Cancerous Cells

[Dulin]

Sir: When a lump is discovered, why don't they do a bone and cat scan to see if the cancer has spread.  If not, radiate the breast and lymph node area before a lumpectomy or mastectomy to make sure if there are cancerous cells they don't escape? Wouldn't the radiation kill all the cancer cells if there are any?  I for one believe cells escape during surgery. The Oncology nurse at the hospital said it was like opening up a can of worms.  I had a lump for many years, and was told it was nothing.  I had scans for other reasons and nothing ever showed up until I had a mastectomy, 3 months later it showed up in the distal femur.  I believe my cancer was contained in the lymph nodes until I had the surgery? Is it possible for just one cell to escape, like to the femur, have it radiated and the cancer may never show up anywhere else ever again? Or is it too late once it's out in your system?  Sorry for all the questions but I'm just looking for something positive. I had 11 positive nodes and cannot do chemo due to other medical conditions. I do take Femara and Zometa for the bones.  Thank you.

[CCF-RN,MSN-rf]

Dear Dulin:  When a lump is discovered it is premature to do scans.  The first step is to see if the lump is cancerous.  Radiation is not usually done before surgery because it can interfere with the tissue and make the surgical healing process difficult.  While it is theoretically possible that surgery could release cells into circulation, research shows that when cancers are removed in a contained manner, this is not usually the case.  The fact that there are cells in the lymph nodes indicates that there is spread - the lymph nodes are part of a system by which fluid circulates throughout the body.  Most cells were filtered out in the lymph nodes by the breast but it is more likely that there were already cells in the lymphatic system.  This is why systemic therapy (such as chemotherapy or hormone therapy) is recommended - to try to rid the body of these circulating cells.  Radiation, a local treatment, would only prolong the ability to treat the whole body.  While it is possible that your femur may be radiated and you have little or no further problem, it is more likely that the diseae, at some point, will resurface because cells are living outside the breast.

[surgeon]

You can't diagnose cancer without removing at least some of it: so everyone with cancer has had to start with some sort of surgery or manipulation of the tumor. Which means that everyone who's been cured of cancer has also had the very same manipulation at the beginning of the process. So removing it or biopsying it is NOT what makes it spread. It's not like opening a can of worms, no matter what that nurse said. The bottom line is this: cancer is discovered in a person at some point. If, when it's discovered, it hasn't spread yet, then there's a good chance of cure. If it had already spread at discovery, then the chances of cure are much less. A tumor that was in 11 nodes had spread out of the breast probably months before discovery. Theoretically, only one cancer cell could spread at the time of discovery, and removing the resulting area of spread could lead to cure. Under certain circumstances, the spread tumors are removed surgically, and can lead to long-term survival. As to what tests to do, at what time: with breast cancer, if it's small, and it isn't in lymph nodes, then very often chemo isn't used. So extra testing usually waits until the nodes are checked, thus saving lots of tests and lots of money in those whose nodes turn out ok. How we treat any cancer is based on years of trying various things and comparing results. It's been shown that doing those tests in everyone as soon as the tumor is diagnosed hasn't led to meaningful changes in treatment or cure. So that's why it's done in the sequence it's done, currently. Things change as new treatments or tests are developed.

[surgeon]

I should have added that radiating the femur could indeed control things for a long time; it can certainly make sense to do it under some circumstances.

[Dulin]

I want to thank you for your answer.  I know they don't want to do unnecessary treatments,like radiation for no reason,  but I still wanted to know if radiation to those areas would kill cancer cells if indeed there are any before doing any type of surgery?  They could biopsy the area before a mastectomy to see if there is cancer?  Just a thought.  This whole situation is very hard to deal with.

[SydsMom]

My sister just had a biopsy, she had a cluster of what looked like calcium deposits.  She was told that she had a couple of cancerous cells, but no lumps.  Will the treatment be the same as if she had lumps?  Is this considered breast cancer?

[SydsMom]

My sister just had a biopsy, she had a cluster of what looked like calcium deposits.  She was told that she had a couple of cancerous cells, but no lumps.  Will the treatment be the same as if she had lumps?  Is this considered breast cancer?