breast disorders
women s health issues
Breast Lumps
Certain symptoms and characteristics are cause for concern: A lump that is stuck to the skin or chest wall A lump that is hard and irregular in texture Dimpling of skin near the lump Thickened, red skin over the breast A bloody discharge from the nipple Lymph nodes in the armpit that are matted together or stuck to the skin or chest wall Because breast lumps may be cancerous (although they usually are not), they should be evaluated by a doctor within about 3 to 7 days. Delay of a week or so is not harmful unless there are signs of infection such as redness, swelling, and/or a discharge of pus. Women with such symptoms should see a doctor within 1 or 2 days. Doctors ask the woman questions about the lump, such as how long it has been present, whether it comes and goes, and whether it is painful. Doctors also ask about other symptoms, including any Nipple Discharge and general symptoms such as weight loss, fatigue, and bone pain. Doctors ask the woman about her medical and family history, including a previous diagnosis of breast cancer and Doctors then do a physical examination, focusing on the breasts and areas near it (see Symptoms ). Doctors inspect the breast, looking for abnormalities, changes in the skin, and nipple discharge. They also feel (palpate) the lump to determine How large it is Whether it is hard or soft Whether it is smooth or irregular Whether it is painful Whether it moves freely or is stuck to the skin or chest wall Painful, rubbery lumps in younger women are usually fibrocystic changes, particularly if the woman has had similar lumps before. Doctors determine whether the breasts are similar in shape and size and check each breast for abnormalities, particularly warning signs. Cancer is more likely if warning signs are present. Doctors also feel the lymph nodes in the armpits and above the collarbone to check for enlarged or painful lymph nodes. Usually, testing is needed because determining whether breast lumps are cancerous or not during a physical examination is difficult and because failing to identify cancer has serious consequences. Ultrasonography is typically done first to try to differentiate solid lumps from cysts, which are rarely cancerous. If the lump appears to be a cyst and is causing symptoms (such as pain or nipple discharge), a needle with a syringe may be inserted into the cyst, and the fluid removed (called aspiration) and examined. The fluid is tested for cancer cells only if any of the following occurs: It is bloody or cloudy. Little fluid is obtained. The lump remains after aspiration. Otherwise, the woman is checked again in 4 to 8 weeks. If the cyst cannot be felt, it is considered noncancerous. If it recurs, aspiration is done again, and the fluid is sent for analysis regardless of appearance. If the cyst recurs a third time or if a lump is still present after it was aspirated, a sample of tissue from the lump or the entire lump is removed and examined under a microscope (biopsy). If the lump appears to be solid, Mammography is typically done, followed by a biopsy. Doctors may do one of several types of biopsy: Fine-needle aspiration biopsy:Some cells are removed from the lump through a thin needle attached to a syringe. Core needle biopsy:A larger needle with a special tip is used to remove a larger sample of breast tissue. Open (surgical) biopsy:Doctors make a small cut in the skin and breast tissue and remove part or all of a lump. This type of biopsy is done when a needle biopsy is not possible (for example, because no lump is felt). It may also be done after a needle biopsy that does not detect cancer to be sure that the needle biopsy did not miss a cancer. Ultrasonography or mammography is often used to guide placement of the needle for the biopsy. Most women do not need to be hospitalized for these procedures. Usually, only a local anesthetic is needed. 