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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Have Two Lumps Under Armpit. Appeared Separately. Ultrasounds Seems Fine. BRCA, Mutation Positive. Lumps Are Sore, Discoloration. Breast Cancer Possibility?

Hi. I have two lumps under my right arm in my armpit area. The first lump has been there for about two years. The second lump just appeared in June. I have had two separate ultrasounds on the lumps and both times I have been told nothing is there. I am positive for the BRCA II genetic mutation, so I am at high risk for breast cancer. Sometimes the lumps are sore and today I noticed there is a bit of discoloration. They are palpable and visible to the eye. I am not sure what to do. It is very unsettling to be told nothing is there when I feel these lumps and know they are not going away. Thank you for your help.
Fri, 4 Oct 2013
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Oncologist, Surgical,  's  Response
It would have helped to have known your age. Anyways, first of all the lump that has been there for 2 years is less likely to be cancerous. However we still need to be sure. May be you have dense breasts and that is the reason the ultrasound has not been able to pick up the lumps. I suggest you get a MRI of both breasts and axilla done. That will definitely pick up any lumps that are there and also comment on the nature of the lumps. If the lumps are palpable, then you can ask your doctor to get a needle test done from the lumps (FNAC), after the MRI has been done. Both these investigations will definitely tell us the exact nature of these lumps. For your BRCA gene mutation, you need to consider one of 3 options. First is a prophylactic bilateral mastectomy with reconstruction. This is the most definitive although it does not decrease the risk of cancer to zero but to 5%. Second is close surveillance with 6 monthly clinical examination by an oncologist + six monthly mammogram/ultrasound + yearly MRI. This will pick up any cancer that may develop at an early stage. The third is taking a tablet called Tamoxifen. You need to seriously consider one of these options after discussing with your oncologist.
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Have Two Lumps Under Armpit. Appeared Separately. Ultrasounds Seems Fine. BRCA, Mutation Positive. Lumps Are Sore, Discoloration. Breast Cancer Possibility?

It would have helped to have known your age. Anyways, first of all the lump that has been there for 2 years is less likely to be cancerous. However we still need to be sure. May be you have dense breasts and that is the reason the ultrasound has not been able to pick up the lumps. I suggest you get a MRI of both breasts and axilla done. That will definitely pick up any lumps that are there and also comment on the nature of the lumps. If the lumps are palpable, then you can ask your doctor to get a needle test done from the lumps (FNAC), after the MRI has been done. Both these investigations will definitely tell us the exact nature of these lumps. For your BRCA gene mutation, you need to consider one of 3 options. First is a prophylactic bilateral mastectomy with reconstruction. This is the most definitive although it does not decrease the risk of cancer to zero but to 5%. Second is close surveillance with 6 monthly clinical examination by an oncologist + six monthly mammogram/ultrasound + yearly MRI. This will pick up any cancer that may develop at an early stage. The third is taking a tablet called Tamoxifen. You need to seriously consider one of these options after discussing with your oncologist.