Is it a local recurrence or chest wall recurrence?

netty46
netty46 Member Posts: 296
edited June 2014 in Just Diagnosed With a Recurrence or Metastasis

Does anyone know if after having a masectomy and then the cancer comes back to same breast do youhave chestwall recurrence or local recurrence?

Back to the lymph nodes I understand is called Regional recurrence.

Has anyones doctor explained this too them?

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  • sueinfl
    sueinfl Member Posts: 258
    edited April 2013

    Hi Netty,

    I will try and remember to ask my doc when I see him in two weeks. I had two masses removed from my left reconstructed breast and armpit last Monday which were positive for PILC along with the skeletal muscle. I was too shocked to ask which skeletal muscle and where...

    Next up are PET and MRI scans with an intake appointment at MD Anderson in Orlando.  Just one adventure after another...

    Sue

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  • makinghay13
    makinghay13 Member Posts: 4
    edited June 2013

    Not diagnosed with recurrence just found out breast surgeon sees nodule in ultra sound of masectomy area and wants to do biopsy. Was told when I had ultra sound it looked clear puzzled.

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  • bdavis
    bdavis Member Posts: 6,201
    edited June 2013

    Its interesting... I had an appt with my local BS this past week... she had once said to me that if I had a recurrance it would not be on the chest wall, but by the skin. This week I asked her to clear that up for me.... She said that during MX, they take all tissue and into the fascia , so there is nothing left at the chest wall... But its harder to get it all by the skin. So recurrances are most likely on the surface and into the nodes. So its interests me to hear about any chest wall activity.

    Sue... the skeletal muscle? I don't get it. How it is in the muscle?

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  • Beesie
    Beesie Member Posts: 12,240
    edited June 2013

    netty, my understanding is that a local recurrence after a MX can happen either against the chest wall (i.e. the front side of the chest wall, where a few scrapings of breast tissue might remain) or against the skin (again where there might remain a few breast tissue cells). 

    If the local invasion moves into the chest wall, then it has spread from being strictly local to being chest wall. Similarly, some of the cells from the local invasion could move into the nodes, and then the recurrence becomes regional.  But if the cells start out in front of the chest wall and in the tiny amount of breast tissue that remains, it's local.  From there, just as with any IDC, it can spread.

    Betsy, what your BS said makes sense but my understanding is that the fascia is not removed in all MXs, particularly if the cancer appears to be nowhere near the chest wall.

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  • She
    She Member Posts: 503
    edited June 2013

    A CWR is considered a local recurrence. Beesie is correct, the fascia isn't always removed with mx, and if it is, margins aren't always clear. A mx doesn't guarantee removal of all breast tissue.



    Here's where it can get confusing. Local CWR are staged in the III's unless the skeletal muscle (pectoral) is involved. It's still a local recurrence but because there is involvement outside of any remaining breast tissue, it is metastatic and Stage IV.



    The anecdotal references all over the Internet refer only to regional recurrence as Stage IV but this isn't correct.

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  • Beesie
    Beesie Member Posts: 12,240
    edited June 2013

    She, that's really interesting.  Good information!

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  • She
    She Member Posts: 503
    edited June 2013

    Thanks Beesie, wish I wasn't living it....

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  • netty46
    netty46 Member Posts: 296
    edited June 2013

    Beesie,

    Bone scan clarified the part of pectoralis, sternum, ribs etc.  Further clarified at surgery when she checked each part ribs, sternum and pectoralis again. It was clear. Nodes were clear also.

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  • bdavis
    bdavis Member Posts: 6,201
    edited June 2013

    So how does one know if the fascia was removed during MX? The bs who I spoke with wasn't the one who did the mx

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  • coraleliz
    coraleliz Member Posts: 1,523
    edited June 2013

    You can request your operative report. My clearly mentions removing the fascia. Other interesting stuff also.

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  • bdavis
    bdavis Member Posts: 6,201
    edited June 2013

    I now realize I only have the operative report for the recon portion, even though it was one surgery.

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  • netty46
    netty46 Member Posts: 296
    edited June 2013

    Bdavis

    On the surgical report for reconstruction if MX was done at same time it should state that whole procedure then state the reconstruction part. Hence thats how  it was found out that Bernard Chang never did. So suprise 12 yrs later breast cancer in the same breast. After meeting with a surgeon here in Florida and he reviwed report he was the one who discovered Chang placed flap on all that tissue.

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  • bdavis
    bdavis Member Posts: 6,201
    edited June 2013

    SO in your case, is the BS or PS at fault? Or both? I would say both. Thanks for bringing this up as its a great topic. My local BS says she ALWAYS  takes the fascia. But she wasn't the one who did my MX. So I have emailed the doctor's office and will actually be there in a couple of weeks, so I will get to the bottom of my procedure. I looked at the operative report and it doesn't have the MX portion on it. It starts with "once the MX was completed..."

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  • mimi6464-2
    mimi6464-2 Member Posts: 2
    edited June 2013

    I also had my CAT come back with 2 chest wall nodules; 1= 7mm, 2= 9mm.  My CAT was done for a different cancer opinion, Vulvar Cancer.  Late 2011 i was diagnosed with invasive vulva cancer and under went a modified radical vulvectomy (no lymph's down there).  I had a CAT right after and it showed a (one) 7mm nodule on chest wall.  By this time, I was 3 1/2 years out from my double mast for IDC right, proph left.  SO I got my CAT results as I was heading in for a ' clean-up ' surgery again on my vagina (or what was left).  These vulvectomy's are a long healing compared to my double mast.  Forgot about the nodule on the chest wall, understandably.  Mid 2012, they wanted to do another 'clean-up' down there, said I needed a vagina break, so they put me on 6 months, 3X's a week chemo.  Had to quit (take a break) 4 times.  So I just had another CAT, and this is where I now have the 2 chest wall nodules.  Went and saw my BS and brought up the CAT results, but he seemed more interested in my downstairs cancer than my chest.  Now I'm upset.  Could these be a recourrence?  They are growing, and multiplying.  Even my PCP can feel them during her breast/chest self exam of me, so do I.  I am just concerned as I had 19 lymph's removed from that side.  And no, I threw away my tomoxifin, and is it not recommended for DES daughters.  Has anyone else had chest wall nodules and it turned out to be nothing?  Should my BS have at the least donw a fine needle asspiration of them?  Trying to deal with mulitple cancers can get confusing.   Thanks if anyone cane give an answer.  I have been on this site since 2006, yet do to internet providers/email password change, they made me start a-new.  I was originally mimi6464, now mimi6464-2.   

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  • netty46
    netty46 Member Posts: 296
    edited June 2013

    MiMi its my understanding that the Cat Scan can tell wether its cancer or not.  Request and MRI to verify with contrast. Also request CTC blood test.

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