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Dr. David
Dr. David, Board Certified MD
Category: Medical
Satisfied Customers: 60230
Experience:  Board Certified Physician
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Ok....thank you so I know one looks 'not good' from ultra

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ok....thank you
so I know one looks 'not good ' from ultra sound , havent got MRI back yet ...will MRI show more ? Or will assessment really have to wait til surgery ???

This is Dr. David. I am reviewing your question now and will be with you momentarily.

it sounds like you are looking at a possible breast mass or breast cancer

an ultasound of the arm pit can look at the lymph nodes of the arm pit and see if they are possibly enlarged with breast cancer

but the mastectomy and axillary lymph node dissection will be able to tell for sure if there is cancer in the lymph nodes.

Customer: replied 10 months ago.
Dear doctor I am not looking at possible breast cancer ! I have diagnosed breast cancer .. a tumour as I have stated . No is reading the question carefully ? I am asking if the MRI will reveal significant spread ( or not ) before surgery ..... thank you

MRI scan can see some breast cancer spread to lymph nodes in the arm pit in some cases.

Customer: replied 10 months ago.
That’s very helpful thank you . I forgot to ask this . I see my consultant next week with MRI results and subsequent to that he will book surgery for already confirmed breast tumour . And removal of as many lymph nodes as necessary ( all ? ) I just wondered if MRI would tell him extent of spread AHEAD of surgery and also whether it would / could make him add chemo to my already planned radio therapy . Thank you for your very helpful response ...

I am cancer doctor.

with most mastectomy, most surgeons will do a standard axillary lymph node dissection of level 1 and 2 of the axilla. you can ask what your surgeon will do.

if there is no evidence of cancer spread to the arm pit, your surgeon may just decide to do a sentinel lymph node dissection of the axilla

if there is large amounts of cancer in the axilla seen on the MRI scan, he may decide to do a full axillary lymph node dissection to remove levels 1-3 of the axilla.

many factors go into the decision if you need additional radiation therapy or chemotherapy.

for chemotherapy, you have to have substantial systemic recurrence risk which would be brought down by chemotherapy.

if you have a large primary tumor or many lymph nodes involved, or high oncotype score or ER negative hormone status or her-2/neu overexpression needing biological herceptin therapy, these are often indicators that you also need systemic chemotherapy

Let me know if you have other questions.
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Customer: replied 10 months ago.
dear Dr Dave .....thank you , a very helpful and clear answer . X

you are welcome

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Customer: replied 10 months ago.
Thankyou again. I have just noted your speciality : and i wonder if you know the answer to this ......It has been suggested ( thus far) by my consultant that I will receive 3 weeks of radiotherapy after my mastectomy plus axilla removalof nodes surgery ...thats's 3x5. So I imagined it would be more ? But am I having the accelerated higher dose in a shorter time ? Is that harder to deal with ? thankyou again; much appreciated . b

that is the new UK and canadian fractionation to get the whole breast radiation done in 3 weeks

if you have cancer in your arm pit and need a more extended radiation field to cover your axilla and supraclav and internal mammary lymph nodes, I tend to use a longer 5 week radiation course with 5 weeks of radiation to the lymph node areas as well.

and then I add a 1 week boost to the area of the surgery which ends up being 6 weeks.

talk to your radiation oncology doctor about those options.

Customer: replied 10 months ago.
Thank you again. Amazing to be able to talk to you inyour specialist field . I have every confidence in my UK surgeon consultant but without this sort of detail and ref points i don't know what questions to ask . I am hopeful that the MRI results will reveal more about axilla lymph nodes ths week . An anxious time so help with this invaluable . Big thank you again Dr D. b

you are welcome
You can always reach me with "a question for Dr. David" in the medicine or oncology categories if you have other questions.
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