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Recurring lumps in neck and armpit. Diagnosed with breast cancer, had mastectomy Advised for biopsy on lumps. Suggest?

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Oncologist, Surgical
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hello sir. i am rica and i am here right now in canada. i have some questions that concerns my aunt who has been diagnosed with breast cancer and had a mastectomy 4 years ago. when she got operated there is 1 tumor that was not taken out of her body because it is located in between nerves. at that time, the cancer was already in stage 3. when she consulted her doctor about the recurring lumps in her neck and armpit, she was told that those are no longer operable. however she was told that they can perform another biopsy on the lumps on her neck and armpit. what i dont understand is why the biopsy will be performed again. and what will be the effects it will do to my aunt. thank you
Posted Wed, 15 May 2013 in Breast Cancer
 
 
Answered by Dr. Rohan Khandelwal 2 hours later
Dear Ma'am,

Sorry to hear about your aunt's problem. If the cancer has spread to the neck, it is non operable but can still be treated with chemotherapy and hormonal therapy. The biopsy of the neck lymph nodes is required for two reasons:
1. to confirm whether the cancer has spread to the neck or not
2. to confirm whether the cancer in the neck (if present), is hormone receptor positive or not. This would govern the next line of management.

Lymph node biopsy of the neck is a minor procedure done under local anaesthesia and hardly takes 20 minutes.

Hoping for the best. Please feel free to clarify any other query.
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Follow-up: Recurring lumps in neck and armpit. Diagnosed with breast cancer, had mastectomy Advised for biopsy on lumps. Suggest? 2 hours later
Hello Dr. Khandelwal. I appreciate your quick response on this query. I think i need to ask you some follow-up questions. Your answers will help us decide whether we will gamble on my aunts surgery.

When my aunt first consult her doctor last week. she was told that they will not operate on her anymore because her body might not be able to take the procedure anymore. besides, that they cannot administer anymore chemotherapy on her. when she had her mastectomy 4 years ago, she already undergone with the radiation chemotheraphy. She is 65 years old now. And we worry about her if she gets to be opened on her neck and armpit that she will just die sooner. And that will be very tragic. She is not a bedridden. But we worry about her getting tied to her bed because of the surgery. Is it really necessary to cut her open instead of just getting the needle biopsy. She was also told that she will be administered with a general anaesthesia and might stay in the hospital for 3 or more days. It's kind of freaking us out.
 
 
Answered by Dr. Rohan Khandelwal 6 minutes later
Dear Ma'am,

Thank you for asking your query. Considering the fact that the disease has spread to the neck, she does not require any major surgery. All she requires is a small lymph node biopsy (which can be done under local anesthesia and is a short procedure), to confirm the spread of cancer and to know whether it is hormone receptor positive or not. If it turns out to be hormone receptor positive, then she will receive oral drugs for 5 years (not chemotherapy) and they can help in prolonging her survival and improving her symptoms.
Unfortunately, a needle test cannot tell us about the hormone receptor status, which is mandatory for treatment. Lymph nodes biopsy does not require three days admission and will certainly not increase her morbidity. You should discuss the points I have mentioned with your treating surgeon.

Hoping for the best. Please feel free to clarify any other query.
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