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Expert Q&A

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Can breast cancer spread despite clear lymph nodes?

Asked by PJ, Texas

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If breast cancer is caught in a very early stage, and a lumpectomy and sentinel node biopsy show no metastasis, can an HER-2 positive type of breast cancer appear later in the lungs, bones, liver, etc.? That is, spread to other parts of the body without any metastasis from the breast tissue itself?

Expert Bio Picture

Conditions Expert Dr. Otis Brawley Chief Medical Officer,
American Cancer Society

Expert answer

Dear PJ:

The answer to your question is yes. The traditional treatment of a breast cancer is removal of the tumor through lumpectomy or mastectomy and a removal of armpit lymph nodes also known as a lymphnode dissection. This is to see if the cancer has spread to the armpit area. I prefer a sentinel node biopsy in which all the nodes are not removed, just those one or two that drain the area of the breast where the tumor is found.

A negative node or nodes lowers risk of spread to the rest of the body but not to zero. A small percentage of lymph node negative patients will have disease show up in the next several years. Common places that breast cancer spreads are the lungs, bones and liver.

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