Like a punch in the gut

songbird72

So Tuesday I went in to see my onc for my one month follow-up from the end of chemo. He asked me if the rad onc had talked to me about my planning CT they did for radiation. Apparently I have a prominent lymph node in the AP window that may be enlarged. My pre=chemo CT report in Jan mentioned nothing of that. He reassured me that there was nothing to worry about but he was going to have the films of both CT's pulled and have them compared (they were read by different people). I have been in free-fall ever since then. Plus, since doing some research online I've learned that a central tumor (mine was in the 12 o'clock position of my breast) has a greater chance for metastases to the internal mammory and mediastinal lymph nodes.

They should have the CT scans read by tomorrow or Monday and I go back to the oncologist Tuesday to start my hormone therapy. I'm doing pretty good not thinking about it but I have my moments. Thank you all for letting me vent. It's amazing how things can set us in a tailspin isn't it?

KBeee

Hate that you have this worry. Keep us posted.

Beatmon

So very sorry that you are faced with this. Fingers crossed and praying for good results when the ct scans are compared. Anyone would be in a "tailspin" Good way to phrase it!.

LisaAlissa

"Plus, since doing some research online I've learned that a central tumor (mine was in the 12 o'clock position of my breast) has a greater chance for metastases to the internal mammory and mediastinal lymph nodes. "

Hi Songbird!

I suspect you should check with your docs before you worry too much about what you've found in your online research. Here's why: The internal mammory lymphnodes are located under your sternum or breast bone (that is, between your breasts). The mediastinal lymph nodes are located between your lungs (also in the center line of your body.

But the tumor description of a BC tumor is based on the clock (where 12 o'clock is straight up.) A "central tumor" on the right breast would be described as being at 3 o'clock and on the left breast would be described as being at 9 o'clock.

Take a look at the second page of "this governent coding manual for breasts" for an illustration showing the clocks as they are applied to the breasts.

HTH,

LisaAlissa

Kessa619

Hi, LisaAlissa. I am confused. My tumor is described as 2.5 centimeters posterior to the nipple at 6:30. Is that not the definition of central? If not, what quadrant is it considered to be? What quadrant is the tumor that is at 12 o'clock and/or 6 o'clock?

Thanks for any input.

LisaAlissa

Hi Kessa,

As I said to Songbird, I'd encourage you to check with your docs, before you spend time worrying about this. I don't know what studies Songbird found in her on-line research. We all know that "Dr. Google" is often a "quack." (What she found might be faulty, outdated/superceded by newer studies or simply not applicable.)

And using definitions from one source to try to interpret the applicability of something else is often a recipe for confusion and misunderstanding. For example, a "central tumor" as described in the research she found (which talks about mets to lymph nodes that are on the center line of the body--beneath the sternum & between the lungs), may or may not be talking about the clock-based location description of BC tumors. It could easily be talking about tumors on the central line of the body...which would be something else entirely (the 9 o'clock (left breast) & 3 o'clock (right breast) positions I mentioned in my earlier post.

When Songbird said her tumor was "at 12 o-clock," I simply noted that that wouldn't be close to the center of the body (over the lymph nodes mentioned). So not to start worrying until/unless her doc tells her that the particular research has application to her situation.

If you take a look at the diagram/image on page 2 of the link I included in my last post, you'll see a diagram which shows how breast locations are described.

HTH,

LisaAlissa

Kessa619

I am a pretty discerning reader and I am not getting carried away on the internet. I just want to confirm my understanding that my tumor is located in the center (as opposed to one of the four quadrants). Your earlier statement was that center is 3 o'clock on the right breast. However, I was given to believe mine was in the center although it was described as 6:30, 2.5 cm posterior to the nipple on my MRI report.

I will confirm with doctor when I see him next month, but in the meatime. . . The diagram does not help me. Does anyone know for sure?

Thanks.

LisaAlissa

You may be right, as a discerning reader. However if someone is referring to the "center" while talking about the lymph nodes Songbird was talking about (beneath the sternum/between the lungs), they are talking about the centerline of the body.

If you're talking about center of the breast, you're talking about a "bullseye" on the nipple. Which is not in the center of the body.

So a discussion about a tumor in the "center" being more likely to have mets to the lymphnodes (which are on the mid-line center) is quite likely mixing apples & oranges when using the term "center."

Which is why I suggested discussing with your doctor, and not worrying about it in the meantime.

BTW, as Songbird is going back to see her doc, worrying about what may (or may not) be found by her doc will only make her miserable, without accomplishing anything. Why give up the joy of today to borrow trouble that may not be yours at some point in the future?

Best wishes,

LisaAlissa

wintersocks

LisaAlissa,

I do think that diagram is really useful. I was trying to work out the site of the tumour I had and this shows it very well. Your explanations are very understandable too.

Kessa619

Oh gosh, I am not disparaging the diagram or LisaAlissa's explanations. My tumor - at 6:30 - isn't specifically on the diagram. And LisaAlissa said that the center of the breast is considered at 3 o'clock on the right and 9 on the left. Some research seems to indicate that inner quadrant tumors (and possibly central tumors?) may drain to internal lymphatics instead of or in addition to axillary. The research I have seen is about center or quadrant of breast, not midline of body. I just wanted to know where my tumor is located because LisaAlissa's statement contradicted my understanding. I find that often I have to advocate with my doctors, alerting them to stuff that may apply to me. I am in no way suggesting that people worry needlessly, just that they have the necessary information to have important conversations. Isn't that one of the goals of these discussion pages? I definitely meant no offense to anyone.

Songbird, my initial CT scan showed a potentially enlarged lymph node in my contralateral axillary. The accompanying PET scan did not light up. So, the lymph node was dismissed as nothing to worry about. I hope your issue is resolved quickly and favorably. None of us wants to worry. Unfortunately, these issues seem to come along snd throw us for a loop. Hope you are getting the support that you need from this site.

songbird72

Thanks for the encouragement guys. I talked to the office yesterday and the radiologist said it was hard to compare the two scans because one was with contrast and one was without. The radiologist suggested another CT scan with contrast. The nurses hadn't discussed it with the doctor yet. I go back to my onc Tuesday to start my hormone therapy so we will have a discussion then. He doesn't seem too concerned but then it's not his future. I do love my onc--I don't mean to imply that. He is great and I trust him.

Also, when I got the copy of my report, it said that it was borderline adenopathy but there was nothing else to suggest ademopathy. I hope I'm concerned over nothing!

songbird72

And if I'm reading your diagram right, then my tumor was split between the UIQ and the UOQ. It was right above the nipple. It is noted as the 12 o'clock position on reports. I did not look into the possibility of what they considered as central tumors but most of the articles I read clarified that they were talking about the middle of the breast saying middle or central.