Lower inner quadrant?
Im going for my core biopsy tomorrow and am looking to find any women who have been Dx-ed with breast cancer in the lower inner quadrant of the breast?
Im looking to find the basic "what to expect" if test results come back positive.
My mammorgram and ultrasound showed a sold mass at about the 4'o clock position.
Im reading up on info on the "internal mammory chain".
Just seeing if there is anyone in either stage 1 or 2 with these characteristic out there?
TIA
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Hi, Marie
for what it is worth, I was diagnosed in 2002 with a 1,5 cm tumor in the 4 o'clock position. Not found on mammogram because it was too deep and I had very dense tissue. I also had one node involvement, turned out to be med grade, med her2, low positiv estrogen. It was close to the rib cage. anyway, I did TAC chemo, rads and 2 years tamoxifen followed by 5 years of arimidex. So far so good, still dancing with "NED". Just think positiv, there is light at the end of the tunnel.
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I had one in that position also. Mammo didn't pick it up even after I showed them where it was.
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My tumour was at 6 o'clock! Very hard to find on mammo as it's so close to the chest wall. Easy to feel otherwise.
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Mine was lower inner quadrant of the right breast, also around 4 o'clock position. I, too, read about the inner mammary chain and asked both my surgeon and my oncologist about the increased risk of the position of the tumor. Both of them said there was no difference in the treatment for such a tumor and looked at me blankly when I cited a study I had read.
At that time, I guess I took it as good news that they were not concerned about my findings. I'm currently 2 years NED and had all but forgotten about increased risk of the LIQ tumor. Please let me know what you find out. I need to bring it up again next time I see my oncologist.
Tricia
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I had 2 tumors one on each side (simultaneous) both at 4:00. (no way to put this in my description, so I just put the largest one in) I complimented my screening mammo technician because when I went for followup more extensive views at another facility, some views didn't show the tumor, yikes, scary to think it could have been missed for another year! Breast surgeon couldn't feel either one on examination. Sizes were 1.2 and 2 cm. Neither oncologist or surgeon were at all concerned about positioning, but it still kind of worries me?
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I had LIQ tumor- I wonder if the oclock positions given change whether it is like you are looking at the breast (where the LIQ would be 6-9 oclock?) . Mine was described as being at 7-8 oclock, but it was the LIQ- just inside of the nipple, mine showed up well bc it was so close to the surface.
I was pretty surprised when they did the core biopsy coming in from the lower part of the breast- going through about 2 inches of breast when the tumor itself was very close to the surface! But they had the ultrasound wand directly over the tumor.
I have read some of the tumor location affects prognosis stuff online and I have always been surprised its not something that docs seem to consider at all. I wonder if its bc %-wise we are a small part of the bc population.
I know the lymph system flows both ways, but when I look at a diagram of the lymph system and the breast- it really seems a lot more likely to me that any cancer cells would be a lot more likely to go into the intramammary chain. I had a .254 cm spot of cancer show up in my sentinel node. It was 7 weeks from my biopsy to surgery, my biopsy needle track still was hurting a lot- I really wonder if the cancer that showed up in the axial node they tested got there somehow from the biopsy.
I do feel somewhat better that I had a PET scan in the beginning of chemo- if there was a large spot of cancer in the mammary nodes maybe it would have shown up on that. I think part of why potential spread to the mammary node chain is ignored is they can't easily get those nodes out to test.
My local rads onc wasn't sure whether I should have radiation or not. I had a mx and I only had the one + node, but I didn't let them take any others out, so there could have been more, hence considering radiation. He sent me out of town to a breast specialist rads onc for a second opinion and she told me of a study she'd read that looked specifically at women with IQ tumors and compared the results of them having the normal ANLD and then also looking at their mammary nodes- a significant % had cancer in the IM nodes and not in the axial nodes.
So I think the main concern is potential undertreatment- women who are told they don't need chemo- or have a mx and don't have radiation, and its not standard to have the IM nodes radiated.
I ended up having my IM nodes radiated on the advice of that onc- my local onc did not intend to do them.
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Something else to consider- women with IQ tumors have higher rate of Cardiac problems after getting radiation. I had left side- over the heart- I had a more precise form of radiation for what's worth- hopefully hit my heart less than regular rads.
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Link to another study about using PET scans to stage IQ tumors. I have to admit I'm concerned now- tho I had a PET scan after my first chemo round- I had had TRAM recon about 6 weeks prior and the high metabolic activity from that all that healing might have masked any postive IM nodes.
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LIQ here also...right breast about 4 o'clock position.
I found the lump myself - it came up ovenight and was painful.No axilliary nodes were palpable, though 3 turned out to be affected. Intra-mammary nodes were not even mentioned.
The day after my mast, the consultant came on her ward round with her retinue of students and said 'I think we got it all - it was quite deep'.This really worried me until I saw my surgeon for results 2 weeks later and he confirmed that indeed they had 'got it all'.
I had all the tx going:: 4 x FEC, 4 x Taxotere, 25 rads to 3 fields (including supraclavicular), 2.5 years of tamoxifen followed by 5 years of aromasin.
It is now just over 9 years since dx. So far, so good.
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My tumor was also LIQ. I had 6 axillary nodes involved. Rads were also to IM nodes, since according to my rad onc is standard here for node+ women.
Leah
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I hope you will take the location seriously. A week ago I had my right breast removed due to cancer deep within the 6:00 position. In spite of 2.2 cm size, the tumor could not be felt due to its position against the chest wall. I met with the onocologist for the first time yesterday, but I will be looking for a new one this week--someone who will take the position of my tumor into consideration when developing a treatment plan. Cancer in the lower quadrants should be treated more aggressively because cancer in the lower quadrants is often in the "untested" intra-mammary nodes. The current oncologist insisted on ordering a $4,000 DX test to give me my odds of surviving if I don't do chemo and radiation. I want chemo because my cancer is grade II/III and is lumpvascular invasive, and I have have good reason to fear that the cancer may in my intra-mammary nodes.
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janetcheryl- I had IQ too- I think you are doing the right thing to insist on finding an onc who will take your concerns seriously. I think tumor location is something they just haven't done that much research on and don't have enough data to make things standard of care for those of us in the minority. The research that is done shows we have a have higher chance of getting undertreated because of cases like yours where you are axial node negative and your onc is trying to save you having to do chemo with the Oncotype DX test- but that test does not account for tumor location- for all you know you could be intramammary node positive and chemo would be automatic. Personally I think with grade 2/3 and vascular invasion you should do chemo anyway.
I had grade 2/3 as well - SNB was false negative and then showed .254 cm spot on histology- which honestly I feel came from seeding from the biopsy needle track (also an area of little to no research done). But that spot made me do chemo- in my case they already suggested it bc of high Ki67 score and my young age (35), but I had planned to refuse chemo cause I was freaking out. In a way , I'm glad I had the node and it led me to treat the crap out of it- once I was doing chemo, doing rads was no big deal. I feel like I pushed to have rads bc of the tumor location.
my local rads onc wasn't sure if I should or not- sent me to a breast specialist rads onc in St. Louis and she told me about research on tumor location showing that a high % of women with inner quadrant tumors had spread in the IM nodes. But something else to consider in doing rads to the IM nodes is the high risk of cardiac damage, esp on the left side (which I had),I had IMRT/Tomotherapy radiation for what's it worth which is more precise and limited the amount of radiation my heart received.
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Hi Aylad:
I really appreciate your response to my post. Monday is a big day for me--I'm telling the oncologist that I'm going to leave her and find someone who will take a look at the location of my tumor in the right breast. It is sad when patients need to do their own research to prevent doctors from under-treating their lower quadarnt cancers. My surgeon thought that the oncologist would want to do both chemo and radiation on me. But the oncologist I saw on Friday said she would not consider radiation since I had a mastectomy.I won't deal with a oncologist that refuses to listen to my concerns.
After reading my surgical pathology report, I'm really glad I chose a mastectomy. In addition to the cancer, the pathologist saw a number of atypical features at various locations within the same (right) breast. I'd like to have the left breast removed because it may have the same atypical lobular hyperplasia as was seen in the breast with the cancer. I've already had multiple MRIs done on the left breast due to focal asymetry. I don't like the idea of constantly having to have my remaining breast monitored for cancer. At almost age 57, my breast tissues are unusually dense, making cancer difficult to spot on mammograms. I favor removal of the left breast prior to any cancer developing.
I'm glad for you that you did both the radiation and chemo. All the research I have seen stresses the need to treat lower quadrant cancers very aggressively. I am thinking about using an oncologist at Vanderbilt University in Nashville--about a 2 1/2 drive from my home in East Tennessee. Where I live, we just don't have good medical expertise. In fact I used a general surgeon instead of a oncological surgeon.
Again my thanks.
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If you wanted to take a really long drive for a consult- I saw Marie Taylor at Barnes Siteman cancer center in St. Louis - she was fantastic- does nothing but breast radiation oncology. My local rads onc hemmed and hawwed- I was in a really gray area whether to do rads or not- I had a skin sparing mast with TRAM recon. He suggested the second opinion and I was all for it- he also sent a friend of mine up there to see her. I'm 3 hours SW of St. louis
I was all about being informed-I went out and bought a new laptop a couple weeks after dx . I felt like I really had to know the right questions to ask with my docs- I was asked if I had a medical background a couple times cause I was so informed. It's my damn health! I'm not blindly handing it over to someone else! I still sometimes wonder if I overtreated-but I have to say no- I'm glad I threw everything at it. It can never hurt to get a second opinion, you really don't even need to have the conversation with your current onc explaining why you are looking elsewhere- you are the customer and you have a right to be satisfied with your care.
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Hello Alyad,
Thanks for your support. I have an appointment the Clinical Director of the Breast Clinic at Vanderbilt on March 31. She wants all my cancer-related medical records and images. In just the last 24 hours, I learned that the MRI corrected the earlier records regarding my tumor location. It was positioned more like 5:00 instead of 6:00 as first thought when they looked at mammograms and ultasounds. Vandy will be doing a variety of scans to determine if my cancer has already spread,
instead of guessing that it has not. Only then will they know what stage of cancer I am in.
I feel certain that the Vanderbilt staff know about cancers in the lower, inner quadrants.
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I'm looking forward to hearing what you learn!
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Me too! I feel like this is certainly something us IQ gals need to push for special treatment since the one size fits all SNB may not detect IM spread . I think I should have had a PET scan before surgery perhaps? the local rads onc was not going to radiate my IM nodes, but he sent me up for the second opinion and thus went with her radiation plan thankfully.
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I have memories of the MRI tech almost dancing around the machine saying 'vascular invasion'!! If that's the case.........??
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Here's my update: My oncologist at Vanderbilt ordered the Oncotype DX Test. I scored a 19, which is at the lower end of "intermediate." She decided on chemo (4 cycles of TC) since my tumor was located in the lower inner quadrant.; however, she did not recommend radiation.
I had my first chemo treatment two days ago and am doing okay. Once I finish my chemo, my medical oncologist plans for me to start hormone therapy. Although I have a lot of trust in her, I might see a radiation oncologist at Vanderbilt for a second opinion. I'm a firm believer in second opinions. By the way, I am very well pleased with the Vanderbilt staff. They appear to be caring, genuine, and intelligent.
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Well I just stumbled upon this thread and am a little nervous right now. I underwent a lumpectomy on my breast last Thursday and am awaiting path results. The BS indicated that only one axilla node lit up during the sentinel node biopsy and it was enlarged. This node did test B9 in a FNA biopsy, and the report indicated no lympatic invasion.
My tumor was located lower outer quadrant left breast, according to US & Mammo, 4 o'clock, according to MRI 6 o'clock - does that make it inner quadrant? Feeling the lesion, I would describe as 4 o'clock. The mass was considered middle depth of the breast. The MRI also indicated that all lymph nodes in all areas looked fine with no adenopathy.
Anyways I have subsequently researched the quadrants of BC and lymphatic invasion so naturally I am concerned about the intramammary lymph nodes that are not tested. In all honesty I was hoping to avoid chemo but now this new finding has me wondering and of course scared. What a rollercoaster ride!
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DebRox, it sounds like your is more outer quadrant, but maybe right on the edge. Since you had lumpectomy, you'll be having radiation. you might ask if they plan to radiate the intramammary nodes. Since yours is on the left side as mine was, concern about hitting the heart with radiation comes into play. I had IMRT/Tomotherapy radiation- a more precise method of delivery, but not available everywhere.
Did you have the oncotype test? Was the FNA the only biopsy of the SNB they did? I would think if it was enlarged, an excisional biopsy would be called for? I think excisonal biopsy of SNB is standard. My intial SNB during surgery tested negative and then when histology test came back it had .252 cm spot of cancer- so I did chemo (but fwiw they wanted me to do chemo even before I had the positive node- I would have had high Oncotype due to really high Ki67 score (76%).I refused further ANLD and did radiation instead. I had a mast with TRAM recon.
You are so right about it being a rollercoaster ride- it does get easier once you get past the surgery and have a treatment plan in place.
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my bc was in the LIQ at the 6 o'clock position in left breast. You could not feel it as it was so deep and did not show on the previous mammogram a year prior. It will be 4 years on July 9th this year since found. I did lumpectomy and rads and been on AI's will be 4 years in December this year. My onco dx score was an 18. Not sure how the rads were done. My sentinel lymph nodes were fine he removed 6 of them and there was no sign of vascular invasion. So far so good and I pray everyday it remains that way. right now am not sorry I did not do chemo because i am scared to death of the stuff have a sister and daughter in law who give it and know to much....I also react to many medications and that scared me with chemo....I was a stage one with 1.5 cm and a grade 3........This bc is somethng no one can perdict...
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Alyad: regarding radiation, I had iort, done at time of surgery directly to the tumor bed. No other radiation is required, unless the snb comes back with micromets. Then I could require external rads.
I am awaiting the path, probably tomorrow. The inital look at snb indicated all clear, but I await histology of that node. Once that is complete the bs will request oncotype test. I have no idea what my k167 score is. Wasn't on my original core biopsy path.
Anyways worried about the intramammary nodes based on where my tumor located. I will be discussing this with my bs at my follow up on Thursday. I wonder if the physicist runs the gieger counter over the intramammary nodes when looking for the sentinel node.
I also meet on onc on thursday before my appt with bs. Yes need to get treatment plan in place. Im petrified of chemo!! I'm 46 and premenopausal, definitely more risk.0 -
Ki67- I guess sometimes its done with initial path- but I've also read its usefulness is limited. However, I believe it is one of the factors that is looked at as part of the Oncotype. I remember my onc saying mine was high- 70% or so- she said we like to see that under 20%- or basically anything over 20% is considered high. My understanding is its a measure of how many of the cells are dividing. So high ki67 is bad, but also means chemo will work better cause it kills cells that are in the process of dividing.
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the thought of chemo is terrifying. I was going to refuse it. But should you end up needing it- it is totally doable.It was the longest 4 months of my life, but I made it through.
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Alyad; I actually received good and bad news in my path. Good news margins and lymph node clear. Bad news tumor larger than expected - moved me to stage 2 as it is larger than 2 cm now. Also grade is more aggressive now grade 3 and the noted vascular invasion along with perimeural. In addition ki-67 is 50%. actually more bad news than good.
Bs will not request oncotype test. She is certain chemo in my future abd after receiving a copy if path sounds like it to me. I'm reeling with this news. Last week on cloud nine with prelim surgery results, this week devastated. I meet with a mo on Thursday.0 -
Debrox, oh I'm so sorry. I'm glad your margins and nodes are clear tho. My tumor was 1.7cm, had a little bit in one node, so I was stage 2 as well. A high ki67 does mean it was dividing alot, but also means chemo will work better.
Losing your hair is the worst part of chemo- at least for me mentally. I felt like if they could take that part of it away, itd just seem like some unfortunate treatment I had to endure, but because it is such an exterior visable thing- hey world- I had cancer! I didn't do a wig, but if I had to go through it again I'd consider it, just to be able to go out in public and feel like the world wasn't staring at my doo-rag. There is a thread on here somewhere about these things called Penguin Cold caps to save hair- where you wear a cold cap to restrict blood flow to your scalp and try to save your follicles- i think its worked for some.
as much as the idea of chemo sucks- if you look at it in the big scheme of things- its a few months of your life to give you a better shot at being around for many many more years to come. I did probably one of the more brutal chemo regimens TAC x 6- three drugs at once. More commonly people do AC x 4, then T x 4. It takes a little longer, but I think its a little easier on your system. I was given the choice and I asked if the SE's were the same and my onc said they were !!! I think bc I was 35 at the time they thought I could handle it better. I had very involved TRAM recon surgery 5 weeks before starting chemo- I think the combo of recovering from major surgery and chemo right after was too much for me.
the actual day of chemo- you really don't feel much- you go and get hooked up and sit there and its no big deal, you don't get instantly ill. Even the next couple days really aren't that bad, maybe I felt more tired than usual. Days 4-6 were the worst for me- but I never threw up. The way your body processes the toxins, that is when the second pass through hits your liver and it feels having the flu or being really hung over. I just laid around a lot and couldn't handle being vertical. I couldn't really concentrate enough to read a book or watch a movie. I took about a week off work after each of the 6 treatments, days 7-10 were kinda iffy. Days 10-20 I felt close to normal, but more tired than normal.
I joined a thread for everyone starting chemo the same month- there may already be a May 2011 chemo thread- you get to know women who are going through everything the same time. i found it very helpful.
I think from what I've read, my SE's fell somewhere on the more extreme side- many women have a lot less SE's and some manage to hardly take any days off work. The more active you are , the better. I wasn't very active. In retrospect I wish I had just taken 6 months off work - I had disability insurance, but I made less and at the time I felt a sense of loyalty to the company I worked for, so I tried to work as much as I could. I got laid off a few months after finishing treatment tho.
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I agree with Alyad. A high Oncotype score is far from a death sentence. It means chemo will benefit you much more than someone with a lower score. With chemotheapy, the chance of reoccurrence could be about the same as someone with a low score.
Just a tip for anyone starting chemotherapy. While the tip doesn't having anything to do with the lower inner quadrant location of my tumor, others with intense intestinal cramping (a possible chemo side effect) might want to know there is a solution.
I'm on day 10 of my first chemo cycle. I was told that days 2 and 3 would be might roughest days of my cycle, instead my side effects grew much worse with time. My intestinal cramping was seriously like hard labor during childbirth. The pain was so horrible that I had decided not to have any more chemo. Finally, on day 6, I called the oncologist and told her of my unbearable pain. She prescribed Bentyl. The drug helped some immediately; and after the fourth dose, the "labor pains" stopped all together. By the way, I am doing everything I am suppose to be doing to prevent all chemo side effects, it is just that some of us have a more difficult time than others. While I don't look forward to future chemo cycles, I think I can endure with God and Bentyl on my side.
I realize that chemo might not be effective in my case since I have an Oncotype score of 19, but I want to do all I can to be cancer free. I'm still concerned about the lower-inner location of my tumor, but I am praying that the chemo will kill all cancer cells wherever they might be.
I wish the best for all of you as you are being treated for your LIQ breast cancers. As a BC survivor told me, "All we have to do is survive until the cure is found." Who knows but what a cure is just around the corner.
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I'm NOT being treated for my LIQ bc....sigh. The surgeon said to save the big guns until next time. At the time I thought I'd dodged the bullet. Now I feel like it just re-aimed.
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I just happened to come across this thread again a couple years later. I don't come here much anymore, mainly posting for anyone who might come across it with LIQ. So in march 2012- a little over 3 years from my initial surgery, I was diagnosed with lung,liver,brain, bone mets. At least I can look back and say I didn't undertreat. My intrammary node chain lit up on my PET scan- I'm pretty sure that's where it spread from. I had 2 3-4 cm tumors in my left lung, and others in the right but those big ones on my cancer side where the ones causing symptoms- a large pleural effusion making me cough. I did 5 months of chemo and got it under control some- switched to hormonal treatment. FWIW, I took tamoxifen for 6 months and then quit bc of side effects.
I'm on ovarian suppression and Aromasin now. I'm doing alternative treatments as well. I feel like conventional medicine is limited in what it can do.
My avatar kitty has been gone for a year too. Miss her so much.
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