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Dr. Andrew Rynne
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Dr. Andrew Rynne

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What does presence of metastatic cancer in the lymph node indicate?

Answered by
Dr.
Dr. Indranil Ghosh

Oncologist

Practicing since :2004

Answered : 1500 Questions

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Posted on Tue, 21 Jul 2015 in Cancer
Question: Hi...I have a question regarding oncology field....
My aunt was found 15 days ago with metastasis cancer in her left armpit lymph nodes. She went through: complete blood work, chest x-rays, mammogram, ultrasound, MR, PET scan, gynocologist's check and 2 times citology punction. All the examinations showed only lymph nodes positive, no other body part with cancer proved yet. The oncologyst says now to go through core biopsy of the affected lymph nodes. Isthis the right way or should we go through other steps?
doctor
Answered by Dr. Indranil Ghosh 15 minutes later
Brief Answer:
Yes this is one approach

Detailed Answer:
Hi
Thanks for your query.

It is a difficult but not uncommon scenario. We have two approaches.

One is we can do the core biopsy, do special tests like immunohistochemistry and try to find out the origin. It will mostly be like breast cancer and then we go for surgery, chemo, radiation, etc.

Another is to directly remove all the nodes with or without the left breast, do all special tests on the resected nodes and then chemo, radiation, etc as required. If the breast is also taken out, sometimes a small focus of cancer may be found there.

Both are acceptable and whatever is suggested by her oncologist should be fine.

Hope this helps.
Regards


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Indranil Ghosh 5 minutes later
Thank you very much!

She did immunohistochemistry by a special citology and they showed adenocarcinoma, but they can not detect origin. Since the results of core biopsy should be accessed only within 8 days and there are already 11 nodes affected - is this situation accessible i.e. isn't it too late?
Also please, what kind of chemotherapy can she expect? Will it be tough and is the chemotherapy necessary?
doctor
Answered by Dr. Indranil Ghosh 5 minutes later
Brief Answer:
yes my preference would be to go for the surgery directly

Detailed Answer:
Starting the treatment is the priority now.

Chemo will be needed as nodes are involved. It may be something based upon epirubicin or adriamycin and taxol or taxotere. Final decision will depend upon exact biopsy report and patient factors.

It may be a bit tough but it varies from patient to patient.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Indranil Ghosh 6 minutes later
Thank you!
The oncologyst suggests First chemotherapy and then surgery - what do you think?
doctor
Answered by Dr. Indranil Ghosh 1 minute later
Brief Answer:
yes that is also fine

Detailed Answer:
If there are too many nodes involved, then surgery first may not be feasible. Then we can apply this third approach. For that core biopsy is must.

After core biopsy, chemo to shrink the tumor and then surgery. Follow that with RT and hormones as applicable.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Indranil Ghosh 9 minutes later
thank you!
we have also tomorrow thermography appointment - do you believe this will maybe show the primary cancer?
doctor
Answered by Dr. Indranil Ghosh 5 minutes later
Brief Answer:
don't think so

Detailed Answer:
I don't think that after so many tests thermography has anything to add.

Let's see!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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