Hi Cecelia -
When I had my recall from a travelling mammo unit, gor the normal 3 yrly mammo for over 50’s I had the 3 step programme at the hospital - compression mammo, ultrasound and core biopsy, all within 2 hours. The Director of the Breast Care Clinic actually did the ultrasound and biopsy - don’t know why. They she took my husband and I into a consulting room and gave us tea in china cups! This was on the NHS so I knew I was in trouble. They explained I had a tumour (never mentioned the word cancer) and I needed either a Wide Local Excision and radiotherapy, or a mastectomy (which frightened me witless as I didn’t even have a palpable lump, and my GP checked this out on both breasts) without rads. They also said I would have some sample nodes removed. I at that time had no clue what lymph nodes were, and the breast care nurse at that meeting showed me a diagram. In the WLE they took out 8 nodes, 3 were cancerous, so I went back a month later for total axillary removal - much more painful than the WLE. In total I had 18 nodes removed, and 1 more was cancerous, so this was when chemo reared its’ ugly head, which of course, I had, along with rads.
I believe women (don’t know about men) have varying number of lymph nodes under the armpit, some have as many as 50, some as low as mine, 18.
As far as I know cancerous non palpable lymph nodes cannot be picked up on a mammo or ultrasound. They have to take them out and send to pathology for diagnosis. I am not sure if palpable lumps in the armpit mean cancer. I think it is just best practice to sample lymph nodes when removing a tumour or DCIS/LCIS in case the cancer has spread. I was unlucky, but many women with bc don’t have the spread.
After my two surgeries, and whilst beginning chemo, I had various scans on my liver, bones and lungs. All were okay. This again, is just a precaution to see if the cancer has spread to these organs. I don’t know the statistics on this spread, but think it may be low.
I didn’t understand at the beginning of my treatment why I needed chemo and radiotherapy. It was explained to me that the chemo is to “mop up” any stray cancer cells that may have gotten through the lymph nodes, and the rads is further insurance to zap any stray cancer cells that may remain in the affected breast.
I am not quite sure where you are in treatment - you mention seeing an Onc, so are obviously having, or about to, have chemo. Is this neo-adjuvant treatment to shrink the tumour before surgery? If so, this could explain why the Onc feels your lymph node for any sign of swelling.
When you have surgery, they will either do the new sentinel node biopsy, or the full sampling like I had, as sentinel node biopsy was not available at my hospital in Devon when I was diagnosed 4 and a half years ago. I think I am right in saying that no doctor - surgeon or oncologist can tell if a lump, malignant or otherwise, is cancerous just by feeling, mammo or ultrasound. (A cyst however can be aspirated and if fluid comes out, is usually benign.) It needs a biopsy of the tissue and a pathologist’s report. Same with lymph nodes.
I am sure if I have got any of this wrong, none of us are doctors, someone will correct me, as I would hate to give you wrong information.
Hope all goes well with your treatment.
Liz.