How can they know not stage 4 if only scanning locally?

[biops]

Apologies I am in the diagnosis to staging/treatment plan limbo so spiralling a little.

I have grade 3 TNBC, tumour looks small (13mm), lymph nodes looked clear on ultrasound but we won’t know until surgery which is 6+ months away as I am most likely doing chemo first.

I have an MRI tomorrow for my chest area, I just don’t understand how they can be confident staging now if they don’t look further?

I’m spiralling a bit as I’ve had lower back ache for a few weeks.

Can you afford to pay for a scan privately? I think I would in your situation. Waiting for the NHS to do stuff can be like watching paint dry - I say this as someone whose DH had stage 4 cancer.

Cancer spreads locally first, so from breast to lymph nodes in the armpit or in the chest. They will look there first. If that shows anything suspicious they will expand the scanning.

@AquaViperI just worry I could be 7+ months away from surgery before they can properly check the lymph node? I know I will be in chemo which helps, but presumably it would be better to know for sure?

Completely understand your concerns. The best person to give you advice specific to your situation would be the breast cancer nurse specialists working with your consultant - do you have their contact details?

Grading is about how abnormal (ie aggressive) the cancer cells are. Staging is about spread, so they can tell the grade of cells from your biopsy, but staging depends on sentinel node biopsy during surgery and also scans.
I know it's hard, but trust the process. I found treatment very impersonal, I suppose because they do do much of it, but they do know this cancer inside out.

Wishing you all the very best, try as much distraction as you can

For staging they would use CT and/or PET scans rather than MRI. Statistically if there isn’t significant lymph node involvement then the chances of distant spread are so low that most guidelines don’t recommend scans as the benefit does not outweigh the risks.

If the MRI shows any suspicious nodes or other areas of concern then usually they will biopsy these straight away to look for cancer. The decision of whether or not to do a staging scan would be reassessed depending on those results.

Thanks all, I have my first oncologist appointment on Friday. I do have breast cancer nurses I can call though they’re the surgery team, not sure if I will get a different contact while I’m with oncology? They made it sound like I won’t have much to do with the surgery team until my genetic testing is back.

You should have a breast care nurse which usually sit within the oncology team. Your surgical breast nurse is completely different and under the surgical team. I had and still have both different types of bcn as they deal with completely different aspects. Would reach out to oncology to ask at your next appt :)

In my hospital, the breast care nurses work for both the surgeons and the oncologists so basically bridge the gap between the two. It’s a small hospital though (I have to go to a bigger hospital for my actual surgery). They’ve been great so far because any time I have a query I can just email them and they will liaise with whichever person they need an answer from, it’s like having your own personal advocate!

They all get together for the MDT meetings too, so don’t worry, there will be surgical input into your case when needed.

I believe there are two different stagings for breast cancer.. the first one it's called a clinical staging and that just relies on a physical examination, the mammogram/other scan and any initial biopsy results that they've got..

Until they take some from the tumour and lymph nodes, you won't get a more exact final staging. But ( in my case at least) they do keep doing scans of this and that along the way. afraid I don't know the names. As others are saying, you do need to place your faith in the docs..

Your treatment will be informed mainly by the clinical staging and the grade - how fast it is growing. Breast cancer is so common and they are changing the protocols all the time.. Best wishes.