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Medical Forum / Diseases and Disorders / Breast Cancer / December 2003? for Sandy L or anyone who has info--aortocaval lymph node...
I was wondering if anyone knew what an aortocaval lymph node is and what the significance of an enlarged one might mean? Is there a way to biopsy it or can it be removed? Where exactly is it? If malignant what symptoms might there be? Can radiation help? > I was wondering if anyone knew what an aortocaval lymph node is and what the > significance of an enlarged one might mean? Is there a way to biopsy it or can > it be removed? Where exactly is it? If malignant what symptoms might there > be? Can radiation help? Aorto would pertain to the aorta and caval to the vena cava. the two are close together in the upper chest, above the heart, but further apart elsewhere, so I would guess that aortocaval means enlarged lymph nodes in that region. Causes could (of course) include metastasis, but could also include tuberculosis, histoplasmosis, coccidioidomycosis, lymphoma, and an inflammatory node for other reasons. It could be biopsied through mediastinoscopy--introducing a fiberoptic endoscope through an incision above the top of the breastbone. If malignant, it could be treated with external radiation or could perhaps be removed surgically by either medistinoscopy or open surgery. Sandy L wrote <<<< Causes could (of course) include metastasis, but could also include tuberculosis, histoplasmosis, coccidioidomycosis, lymphoma, and an inflammatory node for other reasons. >> Well, I know I don't have TB. I have had 2 skin tests for that in the past year for work; both were negative. << It could be biopsied through mediastinoscopy--introducing a fiberoptic endoscope through an incision above the top of the breastbone. If malignant, it could be treated with external radiation or could perhaps be removed surgically by either medistinoscopy or open surgery.>> Nothing is being recommended. Shouldn't they be suggesting a biopsy or ? > Sandy L wrote <<<< Causes could (of course) include metastasis, but > could also include tuberculosis, histoplasmosis, coccidioidomycosis, [quoted text clipped - 10 lines] > > Nothing is being recommended. Shouldn't they be suggesting a biopsy or ? The first step probably will be to repeat the x-ray in a while ad see if it changes. If it goes away, you don't care what it was badly enough to want the biopsy. If it changes, that may force some additional steps. Sandy L wrote <<<< The first step probably will be to repeat the x-ray in a while ad see if it changes. If it goes away, you don't care what it was badly enough to want the biopsy. If it changes, that may force some additional steps. >> This was a CT scan not an x-ray. The first CT scan mentioned something in that area but said there were no nodes greater than 1 cm. This CT scan reported that the node in the aortocaval area was 2.5 cm. That sounds like a change to me. The first CT scan had reported several retroperitoneal nodes but commented that they were 'not likely associated with breast cancer.' Generally, they're not. However, I learned this past year that this was the 3rd most common site for metastases for lobular breast cancer, one of the 3 types I had. In addition, as I have included in previous posts, I had 9 positive nodes and extensive lympho-vascular invasion. So, unfortunately, my risk for mets, as I have been told, is quite high. It is hard not to feel a bit uneasy about the above reports. (Welcome to 'managed care'). Now, the radiologist did have that first report available at time he wrote up report. He just did not have the scans because the tech had only brought him one of the four envelopes which had the scans. In fact I was asked if I had the scans (after the test). I told them that I did not. I then called my onc's office to get the report a couple of days after scan was done. (Report is on tape and dr's can give verbal report, if it isn't yet transcribed). My oncologist told me that they could not find the films for comparison. I called down to x-ray and spoke with the head gal. She told me that the films were there all along--just that the tech had only given the dr. one jacket. He did not ask for anything further at the time he wrote up report. However, he may have done that after nobody was around--although I can't imagine that there wouldn't have been someone around to compare the films. I just want something done, IF needed and could be helpful, while there may still be a window of time to keep things in control, before it's too late. Another question for SandyL or ?--would an aortocaval node be the same as an aortic window node or are they in different locations? > Another question for SandyL or ?--would an aortocaval node be the same as an > aortic window node or are they in different locations? Kaye, it would seem that aortocaval lymph nodes run vertically (in the body) don't read these all, just demo-ing. <http://www.google.com/search?as_q=aortocaval+lymph&num=10&hl=en&ie=UTF-8&oe=UTF- 8&btnG=Google+Search&as_epq=&as_oq=prominent+enlarged+&as_eq=&lr=&as_ft=i&as_fil etype=&as_qdr=all&as_occt=any&as_dt=i&as_sitesearch=&safe=images> it would seem that lymphadenopathy is another word for enlarged lymph nodes http://merck.praxis.md/bpm/bpmtables_print.asp?article_id=BPM01HE13 http://www.aafp.org/afp/20021201/2103.pdf <http://www.google.com/search?q=lymphadenopathy+breast&hl=en&lr=&ie=UTF-8&oe=UTF- 8&as_qdr=all&start=70&sa=N> From the one there that says mcgill.ca a Word document (doc) In assessing lympadenopathy, consideration should be given to present infection or illness, number of enlarged LNs, location(local/disseminated), size, and consistency. LNs larger than 3 or 4 cm are abnormal. The consistency of the LNs provides a clue as the stimulus of lymphadenopathy. Soft and tender LNs are associated with infections. Non-painful hard LNs warn of carcinoma while firm, rubbery Lns are often found with lymphoma. Imaging studies may be undertaken to determine the extent and location of lymphadenopathy. Modalities may include radiographs, CT, MRI, or ultrasound. CT and ultrasound serve as good initial strategies for imaging (CT being more accurate of the two, ultrasound the more economical). [] no idea if this helps or makes things worse. J << no idea if this helps or makes things worse. J >> J, thanks so much. It was most informative--or at least most of it was ;-) I couldn't relate to the testicular cancer even though one of my lab requests indicated that a sperm count had been ordered ;-) (nurse checked of wrong box). > Sandy L wrote <<<< The first step probably will be to repeat the x-ray in a > while ad see if [quoted text clipped - 28 lines] > I just want something done, IF needed and could be helpful, while there may > still be a window of time to keep things in control, before it's too late. It may be appropriate to get pushy now. SandyL wrote<< It may be appropriate to get pushy now.>> I find it all a bit mind boggling. Good news, though--I saw a neurologist last week--one of the top in our city who specializes in M.S. He looked at the brain scans with us, and we felt reassured. He explained how the lesions are most probably related to M.S. and how one differentiates those from brain mets. In addition, he pointed out that they had improved. He said that AC can help with M.S. I was a bit surprised since I didn't think that the chemo crossed the blood-brain barrier. As far as the dizziness and balance problems. That seems to have cleared up. In fact the last bout of balance diffculty was 2 weeks ago after the bone scan. That was the worst of the attacks--lasted 8 hours; however, I haven't had any since and they had been happening daily and up to several times throughout the day. The neurologist thought confirmed my suspicions--that they were most likely due to the benign paroxysmal positional vertigo--calcification deposits in the inner ear that had come loose. I just had a thought though--and don't know if would even be a possibility. Since cancer can present as calcifications in the breast, why can't that happen in the inner ear? Now as far as the CT scan, I am still dumbfounded by that one--the 2.5 cm lesion in the aortocaval node--that wasn't mentioned in the first CT scan but supposedly has been there. I am guessing that aortocaval may be somewhere near the retroperitoneal nodes. Perhaps something is still going on which is related to the unexplained lower leg swelling that I have. My legs are like tree trunks. I am also getting edema in my abdominal area again--but the end of the day I look and feel at least 7 to 10 mos. pregnant. Other than that I am feeling great. Yesterday I went to an outdoor art festival for most of the day. For the first time my lower back hurt while sitting but also for the first time in ages it didn't hurt while standing in one place. I was there from around 1 to 5. Then, today, I met up with some of my walking buddies from the Susan G. Komen 3-day. We did 7.5 miles at about 3.5 miles per hour. It was exhilarating. They are now in-training for the L.A. Marathon. I am contemplating it but not yet ready to sign up. I do hope to do the 3-day again, next year though if all is well. I do hope that all the walking I am doing is not contra-indicated with my swollen legs. The spine dr. told me last Spring that I shouldn't be using the treadmill (because of the mass or cyst in the L4/5 region of lumbar spine and that I should go back to riding the exercycle. I would if we had one but my husband bought the treadmill last winter. As far as I can tell it hasn't worsened the problem, and pain-wise I feel so much better after the exercise. I suppose I should get another opinion there. Anyway, I am still very uneasy about the aortocaval node. If it were there before--at time of first CT scan and if it wasn't mentioned or evaluated, is that medical negligence? If that were the case then I could have been stage IV at time of dx--and that would allow me additional or different options for treatment. I am holding my own now--I think. My shoulder hurts tonight... > SandyL wrote<< It may be appropriate to get pushy now.>> > [quoted text clipped - 42 lines] > at time of dx--and that would allow me additional or different options for > treatment. I am holding my own now--I think. My shoulder hurts tonight... Negligence is sometimes hard to define. If there were a smaller lesion then, it might be possible to look closely at the same place as a larger lesion now and say "It was there, too." If a lesion then and now were close to the borderline of detectability, it would be hard to prove negligence. It there were an obvious lesion then--the sort of thing even I might recognize--then negligence may have been involved. Sandy L wrote: << If there were a smaller lesion then, it might be possible to look closely at the same place as a larger lesion now and say "It was there, too." >> Very true. However, my oncologist said there was "no change" since that first CT scan. The current scan done in 11/03 reports that the lesion is 2.5 cm. The scan of 4/01 states that visible lesions were less than 1.0 cm. <<If a lesion then and now were close to the borderline of detectability, it would be hard to prove negligence. It there were an obvious lesion then--the sort of thing even I might recognize--then negligence may have been involved.>> I guess the fact that there has been supposedly 'no change' is good. I was doing some research on lobular. The retroperitoneum and retroperitoneal nodes are a likely site for metastases to occur. Yet, the radiologist who read the first scan stated that there were several enlarged retroperitoneal nodes, not likely associated with breast cancer. That is true for the majority of breast cancers. However, the retroperitoneal area is the 3rd most common site for mets from lobular. I was relaying the above to an acquaintance/friend who is a private radiologist. He was not aware of the different metastatic pattern of invasive lobular. I was also just sent a post from someone who had an enlarged node in that area. Her node size was about 1.5. She was put on chemo because of that and her node is now .9 cm. When I read of cases like that it reinforces my lack of faith in some of the caretakers I am seeing along with the system. |
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