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Hamsa has a very good point in that a new appearance of cancer doesn't have to have anything to do with the previous one. I had a relative who had breast cancer in 1995 (lumpectomy and focal radiation). Last year, a new appearance turned up in the other breast. It was another "primary" and was treated as such. This time, a mastectomy with breast reconstruction at the same time (Oncoplastic Surgery).
Unless the pathologist was absolutely certain, a lump in her neck doesn't sound very much like a BC met. Pathology is a very visual science. The pathologists look for patterns. Cancer grows in recognizable patterns that allow for their identification. Even two different pathologists looking at the same cells can reach different conclusions about who has cancer and what type. Pathologists can readily distinguish between big invasive cancers and normal tissue, but they disagree about what to call cancer in a large gray area in between.
Usually, a pathologist will never make a diagnosis unless they are 200% sure of the diagnosis. However, there are occasions where the pathologist may turn to an Immunohistochemical (IHC) diagnostic staining test performed on microscope slides, with intact cells and looks for proteins themselves. An IHC is just a furthering of the investigation of the tumor specimen when the original pathology is really unsure.
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