I am facing a 2nd recurrence - original cancer in 91 at 36 yrs, stage I, small lump. Had Lumpectomy and Radiation, tamoxifen for 3 yrs. . 1st recurrence 1996- Local. Stage II, Mastectomy/TRAM Reconstruction treated with Chemotherapy (Adriamycin and CMF) and Radiation.

July 2006 found a lump near the old scar around the outer edge of TRAM near the sternum. Diagnosed with recurrence - grade 3 invasive ductal carsinoma, sections of tissue show multiple iill-defined nodules within ghe fibroadipose tissue and skeletal muscle tissue. The nodules are composed of markedly pleomorphic cells arranged in nests and cords, Cells show brisk mitotic activity. Focal perineural invasion identified and skeletal muscle involvement present. benig over hair bearing skin. Strong positivity for pancytokeratin and GCDFP, negative for HMB-45. Tumor involves the inked cauterized surginal marin in several sections. Still awaiting HER2 and staging.

All of my CT Scans for abdominal, pelvic and chest, bone scan, brain MRI and chest x-ray show negatvie for metastasis.

I am still awaiting to see my oncologist, but I assume at the minimal I will need to go through Chemo again.

Questions:

Does this mean there is cancer in the skeletal muscle and possible spreading could occur through the nerves.?

Where could it spread to?

Can you give any type of prognosis on just the information I provided?
Is radation for the 3rd time even safe or possible?
If the TRAM is removed, what does a surgeon normally do with the area?