If lymph nodes were clear, can cancer spread?

I read the posts often and have appreciated the valuable information I have learned - THANKS!

I am 43 yrs old, I had bilaterial breast cancer (DCIS 1.6 cm and invasive 4 cm lumps), lymph nodes were clear. Completed 6 months of chemo and 6 weeks of radiation and taking tamoxifan. Still experiencing chemo-induced menopause and low white blood cell count.

I am participating in a clinical trial for herceptin but qualified for the 'observation' arm only. During the baseline of tests I mentioned to my oncologist I have been having daily headaches for about 2 months that have woken me up at night and are there in the morning......she ordered a CT
Scan.....which showed a 'spot'.....which is too small to diagnose and now I am going for a MRI.......it takes a while in Canada to get these and I am seriously considering going to the United States for one - does anyone know the cost of MRIs?

Can breast cancer spread to the brain if it wasn't in the lymph nodes? Can it just "show up" in another part of body?
I just finished chemo at the end of January 2004 and radiation in mid April
2004 - I am greatly stressed about this.....

I am going away for the weekend and probably won't have an opportunity to read any replies until I get back....Thanking you in advance for your support!

Here's what I could find....
TI - An assessment of routine liver scanning in patients with breast cancer.
AU - Wiener SN; Sachs SH
SO - Arch Surg 1978 Feb;113(2):126-7.

A retrospective review of the value of routine perioperative liver scanning for patients with breast cancer was performed. The liver was considered to be normal in 231 of 234 patients. The hepatoscan uncovered only one patient with unsuspected metastases. There were eight false-positive studies. Measurements of liver function, SGOT,
SGPT, alkaline phosphatase, and bilirubin levels separated true positive from false-positive hepatoscans for all except one patient.
Abnormal liver chemistry studies also identified liver metastases in an additional follow-up group of 192 patients. The low yield of detection of hepatic metastases during the initial work-up of breast cancer patients suggests that routine hepatoscanning be abandoned unless there is evidence of abnormal liver function.

Palli, D, Russo, A, Saieva, C, et al. Intensive vs clinical follow-up after treatment of primary breast cancer: 10-year update of a randomized trial. JAMA 1999; 281:158.

Most breast cancer recurrences, however, are detected by the patient herself or by physical examination performed by a clinician. Except for mammographic examination, available evidence does not call for the routine use of any diagnostic or laboratory test, including tumor markers for which the effect on survival is still unclear

Jennifer did you have any scans done or did your doctors assume clear lymph nodes meant no metastases? From your message it sounds like the latter. If so, get the MRI. In the unlikely event that you have a brain metastasis, you should inquire about taking Temodar along with the radiation treatment. If you need it I can provide a phase III clinical trial that shows Temodar just about doubling the effectiveness of whole brain radiation.

OTOH with a small spot they may choose some sort of focused radiation in which case Temodar would be irrelevant.

Here's hoping that all of the above is irrelevant and the spot is a blob on the negative!

re internal mammary nodes--it might be helpful knowing because then that area which normally is not given radiation could with increased disease free survival as well as somewhat increased overall survival. http://www.jco.org/cgi/content/abstract/21/14/2713
Journal of clinical oncology, Vol 21, Issue 14 (July), 2003: 2713-2718"The
Roole of Irradiation of the Internal Mammary Lymph Nodes in High Risk Stage II to IIIA Breast Cancer Patients After High Dose Chemotherapy: A Prospective
Sequential Randomized Study"

Conclusion: In patients with high-risk stage II to III breast cancer, the inclusion of the IMN in the radiotherapy field was associated with a statistically significant increase in DFS and a borderline increase in OS.

Hi Jennifer, sorry to hear of the discomfort you have been experiencing. I hope that it isn't cancer. Chemo and often resultant hormonal changes (i.e.
chemo/menopause) can change our body chemistry. As far as the subject title--"If lymph nodes were clear, can cancer spread?" --that question is a bit hard to answer because generally speaking when lymph nodes are tested the only ones tested are the axillary nodes. Recent findings have indicated that a certain %age of breast cancer patients who have negative axillary nodes might still have positive internal mammary nodes. In addition, I believe that a certain % might who are node-negative might test positive if there bone marrow was tested. I am not sure of the exact numbers on either, though. Still, if ones' lymph nodes did test clear, than their chances of spread are mch lower than not that there will be a recurrence. Statistically speaking the odds would be on the side of no recurrence, but it is not impossible for it to happen either.

incidential lumps, shadows are nothing and not cancer, >>

Does that apply to one who has had a cancer dx? I thought that was just the stats for breast lumps in general but that once someone had cancer, that the stats re. possibility of malignancy of any other breast lump was much greater?

when none exists. A year after my chemo ended, a CT scan showed a tiny spot on my lung. Six months later, a repeat scan showed all was clear. >>

Glad to hear that there is still no problem. However, that doesn't mean that there wasn't an initial problem. It is possible that something was there but that your body was able to take care of it. You are quite fortunate if that is/was the case!

Thanks everyone for your replies.....it makes it all a little less frightening...

I was in panic mode when I wrote my note and didn't even THINK that it may be nothing!
I had assumed the worst and was scared....

I appreciate the advice and will consider it depending upon the outcome of the MRI.

Thanks for the support!

True, but it also answers some of the Jennifer's original question as to whether or not if lymph nodes were clear, "can cancer spread"? I am wondering if that happens more often in cases where not all axillary lymph nodes have been removed? I also read that that it isn't that difficult to test internal mammary nodes, although it generally is not, if ever done. It could make a difference, though, because if they were positive, then radiation for that area which is usually not done because of increased risks, could be done.