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Old 02-25-2011, 03:18 PM   #1
bejuce
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On reactive lymph nodes and delayed diagnosis

Hi everyone,

In my disease understanding/acceptance quest, I've talked to quite a few doctors about my delayed diagnosis. I've heard from a few now that told me that it was unfortunate that my diagnosis was delayed but in their opinion, there was nothing wrong in the wait-and-see approach the doctors took with me when I first showed up with a swollen lymph node under my arm in July 2008.

The lymph node was ultrasounded, and the results showed a reactive, benign-looking, 2.5 cm lymph node. I was breastfeeding my 3rd for comfort at night at that time, but weaned him the weekend after I found my node in the hopes of doing a mammogram. The doctors told me to do a mammogram when I was 40 (I was 37 at the time) and come back in 3 months to check the lymph node.

Three months later, in October 2008, another ultrasound still showed a benign-looking, reactive lymph node, but this time, it was 2.1 cm. They again told me to come back in 3 months.

When I did so in January 2009, it was clear that my right breast was swollen, bigger and much denser than the left, with skin edema and nipple changes. I was diagnosed in February 2009.

Maybe I had the "explosive" tumor kind (there was an article recently in the NYT about it posted on another thread), but maybe the tumor was there for a while and no one could identify it.

In any case, my question is: if a young woman shows up in a doctor office with a clearly palpable lymph node under the arm, shouldn't the node be biopsied with a fine needle aspiration? And if the node is still there after 3 months, isn't this a stronger probability that the node indicates cancer?

I find it very distressing to know that women (especially young women not yet at the mammography age) may be showing up at doctors' offices with swollen lymph nodes and not getting the proper biopsy until much later. I could feel my right breast being "denser" than the left back in 04/05 when I was nursing my 2nd, and I suspect my tumor showed up around that time. Or maybe not - maybe it did show up in 08, but it still bothers me that doctors (not all, thank God) have been telling me that nothing was wrong with the care I received and the wait-and-see approach.

Any opinions? As someone who strongly believes in breast cancer advocacy, shouldn't we be sending the message out that underarm lymph nodes should be FNA'd immediately? It's such a simple procedure and I don't know why not more is done (I don't believe in the theory that cancer could spread as a result of a needle inserted in the lymph node, but I'm not sure if the verdict is out on that). After all, everything I know about lymph nodes is that they either become swollen due to infection or cancer, with other causes being much less likely. And lymph nodes under the arm drain the fluid from the breasts, so if a lymph node is swollen under the arm and there are no signs of an infection, then why don't doctors immediately raise the red flag of a cancer diagnosis? What other causes could be affecting the underarm lymph nodes to be swollen?

Not sure what I'm missing, but it just seems logical to me. No infection? Then cancer becomes much more likely.

I'd appreciate all your comments!!!

Thanks!

Marcia
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ER+ (30%)/PR-/HER-2+, stage 3

Diagnosed on 02/18/09 at 38 with a huge 12x10 cm tumor, after a 6 month delay. Told I was too young and had no risk factors. Found swollen node during breastfeeding.
March-August 09: neo-adjuvant chemo, part of a trial at Stanford (4 DD A/C, 4 Taxotere with daily Tykerb), loading dose of Herceptin
08/12/09 - bye bye boobies (bilateral mastectomy)
08/24/09 - path report shows 100 % success in breast tissue (no cancer there, yay!), 98 % success in lymphatic invasion, and even though 11/13 nodes were still positive, > 95 % of the tumor in them was killed. Hoping for the best!
September-October 09: rads with daily Xeloda
02/25/10 - Cholecystectomy
05/27/10 - Bone scan clear
06/14/10 - CT scan clear, ovarian cyst found
07/27/10 - Done with Herceptin!
02/15/11 - MVA-BN HER-2 vaccine trial
03/15/11 - First CA 15-3: 12.7 and normal, yay!
10/01/11 - Bone scan and CT scan clear, fatty liver found
now on Tamoxifen and Aspirin


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Old 02-25-2011, 04:09 PM   #2
tricia keegan
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Re: On reactive lymph nodes and delayed diagnosis

Hi Marcia,

I'm inclined to agree with you and don't know why people presenting this way are told to wait and see, sheer torture in my opinion!!

I was reading the latest news regarding not removing nodes in very early cases and feel uncomfortable about that too, my surgeon and all my Dr's were totally conviced my nodes were clear, but three were positive!! I was'nt surprised as had experienced an ache there for some weeks which the Dr's dismissed, it seems sometimes maybe the Dr's need to listen to the patient more which be nothing more than a hunch, but a hunch thats often right.
I think any woman in your situation should demand a FNA if at all possible!
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A/C X 4 ..Taxol/Herceptin x 12 wks then herceptin 1 yr
Rads x 36 ..oophorectomy August '06
Currently taking Arimidex..
June 2011 osteopenia/ zometa x1 yearly- stopped Zometa 2015 as Dexa show normal bone density.
Stopped Arimidex July 2014- Restarted Arimidex 2015 for a further two years on the advice of my Onc.
2014 Normal Dexa scan
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Old 02-25-2011, 09:07 PM   #3
Ceesun
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Re: On reactive lymph nodes and delayed diagnosis

Where is that explosive tumor article? Ceesun
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Old 02-25-2011, 10:36 PM   #4
Margerie
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Re: On reactive lymph nodes and delayed diagnosis

what benign conditions cause swelling in a underarm node?? Reactive but benign? Was it painful?? An inflammed node would most likely be tender.

Sometimes I think docs are patronizing and think we will become hysterical if they suggest a biopsy. If they are not sure, shouldn't they suggest one just to rule out cancer? How many men walk around with swollen lymph nodes in their groin and are told to come back in three months???

No mammogram when you initially presented????? Grrrrrr.......... not wanting to stir the pot, but that doesn't sound right either.

Sorry, have heard bad news from two friends (both under diagnosed and under treated.......grrrrr)

Looked into the reactive lymph nodes.....

"If the lymph node enlargement is unexplained, it may need to undergo a period of observation for 3 to 4 weeks possibly with the addition of empirical antibiotics.
If it persists after a period of observation then the patient should seek medical attention which may require further investigations using ultrasonography and fine needle aspiration cytology or an excisional biopsy."
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Last edited by Margerie; 02-25-2011 at 10:52 PM..
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Old 02-25-2011, 11:02 PM   #5
Debbie L.
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Re: On reactive lymph nodes and delayed diagnosis

Marcia, I don't think your concerns are unreasonable, at all. Even if not taken from a breast cancer perspective, a swollen axillary node in a healthy person should be checked out, in my opinion.

A large node is what led to my diagnosis, also (but I was 49). My surgeon, like yours, said it was most likely a "reactive" node (he quoted a stat of 80% chance it was benign, I think) but with hindsight I wondered if he hadn't just been trying to keep me from worrying. But whether it was false reassurance or not, he did not dilly-dally around - he did an excisional biopsy as quickly as he could schedule it. This was just a basic general surgeon in podunckville - it's not as if I was at a big cancer center and that's why he jumped on it. It was thought, once it was clear that my nodes were malignant, that it was most likely a lymphoma, probably non-Hodgkins. For about 4 days, anyway. So there are not just breast cancer reasons to get a large node checked out. Mine was larger than yours, but it seems to me like palpable is palpable, and should be biopsied unless there is a clear infection process going on.

As for what is the right thing for you to do about your concerns at this point -- only you can figure out the right answer there. There's a whole RANGE of right answers, and your gut, your heart, your conscience, whatever -- will tell you what's right for you.

Good luck with this, I hope it helps to get input and talk it out here.

Debbie Laxague
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4/01 ~ Bilateral mastectomies (LMRM, R elective simple) - 1.2cm IDC was found at pathology. 5 of 11 axillary nodes positive, largest = 6cm. Stage IIIA
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Old 02-26-2011, 04:59 AM   #6
tricia keegan
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Re: On reactive lymph nodes and delayed diagnosis

http://www.thirdage.com/news/axillar...vival_2-9-2011
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Dx July '05 IDC 1.9cm Triple positive 3/9 nodes positive
A/C X 4 ..Taxol/Herceptin x 12 wks then herceptin 1 yr
Rads x 36 ..oophorectomy August '06
Currently taking Arimidex..
June 2011 osteopenia/ zometa x1 yearly- stopped Zometa 2015 as Dexa show normal bone density.
Stopped Arimidex July 2014- Restarted Arimidex 2015 for a further two years on the advice of my Onc.
2014 Normal Dexa scan
2018 Mammo all clear, still NED!
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Old 02-26-2011, 05:13 AM   #7
Ellie F
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Re: On reactive lymph nodes and delayed diagnosis

Hi Marcia
I read your post your post and it brought my own diagnosis back big style especially the struggle you had.
I also found a large swollen lymph gland in my axilla. Went to see my Doctor who fobbed me off and told me I was neurotic. I returned many times over the next 18 months only to be told that I was making a fuss about nothing!! The only examination I had was a physical breast examination!
Now I think I must have been MAD not to insist on further investigations but I was too trusting.
Eventually I presented with a swollen breast with nipple changes. Initially I was diagnosed with IBC but later another oncologist doubted this and felt it was locally advanced bc.So the jury is still out!
I spent ages 'beating myself up' about being so trusting as I'm now fighting for my life but at that time I was under such stress that maybe I wanted to believe that it was nothing!

Ellie
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Old 02-26-2011, 10:28 AM   #8
AlaskaAngel
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Second (and third) opinions

I am in full agreement with DLaxague about this. I too happen to not be located near a cancer center. For other reasons I received a delayed diagnosis. My PCPs were asleep at the wheel -- too many substituting physicians, and a hospital that did a poor job of checking out the background and experience of a "breast cancer specialist" surgeon... and, a patient who was not persistent enough about the need to question doctors and the system.

The mistake we make is in not listening to our own sense of the problem enough to seek out second and even third opinions, including one from a known center that specializes in detection.

Delayed diagnosis is hard to live with mentally no matter what the outcome, and much harder still for those with a cancer that has spread.

AlaskaAngel
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ER+/PR+/HER2+++, grade 3
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Old 02-26-2011, 04:08 PM   #9
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Re: On reactive lymph nodes and delayed diagnosis

Just an FYI here.... THIRTY years ago I had a freely movable enlarged lymph node in neck that remained there for 3 years....had several thyroid scans since I was at high risk which were all negative....docs said no cancer.....finally, my ob-gyn said you know, I want you to biopsy that even though others say its fine. When I did, it was shown that I had a very slow growing thyroid cancer, about 3mm in size, that never showed as anything on the thyroid, but spread to the cervical node. I say all enlarged bumps and lumps should be suspect until proven otherwise. Ceesun
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Old 02-26-2011, 09:03 PM   #10
Jackie07
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Re: On reactive lymph nodes and delayed diagnosis

My Mother had felt 'something' in her underarm and went to the doctor in 1998. They checked and found Non-Hodgkins Lymphoma. I think age is a big factor. For those of us (my life-long brain tumor could have been found at least 5 years earlier)who don't fall into the 'Norm', it's always a struggle 2nd guessing ourselves and the 'incompetent' doctors who had missed/delayed the diagnosis.
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Old 03-11-2011, 01:30 PM   #11
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Re: On reactive lymph nodes and delayed diagnosis

I found this thread by looking up benign looking lymph nodes on the web. I have been being followed every 6 months with a right breast ultrasound since August due to an abnormal mammogram. They have classified it as a birads 3. I went to my Drs on Monday because I have had for some time now some tenderness under my right arm. Tuesday I had an ultrasound and got the results today that there are 2 benign looking lymph nodes and I am suppose to follow up with another ultrasound in six months on my lymph nodes now too. By reading this post I am getting the impression that this is not the course of treatment I want to take and I should push for a biopsy?
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Old 03-11-2011, 02:39 PM   #12
Jackie07
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Re: On reactive lymph nodes and delayed diagnosis

Hi,

Found a link with detailed information regarding Bi-Rads. Looks to me your doctor is following the guidelines:

http://www.radiologyassistant.nl/en/4349108442109

"A negative diagnostic examination is one that is negative, with a benign or probably benign finding (BI-RADS 1, 2 or 3).
In BI-RADS 3 the radiologist prefers to establish the stability of a lesion by short term follow-up.
In the evaluation of your BI-RADS 3 lesions the malignancy rate should be < 2%.

A positive diagnostic examination is one that requires a tissue diagnosis (BI-RADS 4 and 5).
In BI-RADS 4 the radiologist has sufficient concern to urge a biopsy (2-95% chance of malignancy).

In BI-RADS 5 the chance of malignancy should be > 95%."

[Final Assessment Categories]
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http://www.kevinmd.com/blog/2011/06/doctors-letter-patient-newly-diagnosed-cancer.html
http://www.asco.org/ASCOv2/MultiMedi...=114&trackID=2

NICU 4.4 LB
Erythema Nodosum 85
Life-long Central Neurocytoma 4x5x6.5 cm 23 hrs 62090 semi-coma 10 d PT OT ST 30 d
3 Infertility tmts 99 > 3 u. fibroids > Pills
CN 3 GKRS 52301
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Recc IIB 2.5 cm Bi-L Mast 61407 2/9 nds PET
6 TCH Cellulitis - Lymphedema - compression sleeve & glove
H w x 4 MUGA 51 D, J 49 M
Diastasis recti
Tamoxifen B. scan
Irrtbl bowel 1'09
Colonoscopy 313
BRCA1 V1247I
hptc hemangioma
Vertigo
GI - > yogurt
hysterectomy/oophorectomy 011410
Exemestane 25 mg tab 102912 ~ 101016 stopped due to r. hip/l.thigh pain after long walk
DEXA 1/13
1-2016 lesions in liver largest 9mm & 1.3 cm onco. says not cancer.
3-11 Appendectomy - visually O.K., a lot of puss. Final path result - not cancer.
Start Vitamin D3 and Calcium supplement (600mg x2)
10-10 Stopped Exemestane due to r. hip/l.thigh pain OKed by Onco 11-08-2016
7-23-2018 9 mm groundglass nodule within the right lower lobe with indolent behavior. Due to possible adenocarcinoma, Recommend annual surveilence.
7-10-2019 CT to check lung nodule.
1-10-2020 8mm stable nodule on R Lung, two 6mm new ones on L Lung, a possible lymph node involvement in inter fissule.
"I WANT TO BE AN OUTRAGEOUS OLD WOMAN WHO NEVER GETS CALLED AN OLD LADY. I WANT TO GET SHARP EDGED & EARTH COLORED, TILL I FADE AWAY FROM PURE JOY." Irene from Tampa

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Last edited by Jackie07; 03-11-2011 at 03:23 PM..
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Old 03-11-2011, 03:30 PM   #13
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Re: On reactive lymph nodes and delayed diagnosis

Thank you for your response.

I was fine with the doctor following the protocol for the birads 3 mammogram untils this week when the found the 2 enlarged "benign looking" lymph nodes under my right arm. I just don't want to under go any unnecessary tests but I don't want them blowing anything off either. If I should voice my concerns then I will.
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Old 03-11-2011, 03:43 PM   #14
bejuce
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Re: On reactive lymph nodes and delayed diagnosis

Hi there,

I sure hope it's nothing, but I'd request a fine needle aspiration of the lymph nodes for peace of mind. It's just a poke and hurts less than a blood test. If this had been done in my case, I believe I'd have discovered my cancer 6 months prior.

Best of luck to you and keep us updated!
__________________
ER+ (30%)/PR-/HER-2+, stage 3

Diagnosed on 02/18/09 at 38 with a huge 12x10 cm tumor, after a 6 month delay. Told I was too young and had no risk factors. Found swollen node during breastfeeding.
March-August 09: neo-adjuvant chemo, part of a trial at Stanford (4 DD A/C, 4 Taxotere with daily Tykerb), loading dose of Herceptin
08/12/09 - bye bye boobies (bilateral mastectomy)
08/24/09 - path report shows 100 % success in breast tissue (no cancer there, yay!), 98 % success in lymphatic invasion, and even though 11/13 nodes were still positive, > 95 % of the tumor in them was killed. Hoping for the best!
September-October 09: rads with daily Xeloda
02/25/10 - Cholecystectomy
05/27/10 - Bone scan clear
06/14/10 - CT scan clear, ovarian cyst found
07/27/10 - Done with Herceptin!
02/15/11 - MVA-BN HER-2 vaccine trial
03/15/11 - First CA 15-3: 12.7 and normal, yay!
10/01/11 - Bone scan and CT scan clear, fatty liver found
now on Tamoxifen and Aspirin


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Old 03-12-2011, 08:27 AM   #15
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Re: On reactive lymph nodes and delayed diagnosis

Thank you for the kind words. I too hope and pray they find nothing.

I do not see my doctor in person again until the March 23 to find out if he plans on following the radiologist suggestions and just getting another sono in six months or pursuing anything further unless he calls me sooner then that I will not know.
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Old 03-28-2011, 07:15 AM   #16
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Re: On reactive lymph nodes and delayed diagnosis

I want to keep you updated.

I saw my doctor on 3/23. I have an appt with a surgeon today to see if they want to pursue anything further. I don't really know what any of these technical terms are on my reports but the cyst in my right breast is a complex lobular cyst and under my right arm the report indicates two solid masses having the architectural appearance of benign lymph nodes. I know benign is a good word, but that is all I am familiar with. They had classified everything as a birads 3 but my doctor is sending me to a surgeon anyway with my reports to see what they think.

Here is hoping it goes good today.
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Old 03-28-2011, 08:21 AM   #17
bejuce
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Re: On reactive lymph nodes and delayed diagnosis

Thanks for the update and good luck to you! The lymph nodes are most likely benign and reactive, meaning they are just reacting to the cyst. But to know for sure and ease your mind, I'd ask for a fine needle aspiration of them - a 5 min procedure.

Let us know how it all turns out.
__________________
ER+ (30%)/PR-/HER-2+, stage 3

Diagnosed on 02/18/09 at 38 with a huge 12x10 cm tumor, after a 6 month delay. Told I was too young and had no risk factors. Found swollen node during breastfeeding.
March-August 09: neo-adjuvant chemo, part of a trial at Stanford (4 DD A/C, 4 Taxotere with daily Tykerb), loading dose of Herceptin
08/12/09 - bye bye boobies (bilateral mastectomy)
08/24/09 - path report shows 100 % success in breast tissue (no cancer there, yay!), 98 % success in lymphatic invasion, and even though 11/13 nodes were still positive, > 95 % of the tumor in them was killed. Hoping for the best!
September-October 09: rads with daily Xeloda
02/25/10 - Cholecystectomy
05/27/10 - Bone scan clear
06/14/10 - CT scan clear, ovarian cyst found
07/27/10 - Done with Herceptin!
02/15/11 - MVA-BN HER-2 vaccine trial
03/15/11 - First CA 15-3: 12.7 and normal, yay!
10/01/11 - Bone scan and CT scan clear, fatty liver found
now on Tamoxifen and Aspirin


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Old 03-28-2011, 01:00 PM   #18
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Re: On reactive lymph nodes and delayed diagnosis

What was thought to be reactive lymph nodes above my collarbone, when I was going through tissue expander fills, turned out to be metastatic disease....I am so glad i fought for the biopsy, everyone else just blew it off....that was 8 years ago. The peace of mind of knowing what you are dealing with is priceless!
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Diagnosed at age 49.99999 2/21/2002 via Mammography (Calcifications)
Core Biopsy 2/22/02
L. Mastectomy 2/25/2002
Stage 1, 0.7cm IDC, Node Neg from 19 nodes Her2+++ ER PR Neg
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9/2003 Stage IV with Mets to Supraclavicular nodes
9/2003 Began Herceptin every 3 weeks
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3/2007 Added back the Xeloda with Herceptin for continued mets to nodes
5/2007 Taken Off Xeloda, no longer working
6/14/07 Taxol/Herceptin/Avastin
3/26 - 5/28/08 Taxol Holiday Whopeeeeeeeee
5/29 2008 Back on Taxol w Herceptin q 2 weeks
4/2009 Progression on Taxol & Paralyzed L Vocal Cord from Nodes Pressing on Nerve
5/2009 Begin Rx with Navelbine/Herceptin
11/09 Progression on Navelbine
Fought for and started Tykerb/Herceptin...nodes are melting!!!!!
2/2010 Back to Avastin/Herceptin
5/2010 Switched to Metronomic Chemo with Herceptin...Cytoxan and Methotrexate
Pericardial Window Surgery to Drain Pericardial Effusion
7/2010 Back to walking a mile a day...YEAH!!!!
9/2010 Nodes are back with a vengence in neck
Qualified for TDM-1 EAP
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Old 03-28-2011, 01:59 PM   #19
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Re: On reactive lymph nodes and delayed diagnosis

Sheila, Debbie L, Bejuce, Ceesun and Jackie... I agree wholeheartedly. I still hear from friends who's GYNs, etc. tell them that "watchful waiting" is the recommendation, and it irks me to no end. One friend had been on watchful waiting with mammos and nodes for over a year when I convinced her to go elsewhere for second opinion. She was immediately dxed with triple neg breast cancer... terrifying.

Unreg, please please please push for the "better safe than sorry" path, and get a biopsy from a breast cancer specific surgeon.
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Rt side mastectomy, Her2+, ER/PR+, 10 nodes out, one node positive
Jan'04~
Taxotere/Adria/Cytoxan x 6, NED, no Rads, Tamox. 1 year, Arimadex 3 mo., NED 14 mo.
Sept'05~
micro mets lungs/chest nodes/underarm node, Switched to Aromasin, T/C/H x 7, NED 6 months - Herceptin only
Aug'06~
micro mets chest nodes, & bone spot @ C3 neck, Added Taxol to Herceptin
Feb'07~ Genetic testing, BRCA 1&2 neg

Apr'07~
MRI - two 9mm brain mets & 5 punctates, new left chest met, & small increase of bone spot C3 neck, Stopped Aromasin
May'07~
Started Tykerb/Xeloda, no WBR for now
June'07~
MRI - stable brain mets, no new mets, 9mm spots less enhanced, CA15.3 down 45.5 to 9.3 in 10 wks, Ty/Xel working magic!
Aug'07~
MRI - brain mets shrunk half, NO NEW BRAIN METS!!, TMs stable @ 9.2
Oct'07~
PET/CT & MRI show NED
Apr'08~
scans still show NED in the head, small bone spot on right iliac crest (rear pelvic bone)
Sept'08~
MRI shows activity in brain mets, completed 5 fractions/5 consecutive days of IMRT to zap the pesky buggers
Oct'08~
dropped Xeloda, switched to tri-weekly Herceptin in combo with Tykerb, extend to tri-monthly Zometa infusion
Dec'08~
Brain MRI- 4 spots reduced to punctate size, large spot shrunk by 3mm, CT of torso clear/pelvis spot stable
June'09~
new 3-4mm left cerrebellar spot zapped with IMRT targeted rads
Sept'09~
new 6mm & 1 cm spots in pituitary/optic chiasm area. Rx= 25 days of 3D conformal fractionated targeted IMRT to the tumors.
Oct'09~
25 days of low dose 3D conformal fractionated targeted IMRT to the bone mets spot on rt. iliac crest that have been watching for 2 years. Added daily Aromasin back into treatment regimen.
Apr'10~ Brain MRI clear! But, see new small spot on adrenal gland. Change from Aromasin back to Tamoxifen.
June'10~ Tumor markers (CA15.3) dropped from 37 to 23 after one month on Tamoxifen. Continue to monitor adrenal gland spot. Remain on Tykerb/Herceptin/Tamoxifen.
Nov'10~ Radiate positive mediastinal node that was pressing on recurrent laryngeal nerve, causing paralyzed larynx and a funny voice.
Jan'11~ MRI shows possible activity or perhaps just scar tissue/necrotic increase on 3 previously treated brain spots and a pituitary spot. 5 days of IMRT on 4 spots.
Feb'11~ Enrolled in T-DM1 EAP in Denver, first treatment March 25, 2011.
Mar'11~ Finally started T-DM1 EAP in Denver at Rocky Mountain Cancer Center/Rose on Mar. 25... hallelujah.

"I would rather be anecdotally alive than statistically dead."
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Old 03-28-2011, 03:07 PM   #20
Jackie07
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Re: On reactive lymph nodes and delayed diagnosis

One reason I think they do that ('watchful waiting') is because of the misconception that things can be 'over-treated' and that they want to avoid causing 'unnecessary worries' to the patients. My surgeon had told me that 'it doesn't make any difference' when my recurrence was finally found.

I heard about people losing their life because of misdiagnosis or delayed treatment. I'm not sure I've ever heard of anyone who has 'worried' him/herself to death!

However, being a 'glass half-full', die-hard optimist, I always look at the bright side of things (such as my recurrence was discovered when Herceptin had been approved...) There is a possibility that the doctors are waiting for the 'magic bullet' to be availble for their patients...
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3-11 Appendectomy - visually O.K., a lot of puss. Final path result - not cancer.
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7-23-2018 9 mm groundglass nodule within the right lower lobe with indolent behavior. Due to possible adenocarcinoma, Recommend annual surveilence.
7-10-2019 CT to check lung nodule.
1-10-2020 8mm stable nodule on R Lung, two 6mm new ones on L Lung, a possible lymph node involvement in inter fissule.
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