What causes a lump on the breast?

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Posted on Tue, 24 Jan 2017 in Lump
Question: My aunt has found to have some lump in her breast in mammography and some part of it is given for biopsy for further investigation. Doctor told that no matter whether it is Benign or Malignant, she has to under go the surgery.

10 years back she had a similar lump formation in another breast and it was Benign which was later operated and removed. She has also undergone Hysterectomy 5 years back for fibroid.

My questions are:

1. Since she had couple Benign tumors(breast and uterus) removed already, can we expect even this to be the same Benign tumor?
2. Is the surgery absolutely needed if in case it is Benign formation?
3. If it is found to be Malignant, is it completely curable?
4. Doctor with which specialist has to perform this operation?

Additional info:
1. She has undergone mammography couple of years back and it was a normal one.
2. She noticed the tumor in her breast may be 2 to 3 weeks back.
3. She was complaining heating pain in her chest 3 to 4 months back.

Your advice will be very helpful and thanks in advance. Unfortunately, I don't have her mammography report with me right now to share it with you.
doctor
Answered by Dr. Rishi 1 hour later
Brief Answer:
It is likely to be benign.

Detailed Answer:
Hello,
Thanks for your question.
1. It is quite likely that this tumor is also Benign. Specially because it is recent onset and the burning. Cancerous lumps do not usually lead to pain or burning. Also, because she has a history of previous benign lumps.
2. The surgery might not be required if it is benign. But better to get it removed and then the lump can be sent for a Pathological exam.
3. If it is malignant then there are definitely chances of complete cure since it appears to be early. But we can tell that with surity only after detailed investigations.
4. It should be ideally performed by a Surgical Oncologist/ Oncosurgeon.
Do let me know if any other advice is required.
I would be more than happy to help.
Take care and all the very best for a speedy recovery.
Dr Rishi, New XXXXXXX XXXXXXX
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Rishi 4 hours later
We are currently following up on this with a General Surgeon. Can this operation be done by General Surgeon as well? Please suggest.

Thank you very much for your taking time to give a detailed answer.
doctor
Answered by Dr. Rishi 11 hours later
Brief Answer:
Yes, it can be done by a General Surgeon.

Detailed Answer:
Hello,
Thanks for your answer.

The operation can be done by a General Surgeon as well. But it should preferably be done by a Onco Surgeon who would be more proficient in doing the operation. It also depends as to where you are located and whether you have access to a Onco Surgeon. I could help you if you are in XXXXXXX and could give me more details of your location.
Take care,
Dr Rishi, New XXXXXXX XXXXXXX
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Rishi 5 hours later
She is at present visiting KMC mainpal and treated by doctor XXXXXXX XXXXXXX Rodrigues, Department of Surgery.
doctor
Answered by Dr. Rishi 2 hours later
Brief Answer:
It is a good hospital.

Detailed Answer:
Hello,
Thanks for your answer.
I do not know the Doctor but KMC Manipal is a good hospital. I think you can continue the treatment there.
But if the report comes out to be positive for malignancy then you should definitely consider getting your treatment done by an Onco Surgeon.
All the best and do let me know if I can be of assistance further.
Take care,
Dr Rishi, New XXXXXXX XXXXXXX
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Rishi 15 hours later
Thanks for your feedback.

When I spoke to the doctor, he mentioned that no matter whether it is Benign or Malignent, she should get operated and suggested to get admitted for operation on coming Friday and the same day the Biopsy results are expected.

I am not sure why he is in so much hurry for the operation when the Biopsy results are still waited. I am little concerned because he might have identified it as malignant during the Memogram itself. Is it possible to come to definite conclusion in Mamogram itself?

Also, if it turn out to be Benign, what questions should I ask the doctor before we agree for operation? Should I still proceed with operation.

However, we have decided to take a week time for the operation. I am still waiting for the mammogram result to reach me through courier and will share it as soon as I get it.

doctor
Answered by Dr. Rishi 33 minutes later
Brief Answer:
Surgery can be delayed. Mammogram report is important.

Detailed Answer:
Hello,
Thanks for your reply.
Surgery would be better as surgical specimen can be sent for Histopathological exam and that would be the final result to know whether it is benign or malignant.
There is no emergency for the surgery to be done. You can wait for as long as you want.
Mammogram can indicate whether it is benign or malignant but cant tell with surity. It should give a BIRADS score which can indicate the probability of the lesion being Benign or malignant. Seeing the report I can be in a better position to tell as to what should be done.
You should ask the Surgeon as to why the Surgery is required if the reports indicate that the lesion is benign. Also, you should ask whether they will remove the lump or do a Mastectomy. Will they also remove the axillary lymph nodes or leave them behind.
But do send me the Mammography report before you take the decision and also do look for an Oncosurgeon nearby to take advice from.
Take care and I will try to help you along with the treatment if you so desire,
Dr Rishi, New XXXXXXX XXXXXXX
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Rishi 4 hours later

I have attached the Mammogram report and with respect to BIRADS score it looks scary to me. Also, report says that the lump is found in both the breast.

Please let me know your opinion as we are really scared after seeing the report.
doctor
Answered by Dr. Rishi 1 hour later
Brief Answer:
Appears to be malignant. Contact an ONCOCENTER.

Detailed Answer:
Hello,
This Mammography suggests that the lump in the Rt breast is BIRADS 5 which seems to be malignant(Cancerous) along with lymph nodal enlargement. The Lt sided lesion is BIRADS 3 which could also be malignant and therefore needs addressing. You should contact a Cancer Center or Onco Center where facilities for Surgical Oncologist and Onco Surgeon are available along with Radiation Oncologist. All three would be required to be involved in the treatment. It might turn out that they decide to give Chemotherapy first followed by Surgery, something called NACT(Neo adjuvant Chemotherapy). She might require surgical removal of both breasts and Chemo &/or Radiotherapy.
I think delay in treatment now would not be good as it seems to be a multi-centric cancer.
Take care and do let me know how I can guide you further.
Dr Rishi, New XXXXXXX
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Rishi 6 minutes later
lymph nodal enlargement can be stage 4? Can she survive if it is a cancer?

I am really concerned about the metastatic word in the report.

Can this still turn out to be benign?

Please advise.
doctor
Answered by Dr. Rishi 14 minutes later
Brief Answer:
Please initiate treatment at an Oncocenter.

Detailed Answer:
Hello,
Lymph nodal involvement is a marker of advanced disease. But not necessarily Stage 4. She would survive if the treatment is started soonest. Survival would also depend upon what the Histopathology report of the removed breast lump says.
Metastatic only means that it is due to the malignant breast lump. It is not metastatic in the true sense as it is only Locoregional spread. So do not take that word in this way. In this case, the word Metastatic would actually be true if the Cancer has spread to the bones, lung, liver, etc. This would be ruled out by the Oncologist before initiating treatment.
It could still turn out Benign but a report of BIRADS 5 goes strongly against that specially in the presence of nodal involvement.
I believe you should see an Oncosurgeon tomorrow and initiate treatment at the earliest.
Take care and wish her a Happy recovery.
Do not feel down or get depressed as this disease can be cured.
Please feel free to ask any more queries on this issue.
Dr Rishi.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Rishi 26 hours later
We got the biopsy report today and it says suspecious for malignant tumor. Please find it attached.

Can there be still 50:50 chance that it can be benign?

We have anyways taken an appointment with oncology surgeon tomorow for further follow up.
doctor
Answered by Dr. Rishi 14 hours later
Brief Answer:
It is most likely malignant.

Detailed Answer:
Hello,
Thanks for your reply.
I have seen the report.
It is most likely malignant and due to the suspicion surgery should be done.
Chances of it not being malignant would be 20:80 only.
I suggest complete treatment for cancer should be done now.
Lets not delay anything now.
Take care and do let me know how can I be of help further.
Dr Rishi, New XXXXXXX
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Rishi 23 hours later
Thank you sir for the response.

I had taken her to the oncology surgeon yesterday. He has suggested ultrasound, CT scan,bone scan, echo, ecg and some blood tests. Ultrasound came back as normal study and awaiting for other reports.

Doctor is going to evaluate the MRI and Biopsy slices along with these reports and take further call.

From the clinical examination doctor said that even if it is there it is in first stage and can be cured. I am hopeful that she will be alright.

It is really hard time with sleepless nights and really worried at this point of time.
doctor
Answered by Dr. Rishi 29 minutes later
Brief Answer:
This is the right way to the treatment.

Detailed Answer:
Hello.
I believe you have reached a good Surgeon and he has taken the correct path to treat her. I myself would have advised all these things, specially a Bone scan before surgery.
Do find out whether he will operate on both sides or not.
I would prefer to operate both for best chances of cure.
I also feel she would be cured completely but that all can be said once we get the pathology report of the removed specimen from the surgery and knowing its ER/PR status and HER2neu status.
You are on the right path and do not worry.
You are doing your best and GOD will do the rest.
Take care and have faith and do let me know how I can be of help.
Dr Rishi.

Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Rishi 11 minutes later
Thanks for your positive feedback sir.

I am consulting doctor Prof K S XXXXXXX here in XXXXXXX

I will surely ask on whether he will opearte both or a single breast.
doctor
Answered by Dr. Rishi 6 hours later
Brief Answer:
Always welcome for any help I can extend.

Detailed Answer:
Hello,

You are most Welcome.

The treatment is on the right lines and Im sure she would recover soon. All the very best for the treatment course.

I will always be here if you ever need my help in any way.

Regards,
Dr Rishi.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Rishi 6 hours later
Sir, below are the findings today,

Bone scan - normal
Blood test - normal
CT scan - showing lump in right breast but lungs are normal.

Other pathologist who reviewed the slide gave report that it is suggestive of low grade duct carinoma.

We are admitting her tomorrow to the hospital and operation is scheduled on Monday morning. Doctor would still do the frozen biopsy.
doctor
Answered by Dr. Rishi 9 hours later
Brief Answer:
All the best for the Surgery.

Detailed Answer:
Hello,
These reports are very encouraging.
Please go ahead with the surgery.
Are they removing both the breasts?
Are they doing Breast conserving surgery(BCS) or Modified Radical mastectomy(MRM) or simple lumpectomy? I would prefer MRM actually. Do find out.
Any breast reconstruction also planned in the first procedure only?
These are things you should be aware.
Take care and all the best for the surgery
Dr Rishi.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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