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Breast Cancer (Expert Forum)
New Cancer, Same Breast, decades after Lumpectomy, Radiation, Brachytherapy
Questions posted in the Breast Cancer Forum are answered by medical professionals from The Cleveland Clinic. Topics include Breast Biopsy, Chemotherapy, Hormone Therapy, Lumps, Lumpectomy, Lymph node dissection, Lymphedema, Mammograms, Mastectomy, Radiation Therapy, Reconstruction, Self Breast Exam, and Surgery.
New Cancer, Same Breast, decades after Lumpectomy, Radiation, Brachytherapy
by MarchHare, Jun 04, 2005 12:00AM
1982—age 31---r. brst, DCIS stage I, estrogen neg---axillary dissection (clear), lumpectomy, 5 weeks radiation, brachytherapy---9 tubes in tumor site 48 hrs.
2005--change in the shape of rt brst. 2004 mammogram neg. 2005 microcalcification only, core biopsies cancer. R. mastectomy, node dissection impossible. PATH: Infiltrating ductal, 2.2 cm; invades subareolar dermis; extensive DCIS, comedo, within & surrounding tumor; angiolymphatic invasion, plugs in areola dermis; margins free; Histologic (Nottingham) Grade II, moderately differentiated; 90 % positivity for estrogen, borderline progesterone, no Her2new; no perineural invasion; T2 NX MX L1
PET SCAN:Intense increased activity left axilla & superior mediastinum (azygos region). No enlarged lymph node depicted, but suggestive of early lymph metastases. No abnormality or evidence of metastatses elsewhere. Two opinions of medical oncologists after PET. 1st---no change staging, previous treatment could have changed physiology. 2nd---biopsy left axilla good idea. Concurrent: elevated optic nerves. CT scan unremarkable. No clear diagnosis, currently nothing deadly suspected.
DES daughter. Mother breast cancer age 48, 2 dif cancers, 1 each breast--- radical mastectomy & cobalt, and simple mastectomy, no recurrence, but died of myleofibrosis at 88. No family history of breast cancer---aunt died of Hodgkins.
Can increased activity not be cancer? If cancer, can it be assumed solely breast metastases? How did it “jump” to these areas? Left axilla dissection wise? Before starting chemo? Is optic problem relavant at all?
2005--change in the shape of rt brst. 2004 mammogram neg. 2005 microcalcification only, core biopsies cancer. R. mastectomy, node dissection impossible. PATH: Infiltrating ductal, 2.2 cm; invades subareolar dermis; extensive DCIS, comedo, within & surrounding tumor; angiolymphatic invasion, plugs in areola dermis; margins free; Histologic (Nottingham) Grade II, moderately differentiated; 90 % positivity for estrogen, borderline progesterone, no Her2new; no perineural invasion; T2 NX MX L1
PET SCAN:Intense increased activity left axilla & superior mediastinum (azygos region). No enlarged lymph node depicted, but suggestive of early lymph metastases. No abnormality or evidence of metastatses elsewhere. Two opinions of medical oncologists after PET. 1st---no change staging, previous treatment could have changed physiology. 2nd---biopsy left axilla good idea. Concurrent: elevated optic nerves. CT scan unremarkable. No clear diagnosis, currently nothing deadly suspected.
DES daughter. Mother breast cancer age 48, 2 dif cancers, 1 each breast--- radical mastectomy & cobalt, and simple mastectomy, no recurrence, but died of myleofibrosis at 88. No family history of breast cancer---aunt died of Hodgkins.
Can increased activity not be cancer? If cancer, can it be assumed solely breast metastases? How did it “jump” to these areas? Left axilla dissection wise? Before starting chemo? Is optic problem relavant at all?
Doctor's Answer
by CCF-RN,MSN-JS, Jun 07, 2005 12:00AM
A PET scan is designed to detect areas of hypermetabolic activity - which is common in cancer but can be seen in a variety of other conditions as well. Having a negative (or positive) PET scan may increase or decrease the concern about cancer but no scan can guarantee that there are no microscopic cells. Invasive breast cancer can spread or metatasize. Ways of spread are by direct extension into surrounding tissues, by the body's lymph system, also by blood circulation. Information such as the tumor size, or certain features of the tumor as seen under the microscope, may increase or decrease suspicion of metastasis. Evaluation of the left sided lymphnodes through biopsy, would be dependent on level of suspicion, and if the information would be important in terms of treatment recommendations. The optic problem would need to be discussed with your physician in context of your particular situation, it's relevance cannot be determined based on the above information. The presence of bilateral breast cancer in your mother and the early age of onset of your own cancer raises the possibility of a hereditary form of breast cancer and you may wish to discuss genetic testing and its implications with your physician.
