Chest node affected and treatment w/Tamox?

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slmdavidson
slmdavidson Member Posts: 127
edited June 2014 in Second or Third Breast Cancer

I had a PET scan a week ago as a precaution and it turned up a hot lymph node under my breast bone.  I had 5 clean LN removed during my last surgery in Jan when I was diagnosed with IDC.  This comes 15 months after bilat mastectomy for DCIS (back in 2007).

Anyway - was curious to see if anyone else had lymph nodes affected in the middle of the chest?  They say they aren't going to remove it, can't do radiation, and chemo isn't effective for ER+ cancer.  They will start me on tamoxifen as soon as I finish radiation and then recheck with a CT scan in 6-8weeks to see if it's changed.  I just hadn't heard about Tamoxifen being used as treatment for breast cancer. I always thought of it as a preventative measure? 

Thanks
Laura

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  • tos
    tos Member Posts: 376
    edited March 2009

    Hi Laura,

    I'm so sorry this has happened and I wish I could help you.

    If you have any doubts whatsoever on your Onc's treatment plan than please seek a second opinion for your peace of mind.

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  • mom_of_2
    mom_of_2 Member Posts: 347
    edited March 2009

    Don't quote me on this because I had IDC and DCIS but I believe I have read where Tamoxifen is used for BRAC positive patients who have not been diagnosed with BC as a possible preventative. 

    I am taking Tamox for 5 years post chemo and bi lateral as continuing treatment. Cancer is gone but need to follow thru.

    So sorry and hoping for a clean CT scan for you.

    Kris 

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  • nash
    nash Member Posts: 2,600
    edited March 2009

    Laura, hormone therapy is used to treat active cancer, not just as a preventative measure. There are plenty of women over on the Recurrence and Metastatic Disease board who are on HT as a first line therapy for their mets.

    The nurse is incorrect in stating that chemo is not effective against ER+ cancer. Plenty of hormone positive women have a good response to chemo. There is some debate if it works for all hormone positive women, and that's why there is now a trend towards trying HT before moving on to chemo.

    Going on Tamoxifen and rescanning in a couple of months is a reasonable approach to treating you. If the Tamoxifen doesn't work, they may want to try an AI like Femara or Arimidex (if you're premenopausal, they will have to suppress your ovaries with Lupron to make the AI work). If no forms of HT work, then you would move on to chemo.

    Hope that helps a bit.

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  • slmdavidson
    slmdavidson Member Posts: 127
    edited March 2009

    Thanks Nash - that helps.  I sort of figured if the Tamox didn't show some response on that follow up scan in 6-8 weeks, they'd move on to something else.  I just keep getting the question why I'm not doing chemo from other breast cancer survivors with similar pathology and ER status.  I was just wondering if this is a new approach?  My Oncologist, Dr. Sledge is somewhat of a pioneer.  He helped the study that showed lumpectomy was just as effective as mastectomies so maybe he's finally on to something where we won't need to treat so many women with chemo???  I may go ahead and get a second opinion.

    Laura

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  • TenderIsOurMight
    TenderIsOurMight Member Posts: 4,493
    edited March 2009

    Hi Laura,

    Dr. Sledge, as in George Sledge? Indiana U?. Yes, a pioneer is a good adjective, and very well respected in the oncology community. He gave the Brinker lecture at the San Antonio meeting several years ago and it was fascinating (watched video on line and posted about it on this forum). He's a strong advocate for continued large numbered clinical trials (and funding!) to obtain proper statistical relevance, a need which again showed it's face in the hormonal sequential data of the BIG I-98 trial recently (too few in each arm).

    With limited distant disease (lymph node) and no symptoms, blood marker alterations etc, many oncologists work first with a hormonal in met ER+ states (along with rads in your situation). This allows chemotherapy to be utilized if and when hormonals fail.

    Might I ask if any trials have been discussed with you? I'm wondering if there is one with a hormonal like Tamoxifen or an aromatase inhibitor and the blood vessel cell growth inhibitor Avastin? Then too, Dr. Sledge might feel this is overly aggressive at this point.

    I'm sorry that dang node lit up. Sounds like your on a great plan with the Rads and hormonals. And I can say with confidence you have a great doctor.

    My best to you,

    Tender 

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  • JacquelineG
    JacquelineG Member Posts: 282
    edited March 2009

    Hi Laura,

    I just wanted to let you know, I had an IM node positive too. It lit up w/ the PET Scan. I did have chemo, though I also had 6 axillary nodes positive, so obviously a different situation (and Stage) than yours. BUT they did do a PET scan after chemo and before rads, and the node was no longer there (no signs of cancer) so obviously chemo was effective on it. I also had 25 rounds of rads, which included that IM chain of nodes, more as insurance than anything else. I am ER+ as well, and am on Tamoxifen now. Anyway, sounds like you are in good hands, but keep asking all those questions until they are answered in your mind! If in any doubt, get second opinions. I really like and respect my onc but I have another oncologist who I've been faxing all my info too to make sure he's agreed with the treatment decisions... it does give me more peace of mind.

    Had you had a PET scan before, when treated for DCIS, or was this your first one? I noticed you said 'no radiation' first but then you mention they'll scan you again after rads -- did they change their mind on whether to do rads? If so, just wanted to let you know that my radiation oncologist was confident that if chemo didn't take care of that IM node, rads would obliterate it!

    Wishing you all the best!

    Jackie

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  • slmdavidson
    slmdavidson Member Posts: 127
    edited March 2009

    Hi Tender and Jackie

    Thanks for your posts.  Yes, I'm seeing George Sledge of IU Med center.  I agree a great doctor and so well respected.  The downside to that is he travels extensively so it's difficult to talk to him.  In fact the PET scan results and interpretation of my staging (which was a communication snafu) was done by his nurse.  I won't even see him for two more weeks....which I am finding frustrating, as much as I love him.  I did get a second opinion and that doctor also works with Sledge and felt confident that the info was possibly relayed as more serious than he suspects. 

    Jackie - The first PET-CT scan I had was this recent one a few weeks ago which followed my recurrent invasive breast diagnosis in Jan.  I am half-way through my radiation treatments as of today.  Back in 2007 when I was first diagnosed with DCIS, I had no scans or radiation. Also, according to my radiation oncologist who reviewed the PET-CT pictures, the node in question is not directly under the sternum, it is deeper within the chest, which makes her more convinced it may not be related at all to the breast cancer.  I don't believe she could get to it with radiation with where it is.  They will do anohter scan after I start Tamoxifen and if it gets bigger, they will biopsy it.  If it goes away, hurray! 

    Thanks

    Laura

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  • JacquelineG
    JacquelineG Member Posts: 282
    edited March 2009

    Hey Laura,

     Sounds good -- hopefully the Tamoxifen will work and that pesky node will go away!

    I know what you mean about having a great doctor but not being able to talk to them as often as you'd like. My BS is that way - very well known in the BC field, but just not that accessible since he oversees a bunch of clinical trials and travels all the time. At least you know you are in GREAT hands!

    All the best,

    Jackie

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