Does this sound reasonable - 1255547

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smyth01
Does this sound reasonable - 1255547

My step-sister has beast cancer IIIc, diagnosed Nov 2011 when she was 39, had right mastectomy, axillary lymph node clearance, chemotherapy 6 cycles and radiotherapy to chest, axilla and supraclavicular area, she finished treatment in July 2012, then she went on to have a hysterectomy and bilateral salpingo-oophrectomy, her cancer is ER positive HER negative and she is on tamoxifen.

In December 2012 she found a lump in her right supraclavicular fossa. Ultrasound exam was done and her breast surgeon said it looked like a cyst or lymph node and said he would arrange for her to see her oncologist who would biopsy it if it was still there in 4 weeks. When she went to see her oncologist it was still there and he said repeat ultrasound showed enlarged lymph node but biopsy was not done.

Her oncologist is taking a watch and wait approach and my question's are;

1. in this kind of situation why would a biopsy not be done.

2. with her history does watch and wait sound like a reasonable plan?

Thank you Doctor's any thoughts would be appreciated.

catdander
Reply To: Does this sound reasonable

Hello smyth01, I'm very sorry your sister is in this position. I will certainly ask our breast cancer specialist to give you some input into your question. I know with lung cancer there are times with wait and is the best course of action. I hope this is the case for her. I know it is difficult emotionally to wait but the oncologist is the person who knows most about when and how.

I hope the enlarged lymph node is just inflammation or infection. You should hear back from our faculty within the day.

Janine
forum moderator

smyth01
Reply To: Does this sound reasonable

Hi Janine,

Thank you for your reply and your right it is so hard!

We are hopeful but there has been no history of infection and her blood tests were all normal!

Thanks again

Hannah

catdander
Reply To: Does this sound reasonable

Hannah, I don't want to seem that I know about this situation in respect to breast cancer but lymph nodes fight off infections on a regular basis that aren't picked up in blood tests or known infection, so I wouldn't read too much into that.

It's such a common issue that doctors understand the problem all too well of how difficult it is to wait.

Dr West
Reply To: Does this sound reasonable

Unfortunately, this sounds suspicious enough that I think most oncologists would favor doing a biopsy sooner rather than later. I can't think of a good reason not to do it.

Good luck.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

catdander
Reply To: Does this sound reasonable

Thanks Dr. West.

Hannah, It's always within reason to ask the doctor to get a biopsy sooner. If her onc isn't willing a second opinion with a breast cancer specialist might be in order.

Janine

smyth01
Reply To: Does this sound reasonable

Thanks so much Dr West and Janine,

I think we we're all hoping that as her breast surgeon thought it could be a cyst, that was what it is and the reason they didn't biopsy, but realistically that doesn't seem like a reason not to biopsy especially as from what we've found out most lumps in the supraclavicular fossa appear to be lymph nodes?

We will get in touch with her onc and ask for a biopsy ASAP and hope for good news!

Thanks again for taking the time to reply, it is very much appreciated and a fantastic site!

Hannah

Dr West
Reply To: Does this sound reasonable

It depends how it feels. I've seen more enlarged lymph nodes than cysts in the supraclavicular fossa, but it really depends on the feel of the lump. A firmer mass is very suggestive of a lymph node, particularly one involved by cancer, but a cystic mass is softer.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

certain spring
Reply To: Does this sound reasonable

"Kneaded", surely? Sorry, but standards must be maintained :)

smyth01
Reply To: Does this sound reasonable

Thanks again Dr West,

Can you tell the difference between lymph nodes and cysts on ultrasound or can they be mistaken for each other??

Hannah

Dr West
Reply To: Does this sound reasonable

Yes, ultrasound should be able to see the difference between a fluid-filled cyst and a solid node.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

dr cianfrocca
Reply To: Does this sound reasonable

I agree with Dr West's comments. If imaging suggests an enlarged lymph node, the general approach would be to biopsy it unless that is not feasible for some other reason. Also as Janine indicated, a second opinion is never a bad idea.
All the best,
Dr Cianfrocca

smyth01
Reply To: Does this sound reasonable

Thanks Dr West and Dr Cianfrocca,

My sister has booked an appointment to see her onc next week, I think we were hoping that by not biopsying it mean't it was nothing to be concerned about, but we have all been very worried!

I'm afraid we have been guilty of looking on the internet and it does appear from the information that we have found that if is recurrence to the supraclavicular lymph node she may have quite a fight ahead of her?

Thanks again

Hannah

JimC
Reply To: Does this sound reasonable

Hi Hannah,

If this is the only recurrence, it may be possible to successfully treat it with radiation. There was a discussion of radiation to supraclavicular lymph nodes here: http://cancergrace.org/radiation/topic/preferred-radiation-technology-fo...

Good luck with getting the biopsy and for good results from it.

JimC
Forum moderator

<p>I began visiting GRACE in July, 2008 when my wife Liz was diagnosed with lung cancer, and became a forum moderator in January, 2010. My beloved wife of 30 years passed away Nov. 4, 2011 after battling stage IV lung cancer for 3 years and 4 months</p>

Dr West
Reply To: Does this sound reasonable

I think it would be wrong of us to speculate about the implications of something that hasn't been diagnosed yet. However, I don't think it's wrong to challenge her docs with questions you've formulated based on things you've learned online. Specifically, I don't think it is wrong for you to have advocated for a biopsy here, but I wouldn't want to put the cart ahead of the horse and start planning treatments and anticipating prognosis with so many holes still in the story.

Good luck.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

smyth01
Reply To: Does this sound reasonable

We will certainly being asking or a biopsy.

She has lymphedema that initially developed in the supraclavicular area back in Dec and has now spread down to her hand, could that cause an enlarged supraclavicular lymph node or is the other way around in that a problem with the node could go on to cause the lymphedema?

Thanks

Hannah

Dr West
Reply To: Does this sound reasonable

More likely that lymph node enlargement would impair lymphatic drainage from the limb beyond that area. It's possible that infection or inflammation in a limb would cause the lymph nodes in the draining "basin" for that limb to enlarge, but enlarged lymph nodes themselves can cause a backup of the lymphatic fluid in the limb from which the nodes drain.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

smyth01
Reply To: Does this sound reasonable

Thanks again for your quick reply's, having all this information will be so useful should we need to challenge her onc if he is still unwilling to do a biopsy!

Hannah

dr cianfrocca
Reply To: Does this sound reasonable

Hannah,
I agree with Dr West's comments.
All the best,
Dr Cianfrocca

smyth01
Reply To: Does this sound reasonable

Thank you Dr Cianfrocca!

Well she has been back and her onc agreed to biopsy and now has the results, unfortunately it was not good news, her lymph node was positive for the same cancer as her original diagnosis.

She is going back to discuss treatment options, any opinions on her best options and likely prognosis would be appreciated.

Many thanks again

Hannah

dr cianfrocca
Reply To: Does this sound reasonable

I'm sorry to hear that Hannah. As I am not your physician, I can't make specific treatment recommendations to you. I agree with you meeting with your oncologist to discuss your options for further treatment. Your oncologist will likely want to evaluate the extent of your disease and make recommendations based on that.

Dr Cianfrocca