<s>[INST] Hello doctor, I am a 64-year-old female, operated cancer breast and cancer rectum. I completed the treatment for breast cancer. I underwent neoadjuvant CTRT and anterior resection with covering ileostomy for cancer rectum. I completed adjuvant chemotherapy and ileostomy closure done. My CT thorax shows multiple enlarged left retro pectoral nodes. [/INST] Hello. As per your reports, your mammography is normal. (attachment removed to protect patient identity).  CT (computed tomography) shows retroperitoneal lymph nodes and multiple hypodense lesions. Chances for breast cancer recurring after 10 years are usually unlikely. What can you tell about your baseline stage of cancer breast and cancer rectum? As serum CEA levels are normal, there is discordant radiology and serological picture. I would like to view CT films and if previous CT films are available. The CT is definitely abnormal. Liver lesions can be simple cysts too. If that is the case I would not give much importance to retroperitoneal nodes and just advise you to be in close follow up. May be repeat CEA and CT after three months. There are no definite guidelines for this type of situation. And the plan of action depends on experience and clinical judgment regards how likely is the recurrence. If symptomatic I would advise you to follow up. Most likely the picture looks like recurrence of cancer rectum. But as treatment was completed more than three years ago, recurrence this late is not common and chances of different diagnosis like TB (tuberculosis) or infective cause can also be there. </s>