When I hit my 40s, I was happy, healthy and very, very busy. I was a caretaker for someone I loved. I was writing books. I took up golf, learned about scuba diving and participated in my first triathlon, doing lots of TV work, creating my clothing lines… I was really living life, taking care of myself, eating well and getting regular massages was a part of my regimen.

But I started feeling tired after spin classes, my breathing was becoming an issue and I had to stack 5 pillows under my head when I slept, and a cough made voice overs problematic…last but not least, I had developed an uncontrollable itch. At first I blamed my gluten filled diet, and three days before I was to appear on the Montel Williams Show, I recall standing at Whole Foods grocery store and deciding then and there that I needed to be gluten free. I had been feeling so terrible, I really had to dig deep to rethink how I was taking care of myself.

So I started buying rice cakes. I bought all these wonderful flours: tapioca and buckwheat and others. I made the cookies I craved with the new ingredients, and (although they were a little drier), the new cookies… and my new diet… were just fine. I started feeling better, less itchy, less puffy.

But my energy still wasn’t right, and I had a pressure in my chest that made it hard to sleep. My chiropractor would touch my neck in a certain place, and I’d cough every time. Having a past history as a massage therapist, I knew my body was trying to tell me something.

But I was having trouble getting doctors to listen. Some of them mentioned hormones. One doctor started a conversation with, “I know you’re in the media, and you’re used to having a lot of attention, but…” I actually walked out of his office.

When I sat down with the fifth doctor, I said, “Pardon me… I don’t want to seem overly pushy or stubborn or anything, but I want to have a full set of blood tests, and I’m not going to leave your office until you give me a complete chest x-ray.”

I’m not sure if she agreed with me, but she said she could tell I was very serious. “I feel there’s something in my chest,” I said. And I had to find out what it was despite her additional prescription of Nexium for acid reflux (just in case).

The diagnosis was stage 2 Non Hodgkin’s Lymphoma —a form of lymphatic cancer that is thankfully often curable with chemotherapy (and radiation). What I had felt in my chest was a quite a few tumors and one about the size of a banana. When the doctor called, she said, “Thank God you were persistent.”

What is the lesson I learned here?

It took a few months for me to ask this question, and the answer didn’t come immediately. A little time and distance has given me the ability to think about what this diagnosis told me.

1. I realized that I was going too fast, that I needed to make some changes in my life. I was trying to rush through treatment, and I had to rest. I took a step back one day when I realized that I looked forward to my PET scan because I’d have the opportunity to take a 90-minute nap. This was really an eye opener, and I had to train myself to slow down.
2. I recognized that I needed to ask for help. I never ask for help… Rarely do I say to a friend, “Oh, please come with me.” But during treatment, I asked 14 of my best girlfriends to be my cancer buddies, and all of them are dear to my heart because they were there for me when I needed them most.
3. I understood the power of persistence. If I had listened to the first doctor, or had given up after the third, my situation might have gotten a lot worse before it got better. Thus, even though my persistence was sometimes frustrating, I listened to what my body was telling me and used my voice to tell others.

I hope you can take my lessons and apply them to your own lives, to learn how to slow down, ask for help and speak up. You alone have the power to make your life what you want it to be, and I wish you all the strength to do so.

After a simple shoulder x-ray on January 2, 2007, I learned out of nowhere that something else had shown up in my lung. Ten days later we knew what it was: Stage IV kidney cancer that had spread throughout both lungs.

Suffice it to say that my view of life changed very rapidly. I googled my butt off, but the best information didn’t come from top-ranked medical sites – it came from a community of my peers: people with the same cancer as me, on www.ACOR.org.

In this series I’ll briefly cover the seven topics I wish someone had told me at the outset:

1. Cancer is no longer a death sentence.
2. Understanding the statistics you read
3. Creating a support community of your family and friends
4. Online resources – medical information and social resources
5. The importance of your attitude and feelings
6. Taking care of the caregiver, too
7. Advocating for your own care

Now that it’s mostly all over (I’m well again), #7 seems like the top-level lesson. But when I got the news, #1 and #2 were what I needed to hear first. That’s what I’ll write about next.

Dr. Greene’s Answer:

A radiologist is a physician who specialized in imaging techniques after completing medical school. If one is involved in doing or interpreting the CT scan, there is a higher chance that it will be set for a child. X-ray techs may also be knowledgeable, but they have completed technical school — not medical school.

Read More From This Series:
CT Scan Defined
CT Scan, Ultrasound or MRI?
CT Scan Safety
CT Scans and Radiation Exposure
CT Scan Risks
Higher Risks in Children
Who Should Receive a CT Scan?
X-Ray or a CT Scan?
Alternatives to a CT Scan
When Should a CT Scan be Performed?
Important Tip to Reduce to Radiation
Questions to Ask before Every CT Scan
Other Radiation Exposures
Measures That Radiologists Should Adhere to When Administering a CT Scan
CT Scans and Cancer
When are MRIs not Practical?
What is Ionizing Radiation?
Who are Radiologists?

Dr. Greene’s Answer:

In A-bomb survivors, the lowest exposure measured to increase cancer risk was about 50 mSv. Children who get a single head CT without a special pediatric setting get a dose of about 60 mSv. Out of every 2,500 babies who get CT scans in machines calibrated for adults, about one may die from cancer caused by the scan. Right now, this happens every day.

Read More From This Series:
CT Scan Defined
CT Scan, Ultrasound or MRI?
CT Scan Safety
CT Scans and Radiation Exposure
CT Scan Risks
Higher Risks in Children
Who Should Receive a CT Scan?
X-Ray or a CT Scan?
Alternatives to a CT Scan
When Should a CT Scan be Performed?
Important Tip to Reduce to Radiation
Questions to Ask before Every CT Scan
Other Radiation Exposures
Measures That Radiologists Should Adhere to When Administering a CT Scan
CT Scans and Cancer
When are MRIs not Practical?
What is Ionizing Radiation?
Who are Radiologists?

Dr. Greene’s Answer:

What a tough time for the family!

Most tumors in kids come from a combination of genetic susceptibility and some kind of environmental insult. Not all susceptible kids get cancer, and not all kids exposed to toxins get cancer. However those kids who have both, often do. The list of possible environmental toxins is long. The chemical plants are one possibility. If there is an environmental medicine doctor in the area, a consultation might prove a very wise idea. Most cities now have good doctors in the field. The American Academy of Environmental Medicine, for example, has information on finding a doctor with experience in environmental medicine at www.aaemonline.org.

Dr. Greene’s Answer:

Lumps of one kind or another are a common reason for a visit to the doctor’s office. The lump might be in the neck (that the parents suspect is just a swollen gland), in the knee (that the parents think is from sliding into third base last month), or under the nipple (that the parents hope is due to puberty). I often enjoy seeing parents with these concerns in my own office. Sometimes the parents feel that they shouldn’t even bother their doctor with this because it’s probably normal. But underneath these hopeful, at-home diagnoses lies a common fear–it might be a tumor!

Most lumps in children are not cancerous and are not serious. Thankfully, childhood cancer is uncommon. But parents’ fears are not unfounded. Childhood breast cancer is quite rare, but it certainly does occur, even in boys. In males of all ages, breast cancer accounts for less than 1% of all cancers (American Surgeon, 1999; 65:250–253). But if it is your son, any chance of cancer seems too much. And a lump might be the first sign noticed.

Breast lumps in children often give rise to two immediate fears–Could it be a tumor? Or could something be going wrong with puberty? (A third fear–Will my child be teased?–arises if the first two turn out to be no problem.)

I’ll give you some guidelines for when to be concerned about a breast lump and when you can relax.

Puberty is a time of dramatic changes in the body, especially in the reproductive system. These transformations are brought about by surges of complex and precisely balanced hormones. The last time your 12-year-old had these tides of hormones was when he was a newborn–but then the hormones were yours. Coursing through his blood, your hormones matured his lungs, made him ready for life in the big outside world, and along the way may have given him baby acne and breast enlargement–even nipples that leaked milk. This precious newborn season was gone in a blink.

Now your 12-year-old is making surges of these same hormones on his own as his body turns into an adult’s–a miracle not unlike when you helped turn his body into a newborn’s.

There are five stages of the changes that occur during puberty, called Tanner stages or Sexual Maturity Rating (SMR) stages. Breast lumps in boys are common during SMR 3 and SMR 4.

In boys, SMR 3 usually begins at about age 12 or 13 years and lasts a year or so, although it can be normal in our culture to begin as early as 10 years or as late as 14.9 years, according to Tanner (Journal of Pediatrics, 1985; 107:317). SMR 3 is the time when the testes get clearly larger, the penis gets noticeably longer (then thicker in SMR 4), and the pubic hair (though still small in amount) gets darker and starts to curl.

Sperm is first produced during SMR 3.

Boys grow at their fastest during SMR 3 and SMR 4 (girls get their growth spurts earlier). With your son, you’re probably seeing him outgrow his beginning-of-the-year school clothes already–especially his shoes. During SMR 3, the feet and hands usually grow first, then the arms and legs, and finally the trunk–giving them that adorable adolescent gawky look (don’t tell my 12-year-old son I said that).

SMR 3 also marks the beginning of significant underarm perspiration (the odor, as you’ve probably noticed, can start much earlier).

And teenage acne usually begins at SMR 3, continuing on until the end of puberty.

In newborns, baby acne and breast buds often occur at about the same time. In the same way, many adolescent boys develop gynecomastia–true mammary breast tissue in a male–during SMR 3. The firm lump may occur under only one nipple, under both nipples, or under the two at different rates or sizes. The lumps are often tender when they are growing the fastest. In at least 90% of kids, these will go away on their own. They may disappear as quickly as in a few months, but it is not unusual for them to last up to 2 years (Nelson Textbook of Pediatrics, WB Saunders, 1996). In some children, they may persist without being a problem. Gynecomastia occurs in at least 40% to 60% of boys (Fortschritte der Medizin, 1998; 116:23–26).

Gynecomastia can run in families, and when it does, the disappearance pattern tends to be similar in the family. Gynecomastia can happen in boys of any size but it is more common in bigger teens–either taller, heavier, or both. Obesity can certainly be a cause of gynecomastia in some children (Clinical Pediatrcs, 1998; 37:367–371).

Gynecomastia is different, though, than fatty tissue in the breast area. Boys tend to store extra fat in the upper body (breast and abdomen area), but girls are much more likely to store it in the lower body, particularly the thighs (Pediatrics, 1998; 102:e4). This is the first place it goes on and the last place it comes off. If girls’ breasts do enlarge by storing fat, this is usually one of the first places it disappears with weight loss.

Here are times to worry about lumps in a boy’s (not a newborn’s) breast:

• If they begin before age 10 years or after age 15 years (especially after puberty is complete)
• If they are not directly under the nipple
• If there is overlying dimpling of the skin, skin ulceration, or change in the color of the skin
• If the they feel fixed to the skin
• If they are large–over 1.5 inches (4 cm) in diameter
• If they don’t go away within 2 years
• If the nipples leak milk, blood, pus, or other fluid
• If there are other signs of disease–night sweats, fever, or weight loss, for example

These are all situations in which a breast lump should definitely be examined, in addition to the important regularly scheduled physicals during the puberty years. These children should have a careful physical examination right away. They should probably have an endocrinology (hormone) workup and perhaps an ultrasound or a mammogram, depending on the exam. I would also consult with a health care provider if a breast lump is associated with any signs of infection, such as sudden increased size, warmth, tenderness, drainage, redness, or fevers.

In a recent study at Johns Hopkins University of 60 high-risk boys with large lumps (> 4 cm), most of the boys–45 of them–turned out to be fine, but 15 did have significant medical problems, including one who had a serious cancer. Most of the problems were genetic (such as Klinefelter’s syndrome–XXY boys) or hormonal problems that needed to be treated (Clinical Pediatrics, 1998; 37:367–371). Gynecomastia can also be a side effect of taking steroids or other medications. It can come from liver disease, testicular disease, or neurologic diseases.

If you are ever unsure whether a breast lump is normal, it is always wise to seek the advice and opinion of your child’s doctor.

Good breast health practices for teens include:

• Avoiding steroid supplements
• Avoiding steroid medicines where possible (e.g., keep asthma well controlled with preventive measures)
• Avoiding cigarette smoking and exposure to second-hand smoke
• Avoiding alcohol
• Being physically active daily (exercise)
• Eating a healthy, whole food diet
• Maintaining ideal weight
• Avoiding piercing and tattooing

If normal, benign gynecomastia is bothersome, either because it is large or because it doesn’t go away as puberty progresses, treatment is possible. Sometimes hormones are given to try to shrink the breast tissue. Alternatively, the mammary breast tissue can be removed. A tiny incision is made under the armpit, and the tissue is removed with a fiberoptic scope. The results are great, and the scar is small and inconspicuous (Annals of Plastic Surgery, 1998; 40:62–64).

Normal, small gynecomastia is yet another reminder of the wonderful changes in your son’s body as he becomes a man. While teenagers can be quite trying to live with at times, savor every moment you can as you enter the last few years of having your son in your home.

Did this article help answer your questions on Breast Lumps in teens? Do you still have questions? Let us know in the comments below.

Dr. Greene’s Answer:

Hemihypertrophy, also called hemihyperplasia, is a greater-than-normal asymmetry between the right and left sides of the body. Hemihypertrophy can occur as an independent condition (isolated hemihypertrophy) or as a part of a genetic syndrome (i.e. Beckwith-Wiedemann syndrome). Because hemihypertrophy is a disorder of the body’s normal controls of growth, it is not surprising that people with this condition can also have a higher rate of cancer.

In one study, 168 children with isolated hemihypertrophy were very carefully followed to try to determine the true rate of cancer in children with this condition. Just under 6% developed childhood tumors (American Journal of Medical Genetics, 1998; 79:274–278). The most common cancer is Wilms’ tumor (of the kidney), followed by adrenal carcinoma and liver cancer (hepatoblastoma).

Because most of the cancers occur in the abdomen, the recommendation has been made (by the participants of the First International Conference on Molecular and Clinical Genetics of Childhood Renal Tumors–among others) that children with hemihypertrophy receive a screening abdominal ultrasound every 3 months until age 7 and, at minimum, a careful physical examination every 6 months until growth is completed (I prefer ultrasound). One proposed exception to this recommendation is in hemihypertrophy due to Klippel-Trenaunay Syndrome– the risk of Wilm’s tumor does not appear to be increased in these cases (Pediatrics 2004; 113:326-329).

Some argue that screening for cancer in children with hemihypertrophy is not cost effective because most children do not get these tumors and, even for those who do, these tumors are fairly easy to treat even if caught late. Be that as it may, if it were my child, I would insist on the screening.

Dr. Greene’s Answer:

Seeing the musical, Les Miserables, was a great experience for me. In one of my favorite moments, a little girl appears on the stage alone and sings a hauntingly beautiful solo, “There is a castle on a cloud…”

I like to go there in my sleep.
Aren’t any floors for me to sweep,
Not in my castle on a cloud…

There is a lady all in white,
Holds me and sings a lullaby.
She’s nice to see
And she’s soft to touch.
She says, “Cosette, I love you very much.”

I know a place where no one’s lost.
I know a place where no one cries.
Crying at all is not allowed,
Not in my castle on a cloud.

The real little girl who played the role of young Cosette was living a dream come true. She was a star!

I met her shortly after seeing the show. While she was appearing in the musical, she developed a bothersome cough that was making it difficult to sing. When she came in to have it checked out, the physical exam revealed a large mass in her belly, obscuring her kidney. Her chest X-ray showed that her lungs were filled with cancer and causing her to cough. The little girl who sang poignantly of a place where no one cries had her fairy tale life interrupted when she learned that she had Wilms’ tumor.

Wilms’ tumor, sometimes called Nephroblastoma, is by far the most common of the pediatric kidney cancers. It occurs in about approximately 8 children per million children younger than 15 years (Nelson Textbook of Pediatrics, 17th Ed). The most common age at diagnosis is 2 to 5 years, just as children are bursting with the exuberant energy of discovering their own preferences and desires. Ninety percent of cases are diagnosed before children have completed first grade.

While Wilms’ tumor is the most common of the pediatric kidney cancers, it is not the only one. Clear cell sarcoma of the kidney is the second most common kidney cancer in children, followed by several much less common cancers such as Rhabdoid Tumor of the kidney and Congenital Mesoblastic Nephroma.

Let’s talk a bit more about what we know about Wilms’ tumor. Most of us have at least two genes, both located on the 11th chromosome, that prevent our kidney cells from growing out of control. These genes are called WT1 and WT2 (for Wilms’ tumor suppressing genes). When our cells reproduce, the DNA molecules, or blueprints, are copied for the new cells. Sometimes, the copy is not perfect. Sometimes, the DNA is damaged by exposure to radiation or to chemical carcinogens. Often this damage is repaired, but not always.

Kids who develop Wilms’ tumor have both of these genes knocked out. In some families, one of these genes is missing from the outset. All it takes, then, is one insult to the other gene to produce the tumor. In familial cases, the tumor is more likely to occur in both kidneys. It is also more likely to be associated with other kidney/urinary problems and with two other unusual physical findings: Hemihypertrophy (one side of the body is larger than the other) and aniridia (the absence of the iris — the colored part of the eye). [Note -- this is a bit of an oversimplification. There are several syndromes that are also associated with Wilms’ tumor and recent research shows that another gene on the 16th chromosome is also involved in a very complicated way.]

Familial Wilms’ tumor is likely to occur in about 1/3 of the siblings and offspring of the affected individual. The sporadic form of Wilms’ tumor occurs in only 6 percent of the offspring.

Most often this tumor is diagnosed after the parents notice a painless mass in the flank or abdomen. Some children have abdominal pain or vomiting. Sometimes there is blood in the urine. Unexplained fever or high blood pressure might also make one suspicious of kidney cancer.

The treatment involves removing the tumor surgically and giving chemotherapy. In some cases radiation is also indicated.

Without treatment, kidney cancer is uniformly fatal. With treatment, there is good reason for hope. To help determine the best treatment, and to predict the outcome, Wilms’ tumor is divided into five stages. Stage I means the tumor is completely confined to the kidney. Stage II means the tumor has penetrated the wall of the kidney, but is believed to have been completely removed at surgery. Stage III refers to an unremovable tumor elsewhere in the abdomen. Stage IV means the tumor has spread to the lung, bones, or brain. Stage V means the tumor involves both kidneys. Oncologists also look at histology (how the tumor cells looks under the microscope) to determine the chances of cure.

When it comes to the long-term outlook, a good figure to look at in Wilms’ tumor is the 4-year disease-free survival rate.

Stage I Wilms’ with favorable histology has a 96% four-year overall survival rate. Stage II through IV Wilms’ with favorable histology has an 82-92% overall survival rate. Even with unfavorable histology (tumor cells look aggressive under the microscope), the survival rates for Stage I-III Wilms’ tumors is still 56-70% and for Stave IV Wilms’ with unfavorable histology, the overall survival rate at 4 years is 17%. (Current Pediatric Diagnosis and Treatment, 17th ed)

Experimental treatment with human stem cell transplantation is also being studied as a way to improve chances for survival for children with the most aggressive types of Wilms’ tumors (Current Pediatric Diagnosis and Treatment, 17th ed).

Outcome also depends on the age of the child. Those diagnosed between birth and 23 months have a lifetime relapse rate of only 5 percent. For those diagnosed between 24 and 47 months the rate is 10 percent. And for those diagnosed over the age of 4, the chance of relapse is 16 percent (Saunders Manual of Pediatric Practice, Saunders 1998).

The outcome for all children is significantly better if they are treated at a pediatric cancer center. The best thing that you can do to help is to make sure your niece is cared for at any children’s hospital, or any pediatric department of a university medical center, that is designated as a pediatric cancer center. This is a situation where good doctors who primarily take care of adults with cancer or good pediatricians who don’t primarily take care of cancer are not good enough. There is too much to lose.

Currently, researchers are analyzing molecular, genetic, and clinical clues that may determine the intensity of treatment needed by different children. Hopefully oncologists will be able to use this information to give smaller doses of chemotherapy and radiation to children with less aggressive forms of Wilms’ tumor, therefore reducing side effects while still curing the majority of children. (Expert Review of Anticancer Therapy, Feb 2006.)

The little girl in our story had Stage IV Wilms’ with widespread tumor. Her lungs were almost obliterated by cancer at the time of diagnosis. She was about 9 years old when she came in. After receiving optimal care at a pediatric cancer center, she was completely cured. Her follow-up chest x-ray was crystal clear. She can still look forward to living out her dreams.

Dr. Greene’s Answer:

Almost every day, Shelley, concerned parents ask me about lumps in their children’s necks or scalps. Most of the time, these turn out to be normal. Occasionally, though, they are an early sign of a serious infection or malignancy. No wonder, then, lymph nodes are such a cause of concern — particularly for those who have had a previous experience with cancer.

All of us have hundreds of lymph nodes scattered throughout our bodies as a critical part of our immune systems. This network of nodes functions as a powerful, intelligent filtration system to keep the insides of our bodies clean and healthy.

Tiny vessels called lymph vessels carry germs, foreign particles, and unhealthy or malignant cells to the lymph nodes, where they are trapped. Active lymph nodes enlarge as they attempt to destroy the unwelcome material.

The lymph nodes also function as schools. Lymphocytes, a type of white blood cell, study the foreign material so that they can produce antibodies, killer cells, and other substances to protect the body from the threat.

Sometimes the lymph nodes are overwhelmed in the process. Our defenders can be taken over by a cancer or an infection. These enlarged nodes can become a refuge where the invaders can hide and proliferate.

In a newborn infant, the lymph nodes are often small enough and soft enough not to be felt. But by the time a baby is several months old, healthy, growing, learning lymph nodes are frequently obvious enough to be noticed by parents — to their alarm.

When evaluating enlarged lymph nodes the first consideration is whether these nodes are localized (in one or two adjacent regions of the body) or generalized (spread throughout the body, often including the spleen — the largest lymph node — which is found just under the rib cage in the left upper part of the abdomen). Generalized enlarged lymph nodes suggest that the body is responding to a whole-body problem, such as an infection (bacterial, viral, or fungal), an autoimmune disease (arthritis or lupus), a drug reaction, or a malignancy such as leukemia. The infection might be very mild, or might be as serious as HIV.

Localized enlarged lymph nodes are responding to events in the part of the body filtered by those nodes. A scratch on the finger can produce swollen nodes at the elbow and /or the armpit. Minor trauma to the foot is filtered by nodes behind the knee and in the groin.

The localized nodes most often noticed by parents are those around the head (especially near the base of the skull) and neck. They frequently grow in response either to the mouth organisms that enter the body during teething, or to the tiny particles that get into the scalp from a baby’s lying down most of the day, or to respiratory infections of all kinds (ear infections, colds, sinus infections, etc.) — or, to some combination of these.

Much less commonly, head and neck nodes can grow from cat-scratch-fever, tuberculosis, drinking unpasteurized milk (mycobacterial infections), or eating undercooked meat (toxoplasmosis). They can also grow from an isolated malignancy, such as a lymphoma.

Many people have a sunny attitude toward “swollen glands,” not believing they will really be serious. Others believe these lumps to be harbingers of doom. The truth is somewhere in between. Most of these situations turn out to be fine, but enlarged lymph nodes should be respected.

When should you be concerned?

When examining your child, your physician will pay attention to several important signs:

• Location — enlarged lymph nodes just above the collar bone but below the neck often indicate serious disease.
• Character — nodes that are hard, non-tender, and irregular are very suspicious. Normal nodes are mobile beneath the skin. Fixed nodes, those that are firmly attached either to the skin or to deeper tissues, are often malignant. Nodes that are tender, inflamed, or rubbery in consistency usually represent an infection.
• Growth — enlarged nodes that continue to enlarge rapidly should be evaluated rapidly.
• Associated symptoms — fever, night sweats, or weight loss accompanying enlarged lymph nodes should be investigated thoroughly.
• Size — size does matter! The definition of an enlarged lymph node is size larger than one centimeter (0.4 inch) in diameter. Pea-size lymph nodes are not enlarged, even if you didn’t feel them there before. Any node that is larger than 1cm in diameter should be followed closely by a physician. It should shrink noticeably within 4-6 weeks, and should be less than one centimeter within 8-12 weeks. High-risk enlarged nodes are those larger than 3cm (more than an inch) in diameter.

If lymph nodes remain truly enlarged for more than 2 weeks, or if other worrisome signs are present, then the next steps of evaluation include a complete blood count with a manual differential (CBCd)l. This test looks at the number and type of cells in the blood. Isolated anemia is not usually a problem, but anemia with an unusual white blood cell count or platelet number is worrisome. An abnormal CBC can be diagnostic of leukemia and lymphoma, but it is important to note that most children with neck malignancies have normal CBC’s.

Other simple tests include a sedimentation rate (a general blood test that indicates whether something significant might be going on in the body as a whole), blood chemistries (LDH is often elevated in malignancies, AST and ALT are often elevated in infections that cause enlarged lymph nodes), and a tuberculosis skin test. Depending on the results, other studies might include tests for specific illnesses (mono or HIV), and an x-ray or an ultrasound to get a better picture of what is going on.

If the node remains enlarged (greater than 1cm) for 2 to 3 months, or continues to grow after 2 weeks, then a biopsy of the lymph node may be indicated, unless the physical exam and lab tests are convincingly reassuring. At least half of the time, a biopsy does not reveal a definite cause for the enlargement, but the biopsy can rule out cancer and other serious problems.

Shelley, you bring to this situation your love as a mother, your difficult experience with the misdiagnosis of your own mother, and your determination to seek the best information available about swollen glands. Your pediatrician brings a wealth of knowledge, a practiced objectivity, and the experience of examining and following many lymph nodes. Together you have what it takes to insure the best care for your daughter, as you keep the lines of communication open.

A young mother recently called me. She had seen my story on the web and wanted to talk because she hadn’t been able to find another survivor of “her kind” of breast cancer. She needed to connect with someone who could hold out hope for survival. I am happy to say, that I am not just a survivor, but over sixteen years after my initial diagnosis, I am healthy and disease free! Here is my story – the story she found to be a source of strength.

On March 22, 1996 I was diagnosed with Stage III, High Risk, Inflammatory Breast Cancer. My doctor told us that I probably would not live until the New Year, but I was not ready to just give up. I had too much to live for — a brand new baby (after years of trying, I finally became a mom at age 40), a wonderful relationship, powerful connections to my extended family, great friends, and a job that I thoroughly enjoyed as Executive Producer of DrGreene.com.

One year later, after four surgeries, 38 radiation treatments, and ten grueling months of chemotherapy, I was declared NED (no evidence of disease). This term, now much more popular than “in remission,” simply means that the doctors aren’t able to detect cancer using the tests they currently have available. I may be completely clean. I may not be. All I know for sure is that cancer can’t be found right now. Each day I live with the fact that I am at high risk for recurrence (some say my risk is as low as 30%, others say it is as high as 70%). Each day I know that I may never again feel as good as I do today. I might wake up with a headache, I might begin to feel an aching in my bones, I might not recover from a respiratory “infection” — each a sign that the cancer which started in my breast and moved to my lymph nodes was not killed by my original treatment, but lay slowly growing in another part of my body.

Why do I tell you all of this? One in eight women will have to deal with breast cancer sometime in her life (Dr. Susan Love’s Breast Cancer Book, Sept. 1995). The incidence of male breast cancer is much lower (less than 1% of all breast cancer occurs in men), but it is a very serious disease. On March 22, 1996 a friend of mine had the same surgery I had — an excision biopsy. She also had malignant breast cancer, but hers was Stage I (the tumor was completely contained within a small area). Her only treatment was that simple excision surgery — the surgery that was only the beginning of my year-long (no, life long) fight.

You may be the one in eight who has to deal with breast cancer in her life. If so, early detection is the key to quick, easy, and complete recovery. I’d like to encourage you to begin now to perform a monthly breast self-exam (I found my own lump). If you are in your mid-thirties, call your doctor and insist on a mammogram. He or she may tell you it is not indicated, but insist that you need a “baseline” test. This will be an invaluable reference point if you find a lump in the future. If you are over forty and haven’t had a mammogram in the last year, call your doctor now and schedule one.

This picture is of me (with my wonderful son, Austin) after I’d been on chemotherapy for two months. As you can see, I had no hair — only one of the many side effects from the treatment that helped keep me alive. Breast cancer is real. There is help. Acting early is the key.

You may be wondering why I didn’t find my lump until it was so advanced. At age 37, I had a baseline mammogram. In the years that followed, I was either pregnant (I lost two pregnancies before Austin) or nursing. This is a particularly dangerous time. Many breast lumps are normal in pregnant and nursing women. In addition, mammograms are not routinely performed because the milk in the breasts make the mammogram almost useless. If you are pregnant or nursing, be sure to be very diligent about breast self-exam. If you do feel something “unusual,” bring it to your doctor’s attention. If it doesn’t go away, take charge and get follow-up. Your precious baby needs you — I know mine does!

For information on free or low cost mammograms, click here