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Recurrence 1 year later

Hi there

I have a few questions about my pathology report. The cancer was found in an auxiliary lymph node. What does tumours cells form cords as well as tubular structures mean? Also, there was no cancer found in the breast, however the specimen was described as “florid”. What does that mean? Tests for microorganisms are to be performed.

I had stage 1 breast cancer last year. A lumpectomy was performed with a sentinel node removal No cancer was found in the lumpectomy or lymph node at that time,


Any advice or help is appreciated

Thanks so muc


.



Comments

  • moth
    moth Member Posts: 3,293
    edited December 2020

    In medicine, florid often means well developed or sturdy. I think the other tests are just descriptions of the shape of the tumor. I think they're saying it's not just a small clump of loosely associated cells but rather a more solid formed structure. I don't understand the tests for microorganisms? They should be testing hormone markers to see ER/PR/HER2 status.

    When do you meet with your oncologist to plan your treatment?

  • Lizard123
    Lizard123 Member Posts: 17
    edited December 2020

    I have a phone meeting with my oncologist tomorrow. Any suggestions on what I should ask?

    Thanks so much for the quick reply

  • leesad
    leesad Member Posts: 100
    edited December 2020

    Maybe ask if they think it's a recurrence or if it's possibly been there since your original dx last year and was possibly missed? Did you have any treatment or radiation? I had more cancer in two axillary nodes than in my sentinel nodes so it could've been there whole time and is just showing now. Best of luck.

  • moth
    moth Member Posts: 3,293
    edited December 2020

    Hi Lizard, I suspect your MO will go over all this but the things I'd want to know are:

    -when you'll get your hormone marker results

    -what scans/tests of your breasts they plan (bilateral MRI? don't know what you've had so far)

    -whether they plan to do any body scans (chest/abdomen & possibly head CT or MRI) and nuclear bone scan, to rule out spread anywhere else

    -whether you'll be having baseline blood work

    I think until you have markers back and scans done, it's hard to even speculate on treatment plans so you're in a holding pattern until all the diagnostics are done.

    This must be very stressful. Did you find the lump yourself?

    hang in there


  • Lizard123
    Lizard123 Member Posts: 17
    edited December 2020

    I did not find the lump. It was seen on a mammogram. I have also had an mri. After the mri, a biopsy was recommended.The biopsy found the cancer in the lymph node. I think they missed the cancer last year but I am not sure. I have extremely dense breasts that makes everything more difficult.


    Thank for the support. I will definitely report back when I have more news.

  • beesie.is.out-of-office
    beesie.is.out-of-office Member Posts: 1,435
    edited December 2020

    "Maybe ask if they think it's a recurrence or if it's possibly been there since your original dx last year and was possibly missed?"

    That's what a recurrence is, a development of cancer from cancer cells left behind from the original diagnosis. This can happen because cancer cells are microscopic, and it's impossible to know if every cancer cell has been surgically removed or killed off by treatment. Sometimes recurrences are discovered relatively quickly - such as in Lizard's case, or those rogue cancer cells might sit dormant for years and might not develop into a recurrence until many years later. If all the cancer is successfully removed and/or killed off, and then cancer develops again later, that would be a new primary breast cancer unrelated to the original diagnosis, not a recurrence.

    Lizard, I'm sorry you are going through this. Are you saying that when you had the lumpectomy last year, no cancer was found? So the only cancer found was in your biopsy? Did you have just one sentinel node removed or did you have more than one (that differs by individual - I had 3 sentinel nodes). And did you have radiation after the lumpectomy? What was grade and the ER/PR and HER2 status of your cancer last year? It will be interesting to see if it's the same grade and ER/PR/HER2 this year - if it's the same, that along with the short time since your previous diagnosis makes it most likely that this is a recurrence of the same cancer that has been there all along, although sometimes hormone status changes as a cancer evolves, so it could be a recurrence of last year's cancer even if the hormone status is different. And have you been on anti-hormone therapy such as Tamoxifen or an Aromatase Inhibitor? All these factors about your diagnosis last year may impact the treatments you have this year.

    I hope your discussion with the MO goes well tomorrow and provides some clarity on your diagnosis and the next steps with regard to testing and treatment.



  • Lizard123
    Lizard123 Member Posts: 17
    edited December 2020

    I had 3 sentinel lymph nodes removed and from what I understand a large lumpectomy. I had no radiation. It was not recommended because there was no cancer Iin lumpectomy or nodes. I was on letrozol for a while but had problems due to osteopenia. I was going to start tomoxifen within the next month or so.

    I realize now that I probably should of had radiation.

    I was supposed to have a special test done to see how aggressive the cancer was but the sample was too small and it could not be done last year.

    I will update after my meeting tomorrow.
    Thanks for all the advice.

    I have done chemo before for colon cancer in 2009.

    I have also done genetic testing The results were inconclusive.



  • LivinLife
    LivinLife Member Posts: 301
    edited December 2020

    Wow Lizard that's a lot on your plate and you're back at the beginning of all of this.... You've been given good suggestions and considerations. I hope the appointment goes well and you get some answers while you'll have more appointments and possibly testing yet too. Yes, please let us know how the appointment goes and next steps...

  • Lizard123
    Lizard123 Member Posts: 17
    edited December 2020

    I spoke with my MO. He is sending me for a CT scan and a bone scan. I will have an appointment with my surgeon soon. He thinks she will recommend surgery to remove lymph nodes and maybe a mastectomy.

    He thinks this is a recurrence and is not from the original cancer. He can not guarantee that.

    After that, he thinks I should do a 4 to 6 months of chemotherapy.

    Thoughts?

    Thanks

  • elainetherese
    elainetherese Member Posts: 1,625
    edited December 2020

    Lizard,

    How does your oncologist know that this is a recurrence? Is your cancer still Grade 1? Is it still ER+/PR-/HER2-? If your cancer has the same profile as it did last year, I'm surprised your oncologist isn't starting with hormonals and is going straight to chemo.

  • beesie.is.out-of-office
    beesie.is.out-of-office Member Posts: 1,435
    edited December 2020

    Lizard, if it's a recurrence, it means it is from the original cancer. A recurrence develops from cells left over from the original diagnosis. See my post from yesterday about this. I guess what he means is that while this cancer would have originated from the cancer you had a year ago (and therefore is a recurrence and not a new primary breast cancer), at that time this area of cancer might have been too small to detect, so it wasn't missed as part of the original treatment.

    Good luck with the CT scan and bone scan. Hopefully they are all clear. I can't really comment on the chemo recommendation - I don't know if an Oncotype test would be of value or whether a recurrence in the nodes within 1 year of the original diagnosis is enough to say that chemo is advisable.




  • Lizard123
    Lizard123 Member Posts: 17
    edited December 2020

    The MO told me that they will not test to see the hormone status of the biopsy. It may be done after the surgery.
    Since I am having chemo, he thinks it is unnecessary.

    As long as the cancer has not spread to other locations, the chemo will be “lighter”.

    I think the surgeon will have more information

    I think it is a higher grade (more aggressive) The biopsy indicated intermediate grade


  • elainetherese
    elainetherese Member Posts: 1,625
    edited December 2020

    That's odd. Why wouldn't the MO want to know the hormone status of your recurrence? What do you mean, "Since I'm having chemo, he thinks it's unnecessary"? Do you have confidence in this MO?

  • exbrnxgrl
    exbrnxgrl Member Posts: 4,724
    edited December 2020

    I agree with ElaineTherese. Hormone status is a very important driver of treatment options! Chemo itself is not one generic concoction that all cancer patients get. The hormone status plays into chemo decisions as well because there are many different types of chemo.Please ask your mo to clarify this or even consider a second opinion. Take care.

  • moth
    moth Member Posts: 3,293
    edited December 2020

    It could be that they're waiting for full pathology from the surgery, rather than doing it on the biopsy.

    Before you make chemo decisions, you definitely need a full pathology report, confirming breast ca & subtype, grade and hormone markers. Those things all drive treatment decisions. For example, if you've lost your marker and are now triple negative that would change chemo choices. If this is a new primary and you have HER2+ now, that would require totally different drugs.

    Are you being seen in a large cancer center?

  • Lizard123
    Lizard123 Member Posts: 17
    edited December 2020

    It is a large Cancer Centre. I will ask the surgeon when I speak to her.

    Thanks for all the information.

  • Lizard123
    Lizard123 Member Posts: 17
    edited January 2021

    I have had a bit of news. I have a bone scan tomorrow, a CT scan on Monday and a meeting with the surgeon Thursday.

    I am the most nervous about bone and CT scan. I am not sure what the likelihood of spread to bones or somewhere else.

  • moth
    moth Member Posts: 3,293
    edited January 2021

    Lizard, sounds like you're in good hands. Hang in there. This whole waiting for tests & results is stressful but soon you'll have answers and a treatment plan!

  • LivinLife
    LivinLife Member Posts: 301
    edited January 2021

    Best on scan today Lizard! Understandable you're worried about that and the CT. I certainly hope these lead to good news for you! I hope the appointment with the surgeon tomorrow goes well too.

  • Lizard123
    Lizard123 Member Posts: 17
    edited January 2021

    I spoke with my surgeon today. She is recommending removal of all auxillar lymph nodes and another lumpectomy. She does not think I should do a mastectomy.

    I think I want one considering my history with colon cancer and breast cancer recurrence. For those that opted for a mastectomy, are you happy you did it. Any advice.

    Thanks to everyone. I really appreciate all the advice.

  • moth
    moth Member Posts: 3,293
    edited January 2021

    Lizard, did you have radiation before? And I'm assuming she's recommending radiation this time? One thing to remember is that mastectomy does not prevent metastatic recurrence and that is the one that fatal. I totally get the urge to just be aggressive with it but an aggressive surgery might not be the most evidence-based action. But I get it. I considered it and even after I finished treatment in 2018, I was still considering going back as my doc said it was never off the table to do a bilat mx.

    Is your MO recommending chemo?

  • Lizard123
    Lizard123 Member Posts: 17
    edited January 2021

    I will be getting chemo and maybe radiation. Radiation will definitely be required if I do the lumpectomy. If I do the mastectomy, radiation will only de done if the lymph nodes are more involved than indicated by the MRI.

    I had genetic testing done a year ago because of the two different cancers. It came back that I had a variation in a gene that protects against colon and breast cancer. The geneticist does not know if it increases my own personal risk. There are not enough people with this variation to know what if any part it plays in my situation.

    Thank

  • LivinLife
    LivinLife Member Posts: 301
    edited January 2021

    Wow Lizard! Sounds like quite the appointment.... Ultimately you have to make a decision (surgery type) you are most comfortable with.... I had to have a mastectomy b/c I was unable to have a lumpectomy due to not being able to undergo radiation due to systemic sclerosis (scleroderma). So I doubt there is anything meaningful to help you there.... Then I decided I wanted a BMX more for symmetry - not out of concern about recurrence. I am older and was large busted so concerned about physical discomfort of only having one breast. I have never had any regrets.... In fact my quality of life is improved in several ways. That does not mean that would be true for you if you choose lumpectomy... There are related threads that would somewhat help you get info about others' experiences....

  • simonerc
    simonerc Member Posts: 152
    edited January 2021

    Hi lizard123,

    So sorry you are dealing with this again. That stinks. I have a pathogenic mutation, not a VUS. My docs at major cancer center think there may be “something else” going on as my family/personal history is more severe than the average people with my mutation. Perhaps an additional unknown mutation.
    For me, the decision to have a mastectomy was super easy. With my family history and mutation, I did not want to take any additional risk of another breast cancer popping up and perhaps being more sinister. Our chances of having a second breast cancer diagnosis are higher after having a first diagnosis. My mutation also makes breast cancer more likely. So while a mastectomy may not prevent metastasis from the cancer they found, it would almost certainly prevent a second breast cancer that would not necessarily be caught and permanently eradicated. I have not thought twice about my decision. Good luck to you!