Axillary Lymphadenopathy In Lung Cancer

[Bill]

My wife's last PET / CT rad report startled us by mentioning for the first time activity spotted at her left axilla. But, the radiologist determined it to be a benign finding as the SUV was 1.1. I recall asking Dr. C about axillary lymph node involvement in lung cancer. He answered that such an occurrence was very unlikely because the axillary lymph nodes aren't in the metastatic pathway of LC. He could very well be correct but here's what I found out since. Obviously, we hope that this is a benign finding as the alternatives are LC progression or co-existing NSCLC and breast cancer. In my wife's case nothing is being done currently to rule out breast cancer. Her docs are brushing it off and want to wait for the next scan ( AS USUAL ) . Since this issue came up I have spoken with a couple of other physicians and an OCN experienced in oncology. They stated that it's not unusual for LC to involve one or more of the lymph nodes normally associated with breast cancer. So, both LC progression and co-existing LC / breast cancers, while not common, are possibilities. And, another individual sent me this info :

Axillary lymph node enlargement

Located in the axillae (arm pits).

Lymphatic drainage: Arm, thoracic wall, breast

Common causes: Infections, cat-scratch disease, lymphoma, breast cancer, silicone implants, brucellosis, melanoma

Normally they are not felt. However, sometimes they are felt as small (less than 1cm in diameter), soft, non-tender in normal people. Large tender but mobile lymph nodes indicate infections or small wounds of the arm (as a skin infection or a cat scratch). Harder, fixed or matted axillary nodes often indicate malignancy usually from the lung or breast.

Axillary lymphadenopathy should take into consideration systemic causes of lymph node enlargement as it could be an early manifestation of a more generalized lymphadenopathy.

Some of the causes of axillary lymphadenopathy

Bacterial

localized infection, possibly somewhere in the arm or breast draining into the glands of the armpit, or infection within the armpit itself

cat scratch disease

ascending lymphangitis

lymphadenitis, lymphangitis

Viral

infectious mononucleosis

chickenpox

herpes zoster (shingles)

HIV disease (AIDS)

Malignant

Hodgkin's lymphoma

non-Hodgkin's lymphoma

leukemia

Breast cancer

Lung cancer

Fungal

sporotrichosis

Antigenic

smallpox vaccination

typhoid vaccine

measles, mumps, rubella vaccine (rare)

allergic reaction possibly caused by sulfa drugs, iodine, or penicillin ( END )

Has anybody else dx'd with LC had any scans, PET or otherwise, identifying any lymphadenopathy typically associated with breast cancer ? Or, is there anybody out there with CO-EXISTING LC and breast cancer with corresponding lymphadenopathy ?

Thanks.

[john]

I belive it is pretty rare. The SUV is only 1.1 so I would guess it is not cancer

http://www.jco.org/cgi/content/full/19/9/2571

This article says synchronous lung and breast cancer happens in fewer than 0.5%

http://www.komen.org/grants/awards/abst ... antid=2573

http://www.amjclinicaloncology.com/pt/r ... 44!9001!-1

If anything the most likely thing IF there was breast cancer would be that there was breast cancer with a lung met

[Bill]

John :

Thanks much for the lung / breast cancer info. Have you ( or anyone else ) come across any info RE: the frequency of axillary lymph node involvement in NSCLC specifically or LC generally ? BTW, I wonder what the baseline or normal SUV is for a given area, such as an axillary lymph node ? Zero(0) or one ( 1 ) or what ? The only comparison of normal that I've ever seen in these rad reports is that a radiologist will sometimes comment that observed activity at a suspect location is similar to or comparable to that of surrounding tissue ( therefore presumably a favorable finding ). I'm aware that as a general rule SUVs above 3 or so are considered malignant but I've never seen or heard anything about " normal " SUV values.

Bill

[Fay A.]

Bill,

I have no hard data on the incidence rate of Lung Cancer that spreads to the axillary lymph nodes. But I do know that there are a large number of those of us who have either BAC or Adeno with BAC Features who either have a history of Breast Cancer before or after our diagnosis of Lung Cancer. And I do know that my Lung Cancer spread to my right axillary lymph nodes about a year ago. This also occurred in 2002. Iressa cleared the cancer form the lymph nodes in 2002, and Tarceva cleared the cancer from the lymph nodes in 2005.

I'm with you in that I believe that more attention should be given to the Lung Cancer/Breast Cancer issue. I had a premalignant condition of the breasts when I was in my mid thirties and I opted for bilateral mastectomies for treatment. (My Maternal Aunt and my Mother also had this. They both died as the result of Lung Cancer).

Have you and your wife considered contacting a major cancer center that has a designated Women's Cancer Research Program? I know that City of Hope in Duarte has such a program, as does UCLA I believe.

Wishing you both well.

[john]

1 in 200 is "fairly rare" not very rare as Fay had this happen.

It is interesting if there is some link between the two cancers.

Tamoxifen and Herceptin are drugs that have been used in both lung and breast cancer

And the research on women and lung cancer may lead to more advances.

If you look at the link in my previous post to komen.org it lists a grant for breast/lung cancer research

[Fay A.]

Another member of LCSC, Gail, also is a two times breast cancer and 1 time BAC Lung Cancer Survivor.

[bunny]

I'm curious, in general, about cancers that seem to have 'proximity'. in other words, near to each other on the torso. my mother had a malignancy in her thyroid in 1993. unrelated and different cells, I know, but that would make this current LC her THIRD primary. I agree, there seem to be a ton of women out there with multiple primaries. does is happen as much in men? I feel like I hear about it more, if not exclusively, in women. I am visiting a friend tomorrow who had breast cancer and now has neck cancer. again, close by, physically, although I know they're different cellularly. I am so new to all of this, it's hard to get the mind around some times.

[john]

I think sometimes the 2nd cancer could be caused by the treatment, i.e. radiation.

That may be why they are close together since radiation is a local treatment.

Usually the 2nd cancer caused by radiation will not happen for a long time.

If it happens soon I don't think that radiation could be the cause.

I would guess sometimes they (two cancers) may be related and other times they are not. It probably just depends. Just because someone has two cancers does not mean they are always connected by something.

People who have head and neck cancer are likely to get primary lung cancer.

[chloesmom]

Bill,

I'm an early stage breast cancer survivor and an early stage lung cancer survivor. I had no axillary lymph node involvement with the breast cancer and no involvement with the nodes for the lung cancer.

Both of my cancers were on my left side, with the lung tumor being right behind the radiation field for my breast cancer.

I do know that I read a study somewhere that said that if you are a smoker, and if you get radiation to your breast for cancer, then your chances of getting lung cancer are 9 times greater than a non-smoker being treated for breast cancer with radiation.

My radiation onc also mentioned in passing that my chances of getting lung cancer increase slightly with radiation to my chest.

I don't know if I'm giving you any useful info or not, it's just what happened to me. I just think it's very coincidental that this all happened on the same side of my body, two years after radiation treatment.

I also know of two other women here in my city who had early stage breast cancer, received treatment, and then developed lung tumors a couple of years later. They were treated surgically for the lung tumors, and both are still doing fine 10-12 years later.....that helps.

Cindy

[chloesmom]

Bill,

I'm an early stage breast cancer survivor and an early stage lung cancer survivor. I had no axillary lymph node involvement with the breast cancer and no involvement with the nodes for the lung cancer.

Both of my cancers were on my left side, with the lung tumor being right behind the radiation field for my breast cancer.

I do know that I read a study somewhere that said that if you are a smoker, and if you get radiation to your breast for cancer, then your chances of getting lung cancer are 9 times greater than a non-smoker being treated for breast cancer with radiation.

My radiation onc also mentioned in passing that my chances of getting lung cancer increase slightly with radiation to my chest.

I don't know if I'm giving you any useful info or not, it's just what happened to me. I just think it's very coincidental that this all happened on the same side of my body, two years after radiation treatment.

I also know of two other women here in my city who had early stage breast cancer, received treatment, and then developed lung tumors a couple of years later. They were treated surgically for the lung tumors, and both are still doing fine 10-12 years later.....that helps.

Cindy