Fatty globs of what?

Yesterday was my ultrasound on what the doc thinks is a lipoma (benign, fatty tumor) on the upper inside of my right elbow. I have another one on my left arm, but it is higher and more towards the back of my arm, right over the tricep.

I discovered these myself after I was looking at a chart of the lymph system. I know that finding swollen lymph nodes would be a very bad thing when associated with breast cancer, and that this is how the cancer can spread to the rest of your body - through the lymph system. I know the lymph system travels the entire body, but I didn't know that I had lymph nodes just above my elbows. I thought all the ones near your breasts were just in your armpits, across your collar bone, and in your neck. The chart shows more of them on the inside of your arm, just above the bend of your elbow.

I knew that I had a lump on the inside of my upper right arm. It has been there for several months. Maybe a year or more. It has never bothered me. I always assumed it was some sort of fatty deposit. I have a fatty deposit near my left wrist, and again, it's never bothered me.

I knew a man who had so many of these that he looked like he had marbles just below the surface of his skin all up and down his arms. He told me his doctor had told him that they were fat deposits and not to worry about them unless they caused him pain of some kind. I did what anyone would do and accepted his doctor's diagnosis for my own singular, fatty deposit on my wrist.

When I saw on the diagram that there were lymph nodes above the elbows I immediately palpated the one on my right arm. It definitely felt larger and was definitely more sore and tender than it has been in the past, but only when manipulating it. Then I started feeling all around the back of my left arm, and was completely surprised to find another tender, swollen area, this one higher on my tricep and more at the back of my arm.

Since that makes a pair, I have to assume that maybe my lymph nodes are just in the wrong spot. I called my oncologist to let him know. He told me that in 23 years of treating cancer he had never seen breast cancer cells travel to the elbow lymph nodes. He explained the lymph nodes kind of work like little, filtering sponges, catching and trapping things before they move through the body's lymph system. This is why the cancer cells are "caught" in the armpit, collarbone, and neck nodes - they are the ones closest to the breasts. They have repeatedly palpated those three areas and ask about them every time I have been in to see them, but no one has ever checked or asked about inside my elbows.

I was making a trip to DSM the following day and asked if I could just stop in and have him take a quick look. He said sure, so I did. He examined all of the usual node locations as he has done in the past, with the addition to the elbow ones. The one on my left arm is small - I had to find it twice and show him exactly where to palpate. He repeated all of the same information he had told me on the phone: It is highly unlikely that first of all, those are even my lymph nodes, and second of all, that they would have filtered and collected breast cancer cells that would have run right by the armpit nodes. Just to be certain he said they would do an ultrasound but on the right arm only, since he can barely feel the one on the left.

While I was laying on the table talking to the ultrasound tech (her name was Karri), I was able to get a little information out of her. She told me the size was 2.5 cm, or about an inch. She also warned me when she was going to press down fairly hard on it, but that was something she was supposed to do. I asked why and she explained that they want to know if the tumor compresses or if it stays fairly hard or firm. Mine was staying firm. It was a nice, short ultrasound visit.

After my oncologist had a chance to review the ultrasound and talk to the radiologist late yesterday afternoon, he called me. He told me that he still thinks this is a lipoma. He said there is no blood supply to the tumor, which is about 1" across. It does not "squish" when being compressed, which is good. However, the ultrasound revealed another, smaller tumor under the big one and this one does have a blood supply, and it does "squish" when the bigger tumor is being pressed into it. What that means is that this secondary tumor is alive and growing. The radiologist (and no one else for that matter) can't tell simply from an ultrasound what these tumors are or are not. His position is that since the patient has a history of cancer, all abnormal growths should be looked at as having the potential of being cancerous. (It took me a minute while listening to the oncologist relay this to me that he was referring to me as the "patient".)

The only sure way to know is to do a needle biopsy on both tumors, or to do outpatient surgery (probably even just local anesthesia) and just remove them both. The oncologist said if it was his decision, he would have the surgery done so that they could do a complete pathology on both tumors and have definitive knowledge on both. Again, he stated that he would be "stunned" (his word) if either of these show cancer cells.

I agreed with him and want to take them completely out. I know I have at least one more in my left arm. If the pathology is clean on the ones that are removed, then I won't have to worry about the one that remains. I will meet with him before my chemo treatment this Friday and we will try to get this outpatient surgery scheduled between my chemo treatments, but obviously not during the time frame that my white and red blood cell counts will be way down.

That is all I know so far on the "fatty globs".