cancer in lymph nodes

When I talked to you last, I appreciated your response as far as the questions we needed to ask the surgeon regarding my mother-in-law's breast cancer(infiltrating ductal carcinoma).  Since then, she had a lumpectomy that removed a tumor less than 2cm in her left breast.  The doctor said he also got some good clean margins.  At that time, he also removed 10 lymph nodes that he said were very small.  Two of these tested positive for cancer.  When the doctor gave her the report on the lymph nodes, no one was with her and she told us that he said two of the lymph nodes had "tumors" in them.  Do you think she misunderstood him and he may have just said cancer "cells"?  Is there a difference?  She has been referred to an oncologist - but he can't see her until the end of April.  What is the usual course for chemo in this case?  What stage is the cancer of this size?  Also, what is the prognosis?  Also, isn't it unreasonable for her to have to wait this long for the oncologist?  Thanks so much for all of your help.

[CCF-RN,MSN-JS]

Dear neatfreakmom, When the lymph nodes are checked under the microscope they are looking for cancer.  Whether referred to as tumors or cells it is basically saying the same thing - that cancer was found in two of the lymph nodes.  Based on the above information your mother's disease would be staged at stage IIa,  which is described as a tumor less than 2cm, and positive lymphnodes under the arm.  Standard chemotherapies are usually given as a combination of drugs.  The actual combination will depend on your mother's overall health, cardiac status.  The idea of adjuvant chemotherapy being given before radiation therapy is to treat any possible microscopic spread of the cancer.  When this is complete usually over about 4 months, then radiation therapy will commence.  Depending on the estrogen receptor status of the tumor will determine if hormone therapy will be recommended.  
All of this will be discussed with the oncologist and the specifics as it relates to your mother.  As to the timing, starting of chemotherapy usually happens after recovery from the surgery, about 4 weeks.  The prognosis for a person with stage IIa breast cancer can be very good, this depends on the control of tumor cells that may have spread (based on positive lymph nodes).