Topic: Questions on Node biopsy

My onco ordered MRI, pet scan, bone scan, muga scan after mastectomy & before my chemo

Oh Cindy!  I'll share what I did.  Others will be along, too.  I had an MRI and a PET/CT scan before decisions were made.  I also had a Sentinel Node Biopsy before chemo so that they had an idea of what the stage was. This is not an unusual sequence for ILC.  After all the information from the scans and SNB was gathered, I had chemotherapy before a mastectomy.  I did chemo first because I wanted to know if the chemo worked not because I was aiming for a lumpectomy.  

It may help to schedule another meeting to go over everything again.  Believe me we all are overwhelmed at first and need to ask the same thing over and over.  The doctors are used to that.  Be sure you ask lots of questions.  Get answers you understand, even if it means going line by line over the pathologists report, the PET report, and the MRI report.  Take a small recorder with you so you can refer back to what was said, I did that.  If you don't understand something later, call them back and ask your questions.  You deserve to understand what is happening to you.

I agree with your surgeon; it's good to meet with the oncologist before making any decisions.  You may even want to take copies of your pathology reports on your biopsies, the CDs of your PET and MRI and get the opinions of another surgeon, another oncologist, and if you are considering reconstruction, a plastic surgeon or two.  Some of us even have our slides from our biopsies read by another pathologist.  All this information really helps you clarify what's happening to you and what your choices are.  You don't have to rush.  You don't want to feel rushed.  

Deep breath.  We are here! Come see us and bring your thoughts and questions.  Also, remember we all are incredibly emotional and afraid when we are diagnosed.  We know how hard the whole process is.  HUGS.  G. 

Dear Cindy,

Take a few deep breaths. Then ask yourself and your surgeon whether the procedure can be done next day or the day after. In other words, don't let the surgeon push you into an immediate decision. Take the time to go find an independent medical oncologist at a reputed teaching hospital. Then find another independent surgeon who does only breast work. You need second opinions before starting treatment.

While early detection offers the best chances, a few weeks will NOT make a difference. Also, not sure what you mean by "mets" in your diagnosis line?

Before the treatment plan is decided, the following tests are helpful:

Mammo

Ultrasound

MRI

PET-CT

Biopsy of the tumor

BRCA

Ask for copies of all test reports and images as you get the tests done. Ask the ordering doctor to explain each and every phrase in the reports.

Dear Cindy,

I too think the "needle biopsy" on the node was unusual. But it is done.

For tomorrow be prepared with written questions and ask for copies of reports and ask her to review the reports with you to __your satisfaction__. Do not agree to any _procedure_ that she asks you to do tomorrow itself (imaging tests are ok). If she wants to schedule you for surgery, take the date but also make it clear that you will do surgery after getting an independent second opinion. Take the surgeon's suggested other surgeons and oncologists contact info but do not get the second opinion from these surgeons or oncologists.

Sorry for being a cynic but many of us have been thru' this process. No one can think with a clear head in a surgeon's office when faced with cancer. The surgeons know this and use this advantage to keep you hooked. They lose about 50% of the patients who go for second opinions.

Good luck.

Deanna- Thanks so much for answering!

Now to answer your questions. I have had an MRI done on 10/19/09, and it did in fact show a questionable lymph node. She then said that, she had felt something during the examination the previous week.

Also, my surgeon specializes in strictly breast surgery. I have checked into her background with high marks. It just seems to me i am only getting half the story. In fact today I called them to ask what grade my cancer was because nobody had told me.

My PET Scan is scheduled for Wednesday 10/28/09, and I Have an Appointment on Friday 10/30/09 with the  Plastic Surgeon.

Tomorrow I get the results on the lymph node biopsy. I will keep you all informed. Thank you all so much for listening and caring!! :)

Dear Cindy,

Any update? By the way I revisited the recently updated NCCN guidelines today and have some news for you.

Contrary to what I said earlier, Core Needle or Fine Needle biopsy of nodes is ok in certain cases, eg when the cancer is believed to be invasive not in situ and pre-operative chemo is indicated and the lymph nodes do not look suspicious from clinical exams.

Please let us know how you decided to procced and what's the diagnosis so far?

I had a needle biopsy on a node and that gave us the information regarding the tumour. The lobular tumour in the breast did not show up with mammogram or u/s. The mri showed an area of enhancement.

I hear more people starting chemo before surgery in order to determine if the chemo works.

Good luck.