Expert: Claes-Gustaf Nordquist, M.D. - 11/25/2010

Question
QUESTION: I have asked a question before and it relates to it.
Symptoms:

Rock hard lump in hollow of neck below ear

Recent bout of nausea lasting two weeks despite OTC and odensetron 8
mg every 12

Possibly lump on occipital lobe L side

Two lumps on chest wall below collar bone
I will feel agony in a spot and days later find a new lump sprung up like a
gopher. It was like this with all the nodal growth. Intense site pain then
nothing. No pain, just a lump. None have shrunk but a few have GROWN
and easy to see.

Bony growth on collar bone nearer to shoulder than throat-either a node
or growth due to history of dislocation, sprains and whiplash?

Severe constipation, thin BM, bouts of severe rectum pain, schedule of
stool softeners, laxatives and enema to go once a week. This is in the
past month and a half

Stomach distention, lower edema

Pressure like a fist in chest going from chest V to throat, sporadic pain in
left side

Family history of cysts in breast, polyps in the digestive system, frequent
UTIs, BM issues

Cancer history: breast, colon, ovarian, prostate in near family, all fatal
except for the breast cancer in sister

Serious stress at work, both physical and emotional. It is a highly filthy
maintenance job that required dedicated use of drops to heal damage to
eyes due to the heavy cardboard and cobweb dust, I blow black snot after
work and am chronically exhausted for its schedule and expectation.

Knee changes that began as pain, added swelling and then added lumps
to left knee. What started as one hard spot went to three lumps at a
diagonal from tibia to just below cap, with a hard ridge. Recently, the
lumps under the cap have begun to join, their peaks just as high but the
valley between filling up. Two months the tip of my R. Fibula is growing
and pulling the tendons attached and it is slowly starting to invade space
behind knee. Showed to GP, showed to ortho and x-rays showed the
white demarcation between where the bone once ended  and the new
growth.

No history of broken bones

My first doctor blew off my concerns about the lumps, two orthos -one
saying I need a lateral release while the other just said it was tendinitis-
could not see anything blatantly wrong yet instead of delving they simply
said I was fine. I got a new doctor but he's running out of steam already.

My last appointment was to examine the chest lumps and that's when the
doctor found a lump in my breast and something in my abdomen "that
might be just the aorta but I want it checked."

I have had loads of tests. CA125, CBC, thyroid, metabolic, HIV, CT of
head no dye and two CT scans of abdomen with dye. I have had a
mammogram that came back negative. My mammo test congrats letter
said it was normal but didn't mention the lump. Could the tech have
missed it? It was low to my side and the four slides the tech took seemed
only to get the majority, the fullness of my breast. No chest wall, armpits,
ribs. Shouldn't the doctor want more slides and angles, got the lump
located and magnified? I read online that if there is an area of suspicion
they are supposed to do a more comprehensive series and the four slides
are simply par for the course of non-suspicious mammos- simply put, a
screening test, not a diagnostic, right?
Anyway,  I didn't see the lump in the slides and even if it was a cyst it
should have been seen and in the report, right? Shouldn't my doctor have
looked at the slides to ensure the lump he found was x-rayed?

Le sigh. My new doctor is close to throwing in the towel, I know because
just like the other docs they did a few tests and then dismissed me like I
was some unruly kid. "the results were negative but feel free to come if
anything changes."
My latest doctor's nurse said that to me this very morning but at least she
was compassionate enough to ask after my stomach and sound sincere.

Sorry this is so long. But please. What should I do? Can this all be
stress? Can stomach problems be internal and missed by CT scans? Why
would my doctor not ask after the lump and in the asking relayed the
answer to me? Like "there's a lump. What is it? Yo radiologist, you gotta
make sure you get the area this lump is at!" if he asked after it, why would
he hide what the lump is from me?

Now I know you may toss problems at the feet of stress but on the off
chance you think I need to demand other tests, how do I do it? "Hey give
me a biopsy of this node, do a comprehensive boob test and get the
chest wall and lump area in there if possible. Ultrasound my stomach to
check it out, do a colonoscopy, MRIs..."

What tests should I discuss with my new doctor? With all these basically
normal results, should I just toss the issues to the wayside, cowboy up?
The tests covered some of the most obvious, potentially fatal problems so
if I don't have positives on any of those should I just stop worrying?

Thank you for any doctorly words you can spare. You docs on here have
been so helpful and kind...

ANSWER: Your problems are far too complicated to be possible to solve from afar!
However your breast lump should not only be checked by mammography. At least a needle biopsy of it should be done. Probably also at least an ultrasound scan, maybe also an MRI scan. With that you would KNOW what it is!



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

QUESTION: Thank you for such a speedy reply!
I called today to ask about the lump and it was visible. Their report said I
have an area of breast tissue thickening. They are not concerned about
that and they have not suggested further testing on it or the nodes under
my collarbone.
I don't know if thereis anything else on the report. Getting results are like
pulling teeth! I still don't know what all my blood tests show since the
nurse was in a rush but I assume it is normal since they haven't said
anything.
I KNOW one thing though. I am getting copies of the images and their
reports to look at myself. One of the only good things about the medical
community here is that getting such things are free and quick! I want to
move, get a better job and hopefully a doctor more willing to go the
distance without me kicking them along. I am terrified I'll be like my sister.
If her doctor had done something sooner, been proactive, she wouldn't
have frankenboobies, scars and health issues now from her cancer. Even
if it is benign or mostly stress I want to be darn sure, you know?
Last questions for you.
Is tissue thickening and pain pretty normal? Is hard fixed nodes normal
too and will they ever go down? I neglected to mention age, I am 29 and
on the shot so no period for a year and a half. Is that a combo for imps?

Answer
Dense breast tissues with lumps & pain are rather common. To evaluate mammograms is HARD even for a well trained diagnostic radiologist! It is not something I recommend for amateurs (= patients) to try to do! Such breast problems usually end some time after menopause (not immediately because then there is still estrogen). With such problems it is extra important to complement with ultrasound and/or MRI breast scans since mammography is less able with dense breasts. At your age you have many years with these conditions ahead of you while the cancer risk increases with age. Hormone treatment may increase your breast problems.



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