lymph node recurrance

I am 45 years old.  diagnosed at 38 with breast cance.  Had mastectomy & chem.  Had recurrance in the lymph node on collarbone 4 years later.  had chemo & stem cell transplant & radiation.  now the doctor see enlarged lymph node near heart (3 years later).  What are possible treatments?  Can a biopsey be done on a lymph node by the heart?  Can a lymph node be swollen due to other medical condition (tooth infection for example)?

[CCF-RN,MSN-JS]

Dear Petrina, There can be different reasons for lymph nodes to be enlarged and it does not necessarily have to indicate recurrence of cancer.  The way to be sure would be to biopsy this lymphnode.  The location of the lymph node may make a biopsy of it tricky, so if it was felt to be necessary a cardiothoracic surgeon would most likely be asked to do it.  Having said that, if it could not be biopsied without undue risk, and the degree of suspicion that this was a recurrence was high enough there may be a recommendation for proceeding with treatment without a biopsy, or continued close observation of the node.  

Depending on the treatments you've had before would determine what would be recommended, most likely it would be chemotherapy.  There are various drugs or combinations of drugs that have been used with success in terms of controlling breast cancer.  The goal of treatment of breast cancer that has recurred or metastasized is control of the disease, and to decrease or postpone the occurrence of cancer related symptoms.