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Doctor's Assistant: Have you experienced any bleeding? Pain? Unintentional weight loss?

No. I have metastatic breast cancer and am on chemo

Doctor's Assistant: Are you keeping a personal medical record while dealing with this?

Yes

Doctor's Assistant: Anything else in your medical history you think the doctor should know?

I was first diagnosed in 1998. I am now triple positive and my onc is scheduling me an MRI. Scared to death How long do I have to wait to chat

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3/28/2018
Dr. A
Dr. A, Board Certified MD
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Customer reply replied 22 days ago
I am getting an MRI because my left side of my chin is partially numb as is my lower lip. I read all about numb lip syndrome and since I am being treated for metastatic breast cancer I am getting an MRI soon. Everything on the internet says I will be dead in months. My oncologist did not tell me that. I am asymptomatic as far as my liver, bone, nodes mets are concerned. Is it possible this is not that syndrome
Dr Subbanna MD
Dr Subbanna MD, Neurologist (MD)
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Satisfied Customers: 6,120
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Hi Lisa, I am an American Board Certified Neurologist with vast experience in diagnosing & treating all neurological as well as all other health/medical conditions; the previous expert has opted out and the company has made this question available for other experts, and I am very glad to help you with your health concerns.

I see you have been having partial numbness in the chin and lower lip area on the left side and you have been wondering whether this could represent a metastasis. As a Neurologist I am very familiar with this type of health situation, and I can certainly help you in this regard.

First of all I want to inform and reassure you, please see numb lip or numb chin syndrome is not diagnostic of a tumor related condition, because there are so many many other non-tumor conditions too can cause this sensory syndrome.

Numb lip or numb chin syndrome occurs when the sensory nerve supplying the chin and lower lip region is affected

This sensory nerve is called as Mental nerve, and it is a branch of trigeminal nerve or the 5th cranial nerve

Trigeminal nerve gives three branches and mandibular branch being one of them, one of the branches of mandibular nerve is inferior alveolar nerve, and one of the branches of inferior alveolar nerve is mental nerve, and it is this terminal sensory branch mental nerve that supplies the region where you have been having numbness

Irritation of this nerve (mental nerve), or sometimes of inferior alveolar nerve can cause numb lip or numb chin syndrome

Although cases of metastatic tumors presenting with numb lip syndrome have been described but this symptom does not automatically indicate this is due to breast cancer spreading to the jaw region

There are so many other explanations too for the development of this syndrome, for example a minor local trauma to the jaw or chin region can do this. Sometimes such minor injuries go unnoticed but such minor injuries may be enough to irritate the nerve like this

There could be dental issues. Sometimes dental issues do not present with toothache or swelling of the gums etc initially, rather the initial presentation can be irritation of the adjacent nerves and presenting with numbness like this.

Sometimes health anxiety and fear of serious illnesses too can cause onset of unusual symptoms such as this

There are so many other benign conditions or situations that can cause irritation of this nerve and cause numbness in one side of the chin and lower lip like this

The presence of numbness in these areas certainly does not automatically imply this is related to mets from the cancer

I see an mri scan has been ordered, getting the mri done is a standard approach with this type of symptom but it really does not appear the mri scan will show any mets, rather this will turn out to be some benign issue unrelated to the cancer

Once again I reassure you, please see occurrence of numb lip or numb chin syndrome does not automatically mean this is due to tumor mets, the internet sometimes can cause unnecessary fear & distress because the fact is there are so many other causes for development of numb lip or chin syndrome as mentioned earlier above, so this new onset numbness very well could be secondary to some other cause rather than anything to do with cancer spread, so please not to be scared.

Wishing you all the very best with your mri scan results!

Wishing you the best health!

All the very best!

Please let me know if you have any additional questions or if you want to discuss this further.

Assuring you the best services!

Best Regards!

Dr Subbanna MD

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Customer reply replied 22 days ago
Thank you. I also am dealing with a sinus infection and vertigo. I am just finishing up antibiotics-but as I thought I was getting better-but I am not. Could this have any connection to the numb chin thing. I can also feel cold and hot and pin pricks on the numb side. I also am on herceptin and abraxane and my tumor markers rose 70 points instead of going down. Can infection or antibiotics cause a spike? As you can see, I am in a constant state of anxiety and have to take xanax. My oncologist said he sees maybe one case of mets to jaw or that nerve once every 10 years. Thank you for being so kind and reassuring. You are the kindest online doctor I have spoken with. I just want to live.
Customer reply replied 22 days ago
I also had a pet scan the end of January and nothing was mentioned about my jaw.

You are very welcome! I appreciate the compliments too!

Yes, sinus infection is in fact another cause for this type of symptom in the form of numbness in the chin and lip areas. And also yes, tumor marker concentration can rise due to any infectious or inflammatory conditions or sometimes due to meds such as antibiotics etc too. And as far as mets or tumors causing this syndrome - it is indeed extremely rare, and we should be suspecting various other reasons as a cause for this type of new symptom numbness rather than suspecting tumors or mets.

The information that has been provided in the internet related to this condition certainly appears exaggerating the association of this syndrome with mets because there are indeed so many other non-cancer or non-metastatic conditions that can cause this same symptom in the same distribution because this sensory nerve can get irritated for various reasons, so they should not make it look like if someone develops numb lip or numb chin syndrome then it automatically implies it is due to cancer spread, and this notion is certainly not true. This is similar to irritation of a nerve anywhere in the body such as a pinched spinal nerve, or sciatica, or trigeminal neuralgia, or carpal tunnel syndrome (median neuropathy), or cubital tunnel syndrome (ulnar neuropathy) etc where there is pinching or compression or irritation of a nerve at various regions of the body - but due to so many other causes rather than due to any tumors, and similarly the numb lip or numb chin syndrome too is caused by so many other conditions - as mentioned earlier too, so not to conclude this is all due to mets, and in fact most likely this is not due to mets, and conditions such as sinus infection etc are the ones we should be suspecting rather than tumor/mets etc. And also the PET scan done recently has not shown any tumor/mets in the jaw region so this also indicates the cause for this numbness is something else other than tumor/mets etc

Once again I reassure you, this new onset numbness in the chin and lip area appears secondary to conditions such as sinus infection or some other non-tumor/mets cause rather than any tumor/mets as the cause - for the various reasons mentioned above, so please not to be scared.

Please let me know if you have any additional questions or if you want to discuss this further. And please take a moment and kindly click a positive rating (preferably 5 Star/Excellent) to credit for the time & professional effort put by me in answering your health question, and this is the only way I will be credited for my service to you. Rating me now will not close your question and if you have follow-up or additional questions you can ask them after the rating too!

Wishing you all the very best!

Assuring you the best services!

Best Regards!

Dr Subbanna MD

For future questions you can follow up either here, or you can reach me directly with "a question for Dr Subbanna MD" through my Just Answer direct link mentioned below here;

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Customer reply replied 22 days ago
Me again.....I read that numb chin syndrome can be caused by leptomengial mets. And I still have vertigo from my sinus infection that I do not believe is gone. And I read that central vertigo is a sign of brain mets. I am making myself sick with worry. Plus I have mets every where else. Thank goodness I am asymptomatic from the neck done. Could a massage I had around my ears and neck have caused this numbness?
Customer reply replied 22 days ago
NECK: No FDG avid neoplastic process. No hypermetabolic mass,
adenopathy, or fluid collection.2. CHEST: Progression of hypermetabolic thoracic lymphadenopathy. No
hypermetabolic mass or fluid collection.3. ABDOMEN/PELVIS: New hypermetabolic hepatic metastases. New
hypermetabolic abdominal lymphadenopathy. New hypermetabolic peritoneal
implant.4. EXTREMITIES/SKELETON: Progression of hypermetabolic
osseous metastatic disease.Transcribe Date/Time: Jan 26 2018 2:36PDictated by: DONALD NEUMANN, MDThis examination was interpreted and the report reviewed and
electronically signed by:
DONALD NEUMANN, MD on Jan 26 2018 3:08PM ESTThank you for allowing us to participate in the care of your patient.
Should there be any questions regarding this interpretation, please call(###) ###-####
If you are unable to reach us at the number above,
please feel free to contact Cleveland Clinic eRadiology at(###) ###-####
Narrative* * *Final Report* * *DATE OF EXAM: Jan 26 2018 2:31PMNRN 0063 - NM PET/CT SKULL-THIGH SUBQ / ACCESSION ####-##-####
PROCEDURE REASON: multiple diagnoses* * * * Physician Interpretation * * * *RESULT: EXAMINATION: REGIONAL BODY FDG PET/CT SCAN: (1/26/2018 2:36 PM)HISTORY: 61 year old Female with Malignant neoplasm of unspecified site
of right female breast.INDICATION: Study performed for subsequent treatment strategy.TECHNIQUE: F18-FDG administered IV was followed about 60 minutes later by
PET imaging from eyes to proximal thighs. Free breathing low dose CT was
performed without contrast for attenuation correction and anatomic
localization.
Blood glucose before FDG injection: 134 mg/dL
FDG radionuclide dose:*****Dose-Length Product (DLP): 473 mGy*cm.COMPARISON: FDG PET/CT dated 2/28/2017CORRELATION: None.RESULT:NECK:Physiologic FDG uptake seen in the visualized brain, parapharyngeal soft
tissues, base of tongue, vocal cords, and salivary glands.No hypermetabolic cervical lymphadenopathy or masses. No focal
hypermetabolic thyroid lesion.CHEST:Physiologic FDG uptake in the heart and mediastinum.Lungs and tracheobronchial tree: No hypermetabolic consolidation, mass
or nodules.Pleura: No hypermetabolic pleural or pericardial effusion, or pleural
mass.Mediastinum and Lymph nodes: Several new sites of hypermetabolic
lymphadenopathy are seen, including the upper right paratracheal (maximum
SUV 11.7), left subpectoral (maximum SUV 2.6), and a 2.7 x 2.1 cm left
axillary lymph node (maximum SUV 13.7).
There has been interval resolution of the previously seen hypermetabolic
lower right paratracheal adenopathy.Chest wall: Status post right mastectomy with flap reconstruction and
right axillary lymph node dissection.ABDOMEN AND PELVIS:Physiologic FDG uptake seen in the GU and GI tracts.Liver: Multiple new intensely FDG avid lesions are seen throughout the
liver, compatible with hypermetabolic hepatic metastases. For example:
- 4.0 x 3.9 cm FDG focus in the lateral segment of the left hepatic lobe
(maximum SUV 16.1, slice position 325),
- 5.2 x 4.3 cm FDG focus in the anterior segment of the right hepatic
lobe (maximum SUV 12.8, slice position 342), and
- 3.3 x 3.0 cm FDG focus in the right hepatic lobe inferiorly (maximum
SUV 11.6, slice position 395).Biliary: No bile duct dilation.Spleen: No mass. No splenomegaly.Pancreas: No mass or duct dilation.Adrenals: No mass.Kidneys: No stones, hydronephrosis, or hypermetabolic lesions.GI tract: No dilation or wall thickening.Lymph nodes: New hypermetabolic lymphadenopathy is seen, including the
periportal (maximum SUV 8.7), portacaval (maximum SUV 8.6), aortocaval
(maximum SUV 5.9), left para-aortic (maximum SUV 10.6), and left common
iliac regions (maximum SUV 8.6).Mesentery/Peritoneum: There is a new FDG avid 9 x 7 mm soft tissue nodule
in the left upper pelvis (maximum SUV 2.6, slice position 524),
compatible with hypermetabolic peritoneal implant.Vasculature: Vascular patency cannot be assessed due to lack of IV
contrast.BONES AND EXTREMITIES:There has been an interval increase in FDG avidity by the sclerotic
lesion of the upper sternal body (maximum SUV 4.5, previously 2.5).
Multiple new hypermetabolic osseous lesions are seen, including the right
humeral head (maximum SUV 5.9), left acromion (maximum SUV 3.7), multiple
thoracic vertebrae (for example maximum SUV 5.6 associated with T3
vertebral body), multiple lumbar vertebrae, sacral body (maximum SUV
4.8), several additional sites in the bony pelvis, and both proximal
femora. These findings are compatible with progression of hypermetabolic
osseous metastatic disease.======
Component ResultsThere is no component information for this result.
General Information
Collected:01/26/2018 2:31 PM
Resulted:01/26/2018 3:10 PM
Ordered By:Brian R Murphy, MD
Result Status:Final result
This test result has been released by an automatic process.
Back to the Test Results List
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Customer reply replied 22 days ago
The above is my January pet scan. I was off chemo for two months (just getting herceptin and perjeta) and I had progression.
I find this scary since I am on chemo and my markers went up. I feel like I am full of cancer

If leptomeningeal metastasis is present then the presentation is totally different, patients with this condition are very sick and they have severe diffuse headache, nausea and vomiting, neck stiffness, fainting, and sometimes other symptoms such as double vision, hearing deficits, facial droop, and possibly many more symptoms and signs. The clinical presentation you have been having is not at all suspicious for leptomeningeal mets. And this vertigo must be from sinus issue rather than spread to the brain, because mets to brain once again should produce many more symptoms such as some of the symptoms mentioned earlier above - instead of causing just vertigo, numbness etc. And yes, even massage too can cause such numbness although the sinus issue is most likely the culprit, one or otherway way your symptoms do not appear secondary to mets to the leptomeninges or to the brain etc.

The markers went up appears secondary to infection, inflammation and antibiotic treatment etc rather than related to tumor spread.

I earnestly hope your oncologist is trying his/her best to keep the tumor under control and also to prevent it from spreading any further, and I wish you all the very best and earnestly hope the tumor as well as its spread will respond to the treatments completely, and also the treatments will fully help in preventing any future spread too!

Thanks & Best Regards!

Dr Subbanna MD

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Customer reply replied 20 days ago
my MRI is scheduled for Monday morning. I am so scared it is that syndrome. My oncologist said if I have it-I will get radiation. He didn't tell me I would only have a few months like the internet says. I started a new antibiotic for my sinus infection. I also had acupuncture to try to get rid of the numb chin/lip thing. It did not work.

The internet has not put it right in this instance, if someone is found to have numb chin or lip syndrome it certainly does not mean their life span is shortened, oncologists will obviously try to treat it appropriately and prevent any complications from taking place, but most importantly numb chin or lip syndrome is not yet confirmed in your case, other possibilities such as sinus issues can definitely cause this type of numbness. If possible you may try few more treatments of acupuncture it may still help and also you may try pills such as gabapentin or amitriptyline etc which also can help you with this type of numbness. MRI is not expected to show any mets to explain this numbness, and I wish you all the very best with the mri scan!

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Customer reply replied 17 days ago
Just had my MRI. If they do find a bone met-can't it be radiated. The internet said this diagnosis would give me just a few months. I don't understand as I have other bone mets that do not bother me. My chin and lip are still numb and they tingle once in awhile. My upper back teeth hurt off and on. I don't this this second antibiotic is working.

If there is a met it can certainly be radiated. Although this still could very well be secondary to some other benign non-met reason rather than due to a met, however even if someone has a met causing this syndrome, it is similar to any other mets and has no different level of prognosis compared to mets in any other places of the body, and also if it is present it can certainly be treated with radiation. Also I really do not understand what they are telling, it does not make any sense at all - how they can talk about the prognosis based on met in one region, since a met in this region has no different prognosis compared to that of other regions.

If not already done then you may try nerve-pail pills such as Gabapentin or Pregabalin which can also help with this type of numbness and tingling sensation.

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Customer reply replied 16 days ago
My MRI came back clean. No tumors or lesions. My oncologist wants me to see a nuerologist about my chin and he thinks I have carpel tunnel syndrome. Thank you for being so kind and patient with me. You are so thorough and understanding.

You are very welcome! I am very glad to hear your mri is not showing any mets, and it was expected too because numb chin or lip certainly does not automatically indicate it is due to mets, in fact it is very commonly due to some non-met cause than met cause. Hope a thorough neurological examination by a neurologist in the clinic will help shedding more light into the cause of this new onset numb chin or lip syndrome. Anyway carpal tunnel syndrome should not be considered because this syndrome affects the hand and first three fingers, but not chin and lip region.

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Customer reply replied 14 days ago
my onc told me today that the MRI may not have picked up the lesion in my jaw because it is too small. Now I have to see a nuerologist. I called my dentist and they said my teeth would have nothing to do with it. I am right back to being terrified. Plus I have to get a cat scan next week to see if chemo is working.

It is unlikely mri will miss a met, even if it is very small.

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