Lump In Breast

When the tissue sample is inspected grossly, the tumor is measured in three dimensions using a ruler and the distance to all the margins of excision are recorded. Other observation such as the presence of satellite nodules, tumor necrosis (death tissue), calcifications, relationship with the skin, nipple or deep fascia etc are recorded. The presence of other possible non-cancerous lesions are described. Ultimately, samples of the tumor, margins, other lesions etc. are taken and submitted for microscopic examination. When the tissue sample is inspected grossly, the tumor is measured in three dimensions using a ruler and the distance to all the margins of excision are recorded. Other observation such as the presence of satellite nodules, tumor necrosis (death tissue), calcifications, relationship with the skin, nipple or deep fascia etc are recorded. The presence of other possible non-cancerous lesions are described. Ultimately, samples of the tumor, margins, other lesions etc. are taken and submitted for microscopic examination.

This is such a good, important question.

What I had found during my routine monthly breast self exam was actually a very subtle dimple. I found this after a mammogram and a gynecologist missed it. It took me two weeks to gather up the courage to make an appointment to see my gynecologist to point out the problem.

I was really scared and didn't want to seek out medical help, but I forced myself to speak up and tell my doctor that something was wrong. He listened to me and ordered a diagnostic mammogram, which then found the abnormality.

One of the keys is having a good general doctor in place because a quality general doctor knows great specialists. The saying that birds of a feather flock together is so true.

The key to seeking out the medical care I needed was to act in spite of my fears and to speak up when I didn't like the way I was treated by a medical staff member, including doctors. The key to obtaining quality care was my perseverence. No matter how much a person is frustrated, scared, or feels like shying away from the medical situation, he/she has no choice but to see it through and keep persevering until he/she gets the medical help he/she wants and needs.

It was not easy for me to stay strong and adament about my own care. But I thought of what was at stake here, and it was my life. That was all the motivation I had to keep going toward my goal of quality care.



This is such a good, important question.

What I had found during my routine monthly breast self exam was actually a very subtle dimple. I found this after a mammogram and a gynecologist missed it. It took me two weeks to gather up the courage to make an appointment to see my gynecologist to point out the problem.

I was really scared and didn't want to seek out medical help, but I forced myself to speak up and tell my doctor that something was wrong. He listened to me and ordered a diagnostic mammogram, which then found the abnormality.

One of the keys is having a good general doctor in place because a quality general doctor knows great specialists. The saying that birds of a feather flock together is so true.

The key to seeking out the medical care I needed was to act in spite of my fears and to speak up when I didn't like the way I was treated by a medical staff member, including doctors. The key to obtaining quality care was my perseverence. No matter how much a person is frustrated, scared, or feels like shying away from the medical situation, he/she has no choice but to see it through and keep persevering until he/she gets the medical help he/she wants and needs.

It was not easy for me to stay strong and adament about my own care. But I thought of what was at stake here, and it was my life. That was all the motivation I had to keep going toward my goal of quality care.

I suggest that you see your breast specialist (surgeon) to have the area assessed. The lumps could likely be related to scar tissue, but you always want to err on the side of caution and make sure they are not a recurrance.
As for the underam arm ache...
Make sure you have full range of motion in that arm if it is the one where your lymph nodes where removed. Likely it is scar tissue or something like that but you should see a healthcare provider to determine if there could be other causes for this aching.
Thanks,
Heather I suggest that you see your breast specialist (surgeon) to have the area assessed. The lumps could likely be related to scar tissue, but you always want to err on the side of caution and make sure they are not a recurrance.
As for the underam arm ache...
Make sure you have full range of motion in that arm if it is the one where your lymph nodes where removed. Likely it is scar tissue or something like that but you should see a healthcare provider to determine if there could be other causes for this aching.
Thanks,
Heather

The first thing to realize, is that the term "biopsy" often means different things to different people, so hopefully I can provide some clarification as well as some advice to women who might be in this situation.

It used to be that when a woman felt a lump in her breast, she was given one option - surgery. The lump was removed, and depending on the results she either was told to resume routine follow up (if it was benign) or had a mastectomy (if it was cancer) - women used to sign a consent form that would allow for lump removal and mastectomy all at the same time if the pathology showed that it was cancer. At the time, we did not have the sophisticated imaging and biopsy devices that we do now, and there was only one operation for breast cancer - a radical or modified radical mastectomy.

Thankfully, a lot has changed. Our imaging has significantly improved - ultrasound can be invaluable when dealing with a palpable lump, especially in a young woman, as often we can make the distinction between normal "lumpy" breast tissue, a fluid-filled cyst, or a solid mass. In addition, ultrasound can give us some idea based on the characteristics of the lesion whether a solid mass is benign or malignant, but ultrasound and any imaging test does not take the place of obtaining a tissue sample that the pathologist can review to make a definitive diagnosis.

The standard of care is that minimally-invasive, image-guided biopsies be performed to make a diagnosis, not surgical removal. There are a few situations when image-guided biopsies are not technically possible or are not appropriate, but they can be performed in the majority of cases. If the biopsy demonstrates a benign lesion, the patient may not need surgery at all, or may be a candidate for a minimally invasive method of treatment, such as cryoablation (see my answer on cryoablation for more details). Approximately 80-85% of biopsies result in a benign diagnosis, and we try to reserve the operating room for therapy, not diagnosis.

If the lesion is found to be malignant, further workup such as MRI or other testing might appropriate in order to properly plan the surgery. There are also plenty of studies demonstrating that if surgery is the first procedure performed in the setting of breast cancer, the woman is more likely to require more than one operation either due to positive margins, the need for lymph node biopsy, or other factors. A more appropriate and more cosmetic procedure will be done if the diagnosis is established prior to surgery. This is supported by the American Society of Breast Surgeons (http://www.breastsurgeons.org/statements/PDF_Statements/Percutaneous_Needle_Biopsy.pdf)


As to who should perform the biopsy, surgeon or radiologist - it depends on the individual practice situation and training of the physician. More surgeons are being trained in performance of ultrasound, ultrasound-guided biopsy, and stereotactic (mammogram-guided) biopsy, and the American Society of Breast Surgeons has education, certification and accreditation programs specifically for surgeons. As a surgeon, I would rather perform the imaging and biopsy myself, as I will then have a better appreciation for exactly where the lesion is (more important when dealing with non-palpable lesions), especially if surgery is eventually required. However radiologists do perform the imaging and biopsies as well, and in many situations, work collaboratively with the surgeon.

However the most important point is not necessarily who performs the biopsy (assuming that anyone performing it is qualified), but that whenever possible, a minimally-invasive needle biopsy be performed rather than surgery as the initial procedure. The first thing to realize, is that the term "biopsy" often means different things to different people, so hopefully I can provide some clarification as well as some advice to women who might be in this situation.

It used to be that when a woman felt a lump in her breast, she was given one option - surgery. The lump was removed, and depending on the results she either was told to resume routine follow up (if it was benign) or had a mastectomy (if it was cancer) - women used to sign a consent form that would allow for lump removal and mastectomy all at the same time if the pathology showed that it was cancer. At the time, we did not have the sophisticated imaging and biopsy devices that we do now, and there was only one operation for breast cancer - a radical or modified radical mastectomy.

Thankfully, a lot has changed. Our imaging has significantly improved - ultrasound can be invaluable when dealing with a palpable lump, especially in a young woman, as often we can make the distinction between normal "lumpy" breast tissue, a fluid-filled cyst, or a solid mass. In addition, ultrasound can give us some idea based on the characteristics of the lesion whether a solid mass is benign or malignant, but ultrasound and any imaging test does not take the place of obtaining a tissue sample that the pathologist can review to make a definitive diagnosis.

The standard of care is that minimally-invasive, image-guided biopsies be performed to make a diagnosis, not surgical removal. There are a few situations when image-guided biopsies are not technically possible or are not appropriate, but they can be performed in the majority of cases. If the biopsy demonstrates a benign lesion, the patient may not need surgery at all, or may be a candidate for a minimally invasive method of treatment, such as cryoablation (see my answer on cryoablation for more details). Approximately 80-85% of biopsies result in a benign diagnosis, and we try to reserve the operating room for therapy, not diagnosis.

If the lesion is found to be malignant, further workup such as MRI or other testing might appropriate in order to properly plan the surgery. There are also plenty of studies demonstrating that if surgery is the first procedure performed in the setting of breast cancer, the woman is more likely to require more than one operation either due to positive margins, the need for lymph node biopsy, or other factors. A more appropriate and more cosmetic procedure will be done if the diagnosis is established prior to surgery. This is supported by the American Society of Breast Surgeons (http://www.breastsurgeons.org/statements/PDF_Statements/Percutaneous_Needle_Biopsy.pdf)


As to who should perform the biopsy, surgeon or radiologist - it depends on the individual practice situation and training of the physician. More surgeons are being trained in performance of ultrasound, ultrasound-guided biopsy, and stereotactic (mammogram-guided) biopsy, and the American Society of Breast Surgeons has education, certification and accreditation programs specifically for surgeons. As a surgeon, I would rather perform the imaging and biopsy myself, as I will then have a better appreciation for exactly where the lesion is (more important when dealing with non-palpable lesions), especially if surgery is eventually required. However radiologists do perform the imaging and biopsies as well, and in many situations, work collaboratively with the surgeon.

However the most important point is not necessarily who performs the biopsy (assuming that anyone performing it is qualified), but that whenever possible, a minimally-invasive needle biopsy be performed rather than surgery as the initial procedure.

Thank you! I first found my lump while lying on my bed doing a self-breast exam. Since my mom was a breast cancer survivor, I did self exams occasionally, but never thought I would actually find a lump. At first, I didn't believe I actually had a lump. I didn't know what a lump would feel like, and since I was only 27, I thought for sure it was probably just a normal part of my breast. But when I went to the gynecologist for a different health issue, he was very concerned about my lump.

I personally did not have the test for a genetic mutation. My mom went through testing just months before she died, and the tests did not find any mutations that are currently known about. I discussed the results with my oncologist, and he agreed with my mom's genetic counselor that I do not need to have genetic testing since my results would be the same as my mom's testing. Thank you! I first found my lump while lying on my bed doing a self-breast exam. Since my mom was a breast cancer survivor, I did self exams occasionally, but never thought I would actually find a lump. At first, I didn't believe I actually had a lump. I didn't know what a lump would feel like, and since I was only 27, I thought for sure it was probably just a normal part of my breast. But when I went to the gynecologist for a different health issue, he was very concerned about my lump.

I personally did not have the test for a genetic mutation. My mom went through testing just months before she died, and the tests did not find any mutations that are currently known about. I discussed the results with my oncologist, and he agreed with my mom's genetic counselor that I do not need to have genetic testing since my results would be the same as my mom's testing.

Because I had so many fibroids, I was told to wait until after cycle was complete and if it was still there then have it checked. When I was diagnosed, I waited and when it didn't go away, I saw my doctor. My lump was the size of a golf ball protruding out my skin, but yet the doctor told me it was unlikely to be cancer because I was 35, nofamily history and the area was painful. He did do a needle biopsy to put my mind at ease. Unfortunately, he missed the tumor and therefore told me it was benign. Luckily, I decided to have it removed anyways because of the size and discomfort. That was when they realized there was a problem and a few days later I got the call while driving that I had cancer.

Be proactive but don't overreact. Don't be afraid to get a second opinion. Always write things down because I guarantee you will either forget or confuse things out of stress and nervoussness. Take someone with you if you are worried, it never hurts to have another person there for support and to help you digest all the information. And if you are overwhelmed, talk to someone who can point you to resources that would be best for you. trust your intuition and be aware if something isn't right. I pushed more than once knowing something was wrong and even when I was told I was over worried, I trusted myself and that made the difference. Make an appointment with your gynecologist, who will give you a breast exam. Hopefully, you'll find it is nothing. Otherwise, based on your symptoms, you might be asked to see a radiologist for a mammogram and/or sonogram. If there is still suspicion, but no certainty, you may also be asked to have an MRI.

It is important to act quickly. Don't put your head in the sand. If it is breast cancer, you want it to be detected as soon as possible. Early detection means more choices and more control. And, it gives you the best chance for survival.

There is another condition which is sometimes confused with cystic disease. These "cysts" are sometimes termed fibro-cystic disease. They are solid, painless, and do not typically enlarge or change with hormonal fluctuations. These growths can be andenopathic. These growths are typically easily distinguished from cancer by mamography or ultrasound. These adenopathies tend to signal the increased potential for breast cancer development later on. "Cysts are not cancers and there is no evidence that cysts become cancers. Cysts are sacs in the breast filled with fluid that feel like a "lump."

Breast cysts are common especially among women between the ages of 40-60. Breast ultrasound identifies cysts. It is extremely important to find out whether what you have is just a cyst or something else.

Breast cysts are categorized as simple cysts or complex cysts. "Simple Cysts" are identified and are generally benign being round or oval with smooth edges. "Complex Cysts" contain debris and aspiration is usually required. Techniques used for aspiration (biopsy) include fine-needle aspiration (also called percutaneous), core-needle biopsy, and surgical biopsy.

The pathologist will check the fluid obtained from the aspiration to determine there are no cancer cells.

Your physician will perform several tests to distinguish if the lump is normal or abnormal.
- Feeling the lump (palpation) to determine how hard and if the lump moves around. Cancerous lumps many times are hard and do not move.
- Diagnostic mammogram to determine size and location of the lump as well as learn more about the surrounding tissue and lymph nodes.
- Ultrasound test to determine if the lump is sold or filled with fluid.
- Thermal imaging (not common) measures shifts in physiological and metabolic activity.

If the lump appears suspicious, the next step is to have a biopsy and analyze cells from the lump. Your physician will perform several tests to distinguish if the lump is normal or abnormal.
- Feeling the lump (palpation) to determine how hard and if the lump moves around. Cancerous lumps many times are hard and do not move.
- Diagnostic mammogram to determine size and location of the lump as well as learn more about the surrounding tissue and lymph nodes.
- Ultrasound test to determine if the lump is sold or filled with fluid.
- Thermal imaging (not common) measures shifts in physiological and metabolic activity.

If the lump appears suspicious, the next step is to have a biopsy and analyze cells from the lump.