Lump in Breast
You found a Lump in the Breast.
What next? Should you rush to the doctor?
Only about 1 in 12 palpable dominant lumps in premenopausal women is malignant.
If you are uncertain about whether you’ve got a lump or just lumpy breasts, it’s probably not a bad idea to check it out further. But it’s good to understand more about lumps and what yours could possibly be.
Breast tissue in and of itself can feel somewhat lumpy and sponge-like.
Lumps that feel harder or different from the rest of the breast (or the other breast) or that feel like a change are a concern and should be checked. This type of lump may be a sign of breast cancer or a benign breast condition (such as a cyst or fibroadenoma)
Dominant lump- the one lump / area that is different from all the rest.
The most important thing to know about a dominant lump—benign or malignant—is that it’s almost never subtle. It will stick out prominently in the midst of the smaller bumps and lumps. Will be at least 1-2 cm ,almost an inch, or the size of a grape.
Multiple lumps are rarely malignant.
There are three main types of dominant lumps.
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Malignant lump
The first 2 two are virtually harmless.
The third type—the malignant lump is worrisome. Being a diagnosis of elimination, if it is a cyst or a fibroadenoma, then it is most likely not malignant and therefore not a cause for worry.
The general rule is that one cannot be absolutely certain a lump in the breast isn’t cancer until the biopsy is done.
Cyst
A cyst is a distinct kind of lump. It is a fluid-filled sac which lies within the breast tissue. If large and near the surface it has a squishy feel and fluid can be felt within. If deep inside the breast tissue it feels like a hard lump.
Most often cysts appear suddenly. Sometimes they may be painful, especially if developed quickly.
Typically cysts occur in women in their 30s’,40s’, early 50s’; most common in women approaching menopause. Rarely found in a younger woman or in a postmenopausal woman.
Usually a woman will get only one or two cysts in her entire life. If a woman has multiple cysts, chances are she’ll go on getting them until menopause.
Though most cysts are harmless, investigations are done to confirm it is a cyst and it is benign.
Ultrasound is the best way to confirm the presence of a cyst. It can differentiate between a cyst and a solid lump. Aspiration under ultrasound guidance can help relieve pain due to sudden enlargement, if any, and testing of the fluid can confirm the nature of the cyst.
Cysts are almost never malignant. Incidence of cancer in cysts is just 1%. Intracystic papillary carcinoma, is seldom dangerous as it does not spread beyond the lining of the cyst.
Presence of cysts in the breast does not increase the risk of cancer.
Fibroadenomas
These are common nonmalignant lumps.
Fibroadenomas are formed from the lobules which are particularly sensitive to estrogen stimulation. Therefore fibroadenomas are found mostly in young girls whose breasts are just getting used to hormonal cycling. If hormones are taken after menopause then the chances of fibroadenomas developing increases.
Fibroadenomas are smooth, hard, round lumps, like marbles. They move around easily and slip beneath the fingers. Often located near the nipple, they can develop anywhere in the breast. Usually solitary, can be multiple in one breast at the same time or over a lifetime. They can vary in size from a tiny five millimeters to a lemon-sized five centimeters. The largest are called “giant fibroadenomas.” They usually increase in size gradually over a year to about 2-3cms, and then remain unchanged for several years. In 50% of cases a fibroadenoma would probably disappear after five years and after fifteen years in the rest.
Clinical examination is diagnostic and a doctor can usually tell simply by feeling the lump that it’s a fibroadenoma.
An Ultrasound will show a solid mass and a needle aspiration will draw no fluid.
Mammography will show a solid mass.
A core biopsy will confirm the nature of the tissue within.
If confirmed on clinical assessment usually not removed as fibroadenomas are harmless in themselves.
In older women a core biopsy of all fibroadenomas is done or they are removed. Cystosarcoma Phylloides, or Phylloides tumor is found in 1 percent of cases of what appears to be a fibroadenoma. It is usually a big lump—lemon-size or larger. This is a relatively harmless cancer that does not spread.
Fibroadenomas themselves never turn into cancer. It is rare that a cancer will arise in a fibroadenoma.
Malignant Lumps
A breast lump that's painless, hard, irregularly shaped and different from surrounding breast tissue might be breast cancer. Skin covering the lump may look red, dimpled or pitted like the skin of an orange. The breast size and shape may change, or there maybe discharge from the nipple.
