Imaging Tests

Szucs

Is there one imaging test that is the go to test for seeing if cancer has spread? I would have assumed that if an individual is confirmed as to having breast cancer, they would automatically do "the works," or "pull out the big guns" to determine what else may be going on. Unfortunately, this doesn't seem to be the case.

Larkin

Pet/CT would be the definitive test. If lymph nodes aren't involved and there are no suspicious symptoms, this would probably not be done in early stage disease. These tests use radioactive materials and should not be used if not needed. They are also very expensive even with insurance.Breast cancer cannot kill if it is confined to the breast. And lymph node involvement near the breast does not equal metastatic disease. Metastatic disease means breast cancer has spread to distant areas such as bones, liver, lungs and brain.

Szucs

8.9.2018: Primary Doctor

Right breast: a 2 cm, mobile, solid mass palpable right breast around 2 o'clock. Non tender. No erythema.

8.22.2018: Surgeon

RIGHT BREAST: Breast is free of nipple abnormalities; she has a dominant mass at the 2 oclock position measuring 2 cm; Mobile, and not fixed to chest wall. It is adherent to the overlying skin with erythema and early development of an ulcer. axillary and supraclavicular areas are unremarkable. Lymph nodes: no palpable supraclavicular or axillary adenopathy

LEFT BREAST: Breast is free of skin and nipple abnormalities; there is no dominant masses palpable. Diffuse nodularity with fibrocystic changes. Axillary and supraclavicular areas are unremarkable.

Lymph nodes: no palpable supraclavicular or axillary adenopathy

Assessment: Right breast invasive cancer.

9.21.2018: Surgeon

Pre-op for lumpectomy: EKG was taken and something wasn't quite right. They admitted her to the hospital, did a chest CT. Came home the following day and lumpectomy postponed.

9.28.2018: Surgeon

Chief Complaint: Known breast cancer, new skin nodule in left lower quadrant of abdomen

History of Present Illness: 90 year old woman with known right breast cancer. She was undergoing the pre-operative process when she was found to have large lung nodules/masses. About 2 weeks ago, she also noted a skin nodule in the left lower quadrant of the abdomen.

General appearance: alert, well appearing, and in no distress.

Abdomen: There is an approximately 2 cm nodule in the skin of the left lower quadrant. Hard and fixed to the skin

Impression: Skin nodule, likely metastatic disease

Plan: If the planned supraclavicular lymph node biopsy is non-diagnostic, can consider excision of this skin lesion

So as of right now, she is scheduled for an appointment on October 3, 2018 to biopsy lymph node(s).

The surgeon told her that he thinks it's lung cancer. I am her grandson, and I am starting to get very frustrated. Why can't they get to the bottom of this? Is it lung cancer or stage IV breast that has spread to the lungs? Breast cancer and lung cancer?

Why did her weight loss not trigger some further investigating? For probably more than two years she has had persistent Difficulty swallowing, coughing, always says she "has a cold."

7/16/2016 - 134 lb 7.7 oz (61 kg)
11/09/2016 - 132 lb 15 oz (60.3 kg)
2/20/17 - 129 lb 3 oz (58.6 kg) - upper res tract infection
4/6/2017 - 126 lb 8.7 oz (57.4 kg)
4/24/2017 - 123 lb 14.4 oz (56.2 kg) - DYSPHAGIA (DIFFICULTY SWALLOWING) - Primary
8/31/2017 - 113 lb 12.1 oz (51.6 kg)
1/17/2018 - 109 lb 2 oz (49.5 kg)

6 months and eleven days: 16 pounds in weight loss / 12.4% in unintentional weight loss within 6 months

Larkin

What a lucky woman to have a grandchild willing to advocate and support her. You clearly care deeply and want to help her. Why was her weight loss ignored? Bottom line, in my opinion, ageism and sexism.

As far as her diagnosis goes, unfortunately this is a typical protocol in systematically figuring things out. Was she a smoker or spouse to a smoker? Not that smoking is the only cause of lung cancer but if the answer is yes, my guess would be lung cancer spread to the skin nodule. Breast cancer finding unrelated.

If it is breast cancer spread to the lungs, the final diagnosis is no different. Either way, she has a metastatic cancer which is treatable but not curable. The weight loss is a grave indicator as I’m sure I don’t need to tell you. Has her weight stayed at 109 since January?

As much as I’m sure you want her to have more scans, the surgical biopsy sent to the lab is the only thing that will tell you for sure what you are dealing with. A scan can tell you it sees something highly likely to be cancer but a biopsy can tell you so much more.

I hope by the end of this coming week you will have answers and treatment options. Do keep in mind how she wishes to proceed. Honor what she wants even if you don’t agree. And don’t be afraid to speak up on her behalf or ask for the hospital ombudsman if you believe she is being ignored or neglected in any way