petscan, ct scan

Last March I was diagnosed with stage 2 breast cancer, with 3 tumors in my left side, the biggest being 4 cm. I had a mastectomy, clean margins, nothing in the nodes, and did chemo from April 26th to July 1st. Last week I had a tumor marker test done (came back at 56) so I was sent for a petscan. This showed something in my abdomin (abdomen) and chest that concerned the pathologist. I had a ct scan last Friday and we find out more today. That's all we know. We weren't told where in the chest or abdomin (abdomen), size, etc. I am 29 with no history of breast cancer in my family. How could this have spread if margins were clean and nothing in the nodes? Anything else you can offer me would be helpful. Thank you.

[CCF-RN,MSN-JS]

Dear BriteHope, Knowing the stage of the disease initially, and features such as the size of the tumor, give us an idea as to the risk that a cell may have broken away from the main tumor to migrate to another area of the body.  With a large tumor there is more of a possibility of that so adjuvant treatment with the chemotherapy is done after surgery to hopefully kill any cells that may have migrated prior to surgery.  Neither tumor markers nor PET scans are specific to identifying metastases.  The ct scan will shed more light on the situation.

[surgeon]

Tumor markers are not very accurate in revealing recurrance. It may or may not mean something. Many doctors don't use markers for surveillance because of their inaccuracy, leading to lots of tests that ultimatlely end up ok. However, it's true that when there's invasive cancer, there is always some chance of spread no matter how clear the margins, lymph nodes, etc. This is because the tumor cells can invade directly into blood vessels, and spread elsewhere without passing into the lymph system. So unfortunately you are in limbo right now: you have a tumor that had favorable characteristics for cure, and had aggressive treatment for it, but you have some data now that might or might not be significant.