Potential Lymph Node Metastasis in Breast Cancer Patients

Suspected metastasis of breast cancer to the cervical lymph nodes?

Hello Dr.
Chen, my mother has been diagnosed with breast cancer for eleven years.
Initially, she underwent a total mastectomy of the right breast and axillary lymph nodes, but did not receive chemotherapy.
She has been on hormone therapy for five years and has regular follow-ups.
During her appointment yesterday, the doctor mentioned that a breast ultrasound revealed an unusual lymph node in her right shoulder and neck, with a classification of 4A, and that a biopsy is needed to determine if it is malignant.
My mother is 73 years old and has high blood pressure.
She also has issues with phlegm in the morning and a sensitive gastrointestinal system that easily leads to diarrhea.
Upon hearing about the biopsy, she expressed that she does not want to seek further medical treatment.

I would like to ask the doctor: if the biopsy results are malignant, aside from surgical removal, would she need to undergo radiation or chemotherapy? I am very concerned that, given my mother's physical condition, undergoing radiation or chemotherapy would only affect her quality of life.
If we choose not to perform the biopsy and it turns out to be malignant, what potential scenarios could arise? Regardless of treatment options, my primary consideration is to ensure that my elderly mother can live well.
Thank you for taking the time to answer my questions.

Ms. Chen, 40~49 year old female. Ask Date: 2011/12/07

Dr. Chen Sirong reply Oncology

Ms.
Chen / 41 / If a biopsy is not performed, what potential scenarios could arise if it turns out to be malignant? 1.
If it is malignant, recurrence and metastasis could occur, leading to various symptoms that cannot be cured without treatment, which would continue to trouble her, and you would be exhausted from the effort.
2.
If it is benign, confirming this would alleviate unnecessary worry for your mother.
My personal recommendation: a biopsy is essential for confirmation.
If you prefer to start with a PET scan to check for metastasis, that is also an option, but ultimately a biopsy is necessary for confirmation.
If the biopsy indicates malignancy, in addition to surgical removal, will radiation therapy or chemotherapy be needed? 1.
Surgery, radiation therapy, and chemotherapy may all be required.
2.
Only chemotherapy is more harmful to the body, but after recovery, she should be able to regain her health.
3.
However, it is possible that after undergoing all three treatments, she could live for another eleven years! 4.
I recommend proceeding with all treatments; if it becomes truly unbearable, adjustments can be made.
5.
Not proceeding with treatment would only lead to unnecessary worry, and without intervention, the condition will likely worsen.
She may not necessarily have a better quality of life without treatment.
Please support and encourage her.
Thank you for your letter.
Sincerely, Chen Si-Rong.

Reply Date: 2011/12/07

More Info

Understanding potential lymph node metastasis in breast cancer patients is crucial for determining the appropriate treatment and management strategies. In your mother's case, having a history of breast cancer for eleven years and undergoing a mastectomy with axillary lymph node dissection, it is important to monitor for any signs of recurrence or metastasis, especially given the recent findings of a suspicious lymph node in the right shoulder and neck area.

When a lymph node is identified as suspicious, as indicated by a classification of 4a on ultrasound, it typically suggests that there is a moderate concern for malignancy. The next step, as recommended by your mother's physician, is to perform a fine needle aspiration (FNA) or core needle biopsy to obtain tissue samples from the lymph node. This procedure is minimally invasive and can provide critical information on whether the lymph node contains cancer cells.

If the biopsy results confirm malignancy, the treatment options will depend on several factors, including the extent of the disease, the patient's overall health, and previous treatments. In general, if metastasis to the lymph nodes is confirmed, the following treatment strategies may be considered:
1. Surgical Intervention: If the lymph node is found to be malignant, surgical removal of the affected lymph node(s) may be recommended. This is often referred to as a lymphadenectomy.

2. Adjuvant Therapy: Depending on the characteristics of the cancer (such as hormone receptor status and HER2 status), your mother's oncologist may recommend additional treatments, which could include:
- Chemotherapy: This may be suggested if the cancer is aggressive or if there are multiple lymph nodes involved. Chemotherapy can help reduce the risk of recurrence.

- Radiation Therapy: This is often used after surgery to target any remaining cancer cells in the area. It can be particularly effective if the cancer has spread to lymph nodes.

- Hormonal Therapy: If your mother's cancer is hormone receptor-positive, continuing or resuming hormonal therapy may be beneficial.

3. Palliative Care: Given your mother's age and existing health conditions, it is essential to consider her quality of life. If aggressive treatments like chemotherapy or radiation are deemed too taxing, palliative care options can be explored. This approach focuses on relieving symptoms and improving quality of life without necessarily pursuing curative treatments.

If your mother decides against the biopsy and the lymph node is indeed malignant, there are risks associated with not knowing the status of the cancer. These risks include:
- Progression of Disease: Without treatment, the cancer could spread further, potentially leading to more severe health issues.

- Limited Treatment Options: Early detection and intervention often lead to better outcomes. Delaying diagnosis may limit treatment options in the future.

Ultimately, the decision regarding whether to proceed with the biopsy and subsequent treatments should involve a thorough discussion with her healthcare team, considering her preferences, overall health, and the potential impact on her quality of life. It is essential to balance the need for effective cancer management with the desire for a good quality of life, especially for elderly patients.
Encourage your mother to express her concerns and preferences to her healthcare providers, as they can help tailor a treatment plan that aligns with her values and health goals.

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