Expert: Claes-Gustaf Nordquist, M.D. - 6/7/2007

Question
Dear Dr. Nordquist,
I will try to be as concise as possible, you appear to be a very busy man! I am now 40 years old. Six years I had a breast-conserving mastectomy with lymph node dissection.  One of the 4 nodes was positive for cancer. Five years ago I finished a 6 mo. course of chemotherapy, followed by 5 weeks of daily radiotherapy for breast cancer.  Recently, I have "felt" that texture/density/scar tissue was changing and saw my GP for investigation. I have had a mammogram and ultra-sound. There are microcalcifications on/near the scar tissue of the original surgical site. I know you can't tell from looking at the films, but my surgeon says he doesn't thing it's anything serious, but just the same, I'm headed for a stereotactic core biopsy (waiting for the appointment). I understand that when breast cancer recurs in cases of lymph node involvement there is a risk of metasteses to the bone, liver, lungs or brain. I am overweight and might be considered a high-risk. Several months ago I fell down a stair and jammed the joint of my large toe. Because I could wiggle it and walk on it, I never had it x-rayed. It has never completely healed, I have unexplained, quite noticeable pain in the joint, even in the middle of the night, keeping me from sleeping...how likely is it that there is cancer in that joint? Should I be worrying to the degree I am? I am a school administrator and teacher and I don't have the time to be as affected as this.  In the dark of the night, I'm lying awake, certain that the cancer has returned and that I'm dying.
Thank you so much for taking the time to read this long note, and for taking the time to answer.
Denise Graham

Answer
It is good that this biopsy will be made, after that you will KNOW if anything there is wrong. With regards to your toe, it is not very probable that any cancer is there but I can not guarantee that. So I suggest that you take an x-ray of your toe. To make sure that there is no cancer anywhere maybe you should have at least a PET scan made of your body. Good luck!