Annual Update / Possible Bump in the Road?

Well ladies, I am now 13 years out from my first BC dx - stage 2A IDC of right breast and just over 7.5 years out from my second BC dx - stage 3C ILC of the left breast.  I have been blessed with NED all this time and life has been good.  I don't spend as much time on these boards as I used to but do check in from time to time.  I usually give an update here each year after my annual CT scan and visit with my oncologist.  I had my CT of chest/abd/pelvis one week ago and met with my oncologist yesterday.

Labworks are all normal including my Ca27:29 which is 36.  The CT scan found much the same as it does every year, including old granulomatous disease in the lungs and spleen (a result of living in the Midwest all my life with Histoplasmosis), minimal chronic parenchymal changes in the upper lobes post radiation tx, a persistent right adrenal nodule that never changes and some mild fatty infiltration of the liver.  These conditions have all been present for many years and considered benign.

The CT also reports a new finding which at this time is of uncertain significance.  I have a "1.1cm Pretracheal lymph node which is slightly larger than the previous study (2012) at which time it measured 8mm".  I learned from my oncologist yesterday that radiologists rarely report lymph nodes specifically until they reach the 1.0cm size.  At that time their radar goes up and they start paying more attention to the surrounding area of the suspect node.  The Pretracheal nodes are at the front side of the trachea, below the sternum and within the Superior Mediastinum which is the uppermost part of the chest cavity.  Within this area is the trachea, esophagus, major blood vessels such as the Aorta, Superior Vena Cava, Pulmonary Artery, Laryngeal nerves etc.. It is a small compartment in the upper chest and somewhat difficult to navigate for nodal biopsy.

Because the current 1.1cm node is too small to be reliably picked up by PET scan and there are no other indications of enlarged nodes anywhere else on CT, along with the lack of symptoms and normal labs, we have decided to repeat the Chest CT in 6 months. It took 12 months for the node to gain 3mm in size. If in 6 months the node has grown in size to at least 1.5cm, then a PET scan will be done.  If there is increased uptake in that nodal area, I will most likely be scheduled for a Mediastinoscopy with biopsy either by a pulmonologist or thoracic surgeon. It is not a procedure I would wish to have but is supposedly the "gold standard" for gaining biopsy samples of mediastinal nodes.

Of course, I am hoping this slightly enlarged node is due to some other transient infection or immune response and will be no larger or maybe even smaller in 6 months.  I did have an active eye infection with orbital swelling at the time of the CT scan and my oncologist suggested that could be reason enough for a small enlargement. (whether she said that to make me feel better or because it is a possible cause I don't really know). 

Either way, barring any new symptoms, I am willing to wait the 6 months if it assures a more accurate diagnosis of what is actually going on.  Given my advanced local nodal involvement at the time of my bilateral mastectomy in 2005, the concern is breast cancer mets of course.  I am not prepared to go there just yet, but I have no illusions as to my recurrence risk.

So this may not be exactly my usual positive and “still NED” annual update, but I am not yet conceding otherwise.  Time will tell, but for now nothing has changed other than the acute awareness that even when life is good, cancer has a way of pulling us back to that scary place.  Whether it turns out to be just a scare or a new path my life is about to take, all I can do is make the most of this moment, today….and tomorrow will take care of itself.  Thanks for listening.  If anyone has had a similar experience with mediastinal nodes I would be interested in hearing your story.