing.

Edited to add: I have been looking around this site. It seems that ILC can have high er with low PR. I have been wondering about whether this could be ILC since it was flat, even though in the node. Might go over to the ILC forum to ask.

Butterfly66

Hi Zayb

omg! This sounds like my situation. I had my BC in January 2008. I had left breast masc, IDC in the left breast stage 2b. 7/24 lymph positive. Right breast DCIS. ( lumpectomy) I didn't have my nodes checked on that side. I guess ons surgeon assumed there was nothing.

I waited a year to remove right breast and do reconstruction of both at the same time. ( I wanted my skin to heal after rads on my left side,chest wall,nodes,

In October 2015, I went for my ultra sound.they saw a swollen lymph node under my right under arm. That day when I meet with my onc surgeon, he tells me he saw the film. And he didn't feel it was anything. He checked me and didn't feel anything at all. 2 weeks later I see my other onc surgeon and onc told them about the ultra sound ( at a different hospital) they both checked me and said nope nothing, see u in 6 months. Well Exactly 1 month later I get the dreaded call,it is after all cancer. In 2 lymph nodes.

Get a pet scan all clear except for 4 hot lymphs. , breast MRI can only detect 2 lymphs hot. Now the ALND, and so the actual numbers???? 16/37 !!!!!!! Damn!!!!!!

So now I started carbo/ taxol on jan 27, then taxol in between the 4 treatments of carbo/ taxol. I will be done these on March 30 and the taxol on April 13 or 14.

Onc has no idea where it came from either. He tells me I'm unusual , ( is it because he doesn't know where it came from).

I think that it came from my right side. I think that the lumpectomy was not clear margins and this sucker was dormant!!!! Oh I forgot to mention I was er+ pr+ Her2 - now he say I'm border line triple negative. I didn't know there were 3 sub groups in triple negative tumor. ????!!

So I like u, I feel like I'm in limbo, like startrek , where no onc really knows lol

Gotta laugh

Positive thought coming ur way! ))

zayb

Sorry to hear about your new diagnosis Butterfly. What a shock to find 16 positive lymph nodes! I hope the chemo does its job!!

KBeee

mine came back when it "shouldn't have" either..... In 2 spots. I think it's not always that they missed some tumor, but that it just takes one cell left behind. My second tumor was by the oath of initial vote biopsy needle, and I always have wondered if that drug a couple cancer cells with it on the way out.

Butterfly, Hoping the chemo kicks it to the curb for good

Zayb, what is their plan now? My mom had a new primary recently... Almost 24 years later. It was ILC and she also seemed to have an odd shaped node; surgeon thought it was 3 benign modes..... Nope. It was one odd shaped cancerous one

zayb

Hi KBee, hope you are doing well! Sorry your mother has a new primary. Did she have a mastectomy 24 years ago? Is her new primary only in her lymph node?

Nothing much going on here. I had surgery, did chemo, and am now on Anastrozole. So far no noticeable side effects. I have been doing lots of walking to ward off any bone or joint pain.

I am going a little nuts now though wondering about whether I should have rads. My oncologist didn't recommend it. Sometimes I can sort of see why. I am not in the same position as many people with my one positive node since I don't have a breast and hadn't had one for 5 years at the time of my diagnosis. So I think there is probably little concern about a local recurrence since I didn't have one already. I also had pretty extensive surgery when they did the revision of my mastectomy, 24x18xalmost 2 cm was removed from between my skin and chest wall plus all my level 1 and 2 lymph nodes and the surrounding fat. My one cancerous lymph node was big but had no extra capsular extension.

I am just really confused about the studies on radiation. The studies from 1960s - early 1980s seem to conclude that radiation is good for any number of positive nodes. 12 fewer recurrences per 100 people and 8 fewer deaths per 100 with radiation than without. This just seems almost impossible. It also seems to be saying that radiation is a greater benefit for people with fewer nodes, a 32% difference as opposed to a 20% difference. It makes me wonder how many women had recurrences if the difference was that great!

Given what I was told combined with the results of the 1960s-1980s study, adding radiation would bring my risk of recurrence to practically 0, which seems impossible. Another study available here on this site says that in the group of women who had a mastectomy and no radiation, 2.1% of the women with 0 positive lymph nodes had a recurrence (I assume they mean a local recurrence) and only 3.3 with one positive node had a recurrence at 10 years. This seems so much different than what the previous study concludes about radiation.

Are there more newer studies about the need for radiation?

KBeee

ZayB, My mom had a unilateral mastectomy in 1992. She had a new primary this year. It was in the breast and lymph node on the other side.

So glad to hear you are doing well on Anostrozole. I've been walking or running every day too!

Radiation is a hard one. Hard to know if it's beneficial for you or not. I would perhaps get multiple opinions and weigh the pros and cons. I really had not choice and knew it, so I did it this time around since I already had mastectomy last time. Once you get some opinions, make the best decision for YOU and then just do not look back.

Butterfly66

thanks KBEE. I'm doing well at the gym every day between treatments. I

I find the studies are ........ No doctor can predict what will happen. I truly believe that every woman every bc cancer is unique. You can't predict how ones persons body will respond to chemo,rads,hormonal therapy.

I think that's why most doctors cannot give you concrete answers.

)

funthing42

Hi everyone,

Thanks Kbeee for talking to me early in other forum.

I'm trying to seek out similar dx's.

I've had breast cancer 4x. Each time the Her 2 switching on and off.

All times except the last node neg.

Anyways CA was on the right only. B/l mx.

It came back locally in the skin after mx. Rt.

I had Rads x2.

So this last time onc said markers went up.

Pet scan revealed nodes under my axilla on the left side.

Her 2 positive. I told even though pets and MRI's from head to toe all neg except nodes.

Please help with any insight I'm exhausted.

I have not had any remission. Except the 4 years after Lumpectomy and Rads.