Expert: Claes-Gustaf Nordquist, M.D. - 1/12/2008

Question
QUESTION: I am a 62 year old female.My cervical node biopsy shows metastasis poorly differentiated adenocarcinoma. The immunostains suggest it is breast cancer. However, the mammography and sonography of the breast found no lumps. The sonography also found a malignant node on the left axillary region (although a biopsy has not been done here so far). Would I still have late stage breast cancer if mammography and sonography have found nothing?

ANSWER: To be on the safe side I would also suggest an MRI breast scan! Well so far we have some indications that this may be a breast cancer but no sure breast cancer has been found! So I would call this lymph node metastases of unknown origin (but where a breast cancer is suspected also due to the location of the lymph node lesions). Another thing that should be done is a CT scan of your lungs in order to rule out if possible anything there. Another thing that can be done is a PET scan to search for tumor suspect lesions anywhere and everywhere. Therapywise I would suggest radiation therapy against your lymph node lesions (after biopsy confirmation) and chemo therapy.
Good luck! Please keep me posted!


---------- FOLLOW-UP ----------

QUESTION: Thank you very much for your response. It is very much appreciated. According to the immunohistochemical staining results for the cervical lymph node (on the neck), the Tumor Cells are ER(+), PR(+), HER-2(-), GCDFP-15(+), and TTF-1(-). Findings are compatible with metastatic breast carcinomia. I have also read the some breast cancers are not visible on mammograms. Is it possible to have breast cancer not detected by mammograms which are still spreading? How do I know what other organs have been infected?

Additionally, circumferential pleural thickening was seen on the right chest. The subcentimental pretracheal nodes size is 7-8mm. No lung mass or infiltration was seen.

Answer
Thanks! yes a breast cancer seems likely. Yes such a mammography failure is possible. That is why I suggested a breast MRI scan! The lung CT scan is also important as is the PET scan which can not only (perhaps) find the primary but may also find other places it may have spread to.