I Feel a Breast Lump!

The First visit to the Oncologist

I think I feel a 'Lump'
in my breast

A 'lump' or a 'hard knot' in the breast, is by far, the most common symptom, with which a lady usually presents to us. It may or may not be associated with pain, most often not. Some women notice it while taking a bath, while others notice it while changing into night clothes. Some feel a pain, which brings them to notice the lump.

So what is
this 'lump'?

The normal breast tissue is 'soft'. Soft, as in, a soft sponge. Or soft as in, a dough ('roti ka atta'). In a soft tissue, the fingers will easily 'sink in'. In sponge, they will 'sink in' on mild pressure, whereas in a dough, they will 'sink in' on a little more pressure than for a sponge. But when 'something hard' is hidden in the breast (for example, if a 'walnut' is hidden in the sponge), while pressing with the fingers there (sinking in the hands) in that area, the fingers tips feel a definite 'difference' from the rest of the breast. It feels 'hard' or 'very hard'. This is a 'lump' or a knot'. A detailed description on symptoms of breast cancer is given in the section below. Click below to go to it, it will open in a new window, so you can close it after reading and come back here:

Symptoms of Breast Cancer

Remember, all lumps are not cancerous! In fact, most lumps in women below 30 years of age are 'fibroids' and are not cancerous. As the age goes on increasing from 30 to 50, chances of lumps being cancerous increases. Beyond 50 years of age, most 'newly detected' lumps will be cancerous. SOme of the symptoms which we see commonly in the clinic, are shown below in images.

Breast lump

Large Lump

A large breast lump with nipple deviation

A 'painless lump' is the most common symptom. Usually smaller lumps are felt. The above lump is large, for you to understand. The skin is stretched and 'shiny', as pointed by arrow. Another arrow points to a part of lump projecting into the skin.

Skin Thickening

Thickening of skin due to involvement

A 'deep' seated tumour 'blocks' lymphatic outflow from breast and makes skin 'thick' - like the 'peel' of an orange fruit. Such a skin thickening is a sign of advanced cancer.

Nipple Excoriation

Nipple excoriatipn called as Paget's disease

An 'ulcer' on the nipple is clearly seen. In this lady, there was a deep tumour, in the region behind the nipple. Sometimes, the nipple also gets 'pulled inwards' and cannot be 'pulled out' if you try to.

Our Approach at this 'First Visit'

When the lady enters my room, the apprehension, the anxiety is very much visible on the face. When my eyes meet hers and her husbands' or any other accompanying relative, I can sense it - the fear in their minds - that the next few minutes what they may hear from me, will potetntially change their lives.
I prefer to liven the atmosphere a little, so after taking a detailed history and a clinically examination of the lump, the first step I do is to allay their fears - I tell them, to not worry, whatever this is, looks curable and she is going to be fine.

When I examine the lump in the breast along with the armpit, it gives me a rough idea of what am I dealing with? And if it looks cancerous, a detailed examination will guide me roughly towards what stage is it? This part is important, since that is going to determine, not only all the further tests, but also is going to me decide on whether to do surgery first or chemo first; and when time for surgery comes, to decide which type of surgery can I do for her.

For our description purpose, let's assume the lump looks cancerous. I make a note of family history of cancer (if any), other past history and do a detailed examination and assessment. And more important than everything, this first visit helps me understand the patient's nature, which in turn helps me develop a connection with the patient and her relatives, and give them an assurance, a hope, that we can easily come over this. Definitely.

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Journey of BC: Diagnosis

1. I feel a lump! - The first visit to doctor - You are presently on this page
2. Is it really cancer? - Confirmatory tests
3. What is the stage? - Staging and fitness tests
4. Will it be surgery first? or chemo first? - Treatment planning and sequence

Journey of BC: Surgery

5. Should I conserve or remove breast? - Choice of Surgeries for breast cancer
6. How long will be the surgery? - Admission and Surgery
7. Care after surgery - Precautions and guidelines
8. What next? - The Pathology Report

Journey of BC: Further Treatment

9. How many chemo cycles? - Chemotherapy Consultation
10. Is a PORT necessary? - ChemoPORT insertion
11. Will I be normal during chemo? - The Chemotherapy time
12. Is Radiation painful? - Radiation Therapy
13. Yes!! I did it! - Treatment is over
14. How frequently do I meet doc? - Follow up guidelines

Other Topics

Risk Factors - The Risk Factors for Breast Cancer
Symptoms of Breast Cancer - Know the Symptoms of Breast Cancer
Early Detection of Breast Cancer - The Guidelines

Neo Adjuvant Chemotherapy (NACT) - For LABC
Sentinel Node Biopsy - How is it done?
Targeted Therapy - Trastuzumab
Hormone Therapy - Who gets it?