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Topic: Primary in Armpit

Forum: Just Diagnosed — Discuss next steps, options, and resources.

Posted on: May 6, 2011 12:08PM

Maybe484 wrote:

I'd like to hear from anyone whose primary tumor was in their armpit.  Mine is right where I shave.  Because my original surgeon thought I had a sebaceous cyst, he did not test my lymph nodes or take clean margins, unfortunately.  Now I am facing a second surgery with a different surgeon, more of a specialist.  I've had a CT scan, bone scan, MRI, mammogram, and ultrasound, and the surgeon has determined that that is the primary tumor.  I'm concerned about what special complications I may have from more extensive armpit surgery.  Of course I'll ask my doctor too, but I'd like to hear from anyone who's had personal experience.  Thanks in advance.

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May 6, 2011 01:50PM beacon800 wrote:

maybe484, I am so sorry to hear about your diagnosis.  I don't have any experience there, but wanted to offer you my support.

Your dx does sound so unusual.  Was the tumor in a lymph node or was it in the armpit tissue itself?  Is it definitely a breast cancer? 

I had a weird cyst type thing in my armpit, same side as my LCIS. It was concurrent w/ my dx and treatment.  I showed it to my GP and to my breast surgeon.  Both dismissed it.  The breast surgeon told me that, "even in the scheme of weird, it would be weird if that were cancer."  But he did measure it and note it.  

LCIS, PLCIS.

Dx 7/24/2009, LCIS, Stage 0, 0/0 nodes, ER+/PR+, HER2-
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May 6, 2011 04:21PM Maybe484 wrote:

Thank you for your support.  I feel like a freak.  The original surgeon said that he'd be "shocked" if the diagnosis came back cancer--he thought even after surgery that the mass--slightly less than 1 cm--was a sebaceous cyst because of its location (near the skin surface).  I found it in Dec. and immediately had a mammogram and ultrasound.  The radiologist who read the ultrasound thought it was an inflamed node.  So the surgeon said to come back in 3 months, at which time he decided to do an excisional biopsy, so that I could have "peace of mind."  I was shocked when the pathology report said invasive breast cancer, no lymph node characteristics.  I have subsequently met with a team of specialists at a major breast cancer center who concurred after studying the pathology slides themselves.  They say that the tumor was at the very tail end of where breast tissue can be present--smack dab in the middle of my armpit.  It's 100% ER+ and also PR+ and grade 2--I don't know the stage yet because my nodes haven't been checked yet.  I'm dreading the second surgery because I already have a seratoma at the incision site, and the site is still super sensitive. 

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May 8, 2011 05:49PM, edited May 8, 2011 05:58PM by browniefranks

Core needle biopsies sample different areas of the tumor and while one section may appear be DCIS, another may appear benign and another may be grade 2. It depends on how the tumor is progressing, and where the radiologist samples. The best approach is MRI with contrast followed by excisional biopsies.  I am sorry they put you through all this before you were finally diagnosed but breast cancer can be anywhere there is breast tissue including armpits. BTW I remember when I was nursing my first child and I had milk squirt out of my armpits, I was shocked.

Maybe484 Grade 2 is good! Thank goodness it was diagnosed at a treatable stage. No nodes involvement is great. Now your focus is to treat it and get to a new type of normal. Good luck and feel free to vent any time.  My cancer was closer to my chest wall/muscle and the surgery left me very weak on that side. It's likely that you may have residual pain from armpit surgery, but you should talk to your doctors about minimizing nerve damage during surgery as well as your concerns. Speak up to them! Good luck with treatment.

Dx 3/3/2011, IDC, 2cm, Stage IIa, Grade 2, 0/3 nodes, ER+/PR+, HER2-Surgery 03/23/2011 Lumpectomy (Right)Surgery 03/23/2011 Lymph Node Removal: Sentinel Lymph Node Dissection (Right)Chemotherapy 04/05/2011 Cytoxan, TaxotereRadiation Therapy 09/04/2011 External, 3-D conformal external beam radiationHormonal Therapy 01/12/2012 TamoxifenSurgery 01/16/2014 Mastectomy (Both)Surgery 01/16/2014 Reconstruction: DIEP flap (Both)
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May 9, 2011 09:29AM, edited May 9, 2011 09:36AM by Maybe484

To clarify, I didn't have a core needle biopsy.  I've had numerous core needle biopsies of other masses--I have tons of cysts--so I know about that.  But on this particular armpit mass I had an excisional biopsy--the entire mass was removed but without clean margins.  Now I have to have margins removed, plus lymph nodes.   None of the scans--MRI with contrast, bone scan, CT scan--showed any tumors elsewhere.  The reason they put me through all of those tests is that they weren't convinced the armpit tumor was my primary tumor; I feel confident in my new team of doctors and that they know what they are doing; they are specialists at a top-notch teaching hospital.  Now my concern--other than the cancer, of course--is arm function after the second surgery and after intense treatment of my armpit.  So I'd like to hear from anyone with first-hand (pun intended) experience of this.

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May 15, 2011 06:39PM browniefranks wrote:

Maybe484 contact the member with profile name 

InTwoPlaces, her primary tumor was in her armpit!

Dx 3/3/2011, IDC, 2cm, Stage IIa, Grade 2, 0/3 nodes, ER+/PR+, HER2-Surgery 03/23/2011 Lumpectomy (Right)Surgery 03/23/2011 Lymph Node Removal: Sentinel Lymph Node Dissection (Right)Chemotherapy 04/05/2011 Cytoxan, TaxotereRadiation Therapy 09/04/2011 External, 3-D conformal external beam radiationHormonal Therapy 01/12/2012 TamoxifenSurgery 01/16/2014 Mastectomy (Both)Surgery 01/16/2014 Reconstruction: DIEP flap (Both)
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May 16, 2011 09:23PM, edited May 22, 2011 04:52PM by Maybe484

Thanks--I'm scheduled tomorrow a.m. for a re-excision lumpectomy and sentinel node biopsy.  I'm anxious to have it done but anxious (scared) to find out about node involvement.  The tumor was so close to my lymph nodes that I fear node involvement.

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May 20, 2011 08:36PM browniefranks wrote:

Maybe484 hope you have no node involvement...

Dx 3/3/2011, IDC, 2cm, Stage IIa, Grade 2, 0/3 nodes, ER+/PR+, HER2-Surgery 03/23/2011 Lumpectomy (Right)Surgery 03/23/2011 Lymph Node Removal: Sentinel Lymph Node Dissection (Right)Chemotherapy 04/05/2011 Cytoxan, TaxotereRadiation Therapy 09/04/2011 External, 3-D conformal external beam radiationHormonal Therapy 01/12/2012 TamoxifenSurgery 01/16/2014 Mastectomy (Both)Surgery 01/16/2014 Reconstruction: DIEP flap (Both)
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May 20, 2011 09:52PM Maybe484 wrote:

Thanks so much, browniefranks.  I had 3 nodes removed and should find out next week.

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May 21, 2011 08:23PM browniefranks wrote:

Maybe484 hope the wait is not too stressful and you are recovering well from the surgery... Take care

Dx 3/3/2011, IDC, 2cm, Stage IIa, Grade 2, 0/3 nodes, ER+/PR+, HER2-Surgery 03/23/2011 Lumpectomy (Right)Surgery 03/23/2011 Lymph Node Removal: Sentinel Lymph Node Dissection (Right)Chemotherapy 04/05/2011 Cytoxan, TaxotereRadiation Therapy 09/04/2011 External, 3-D conformal external beam radiationHormonal Therapy 01/12/2012 TamoxifenSurgery 01/16/2014 Mastectomy (Both)Surgery 01/16/2014 Reconstruction: DIEP flap (Both)
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May 21, 2011 08:46PM Binney4 wrote:

Maybe, so glad the surgery is behind you. I hope you've already seen a well-qualified lymphedema therapist, but if not, you might want to ask any doctor on your team for a referral. a therapist can take baseline arm measurements for future reference, give you lymphedema risk reduction tips, teach you a prophelactic lymph massage routine you can do yourself, and fit you for a sleeve and glove to wear for exercise, travel, or any unusual activities. Here's how to find one near you:
http://www.stepup-speakout.org/Finding_a_Qualified_Lymphedema_Therapist.htm

And here's information about lymphedema risk reduction:
http://www.stepup-speakout.org/riskreduction_for_lymphedema.htm

Our doctors can sometimes get so busy dealing with the bc that they forget to tell us how to protect ourselves from lymphedema, but it's well worth knowing, especially with so much surgical trauma to your axilla.

If you'd like to send a private message to KS1, she too had a primary outside the usual area. 

Hoping for only good news next week!

Be well,
Binney

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May 21, 2011 09:06PM TooManyCocktails wrote:

There were no palpable lumps in my breast; but there was what the doctor called a "cyst" in my arm pit.  There was just one and the doctor said that it was "residuals" of mastitis.  She refused to biopsy it. About four months later another lump grew next to the "cyst".  This time she decided to biopsy both the "cyst" and the mass.  She said that it was, probably, nothing.  It turned out to be Invasive Ductal Carcinoma.  By this time, there were 41/41 positive lymph nodes.  She said that the cancer was in the axillary tail of the breast.  Due to having a history of BC in my family (2 sisters, one recently died),  I chose to have both breasts removed.  The pathologist found 18 microscopic multifocal areas in all quadrants of the breast on the side were the positive nodes were.

"If you ever drop your keys into a river of molten lava, let 'em go, because, man, they're gone." Jack Handey

Dx 10/8/2010, IDC, 3cm, Stage IIIc, Grade 3, 40/40 nodes, ER+/PR+, HER2-
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May 21, 2011 10:09PM, edited May 21, 2011 10:34PM by Maybe484

Thank you for all of your well wishes and helpful suggestions.  Due to multiple cysts, I have been closely monitored for over a decade, and yet this tumor--given where it was--really took me by surprise.  I'm now seeing a multidisciplinary team of doctors at a breast clinic at a university hospital and so feel more comfortable with my care, and yet they have yet to refer me to a lymphedema therapist.   My cancer is definitely in the axillary tail (or upper armpit) and was close to the skin surface too (thus the initial diagnosis of a sebaceous cyst).  My doctors said it was an unusual, but not unheard of, location, so I'd urge anyone with a suspicious lump in their armpit to get it biopsied.

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May 22, 2011 03:42PM browniefranks wrote:

Toomanycocktails, the refusal of your doctor to order a biopsy borders on malpractice. It's frustrating when Doctors act like the gate keepers to access to proper health instead of partners in our health care. My radiologist did want to do a biopsy even after myself and my primary care physician insisted on it, he gave me the option to return in a week for the biopsy or watch till next physical (1 year), since according to him "it was likely nothing." Fortunately, I came back in a week and did not wait. When will these people stop lying to women that they can tell what a lump is without a biopsy? Only a pathology report can 100% diagnose cancer. MRI, Mammogram, ultrasound, BSE are all detection tools. When a woman walks into the room and she knows there is a lump there, she wants to know what it is, not be patronized or dismissed. 

Maybe484, all my fingers and toes are crossed for a positive outcome... 

Dx 3/3/2011, IDC, 2cm, Stage IIa, Grade 2, 0/3 nodes, ER+/PR+, HER2-Surgery 03/23/2011 Lumpectomy (Right)Surgery 03/23/2011 Lymph Node Removal: Sentinel Lymph Node Dissection (Right)Chemotherapy 04/05/2011 Cytoxan, TaxotereRadiation Therapy 09/04/2011 External, 3-D conformal external beam radiationHormonal Therapy 01/12/2012 TamoxifenSurgery 01/16/2014 Mastectomy (Both)Surgery 01/16/2014 Reconstruction: DIEP flap (Both)
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May 22, 2011 04:40PM, edited May 22, 2011 04:54PM by Maybe484

The surgeon I originally saw didn't order a biopsy either.  And that delayed my surgery and ultimately my treatment by quite a few months.  And if he'd done a biopsy, I would've possibly been spared one of my axillary surgeries.  I'm trying to look forward, not backward, but I've definitely become more of an advocate of my own healthcare.

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May 22, 2011 04:50PM SpunkyGirl wrote:

Maybe,

My primary was in my armpit at the tail end of my breast tissue, and so much of your story is similar to mine.  Please follow Binney's advice about seeking a good LE therapist.  I'm so glad I did, because so far my problems have been minimal. 

Good luck to you as you go through treatment.  Feel free to PM me.

Hugs

Bobbie

"Gratitude is the fairest blossom which springs from the soul."

Dx 9/4/2006, IDC, <1cm, Stage IIIa, Grade 2, 8/20 nodes, ER+/PR-, HER2+
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May 25, 2011 11:11AM Maybe484 wrote:

Just posting to thank everyone again for their support.  On the re-excision, the surgeon obtained clear margins, and my 3 SNs were clear--thankfully.  I am waiting now on the results of the Oncotype Dx to see whether chemo is advised in addition to rads.

Again, I'd like to urge everyone to check their armpits and upper arms, when you do BSE.  When having ultrasounds, ask the tech to check in that area as well.  If you do find a lump, do not allow any doctor or tech to tell you that it's just a cyst, unless they biopsy it first.  A primary BC tumor may indeed originate in your upper underarm!

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May 25, 2011 05:56PM browniefranks wrote:

Maybe484, I am so glad that you've no node involvement. Best of luck with treatment!

Dx 3/3/2011, IDC, 2cm, Stage IIa, Grade 2, 0/3 nodes, ER+/PR+, HER2-Surgery 03/23/2011 Lumpectomy (Right)Surgery 03/23/2011 Lymph Node Removal: Sentinel Lymph Node Dissection (Right)Chemotherapy 04/05/2011 Cytoxan, TaxotereRadiation Therapy 09/04/2011 External, 3-D conformal external beam radiationHormonal Therapy 01/12/2012 TamoxifenSurgery 01/16/2014 Mastectomy (Both)Surgery 01/16/2014 Reconstruction: DIEP flap (Both)