QuestionQUESTION: Dear dr Nordquist,
Four years ago my wife had cancertissue in one breast. It had been found in a very early stage. The tissue was removed by breast-sparing surgery. The edges of the ectomy were reported to be clean by the laboratory. Afterwards radiation was administered.
Three years later one spot of calcification was found in that same area. We were not notified. This autumn some ten specks of calcium were seen on the mammographs. We were told that either they just were the result of previous surgery or a sign of new cancertissue.
Punction using a thick hollow needle was tried, but it failed: just out of reach. Then the area was cut out by surgery: there was found a cancer of 3mm diameter, around it 10 to 12 mm of clean tissue at every side. They did not decide wether it was a residue or recidive. It seems most likely to be a residue. Several scans have been carried out to look for spreading of the cancer to lungs, bones or intestines. Nothing detected.
This was last december. The proposal for further treatment was full breast-abduction and removal of all lymph nodes.
We asked for a second opinion at our national cancer institute Anthonie van Leeuwenhoek. They said the abduction was necessary, but not the lymph nodes removal.
We consider 'our' cancer a very slow and not very active one. It was there four years ago, could have been cut out or else radiated 'away'. Yet it came back, but was cut out AS IF breast-sparing surgery was done once more (though it was just meant for diagnosis). We understand that extra radiation is out of the question. But couldn't we just go into semi-annual checkups again INSTEAD of having the breast amputated?
If abduction would be carried out we expect the analysis to show that no cancer could be found - proving that in hindsight the breast could have been kept!
Extra info:
My wife now is 54 years of age, she had her menopause.
Nothing was mentioned about eventual receptors for certain hormones or
particular proteins.
Please advise us as to wether IN HER CASE
- breast abduction can be avoided/postponed
- diagnosis (eg by mamographs) can be done without a real risk that detection would be too late
- an eventual new cancer (residue/recidiv) will not be quite aggressive per se
- there are other aspects to consider
Please do not read this as a wiseguy-idee-fixe, we really want to be convinced of the necessity before the operation! Or to avoid (postpone?) it if that can be done safely.
ANSWER: Unfortunately I have to agree with her drs. since no more radiation can be given. I do think however that the surgery can be done together with breast reconstructive surgery. Please discuss that with her surgeon!
---------- FOLLOW-UP ----------
QUESTION: Dear dr Nordquist,
Thank you for your swift response! One more question though.
We are considering the slowness of this cancer and the fact that either it has been completely removed or there is still a trace left.
Why can't we await what is shown on mammographs and if there is a new growth THEN have the abduction? Or avoid it!
AnswerHonestly I believe that this is NOT her old cancer! It is in my opinion far more probable that this in fact is a NEW cancer. Since she has already been irradiated before and if this indeed is a new tumor we do not know how fast it is growing I do have to tell you that amputation (mastectomy) is the only way to go.
