Is this cancer?

Here’s a breast lump from a 17-year old girl who had it for a 2 years. It had been increasing in size and recently she started having pain. The question for the week is: “Is this cancer?” What do you think? Breast cancer or benign disease?

What is cancer?

Cancer is a set of cells that grow & multiply rapidly, beyond control and beyond the normal limits of that type of cell. Because of the rapid growth, the surrounding normal cells are disrupted and the function destroyed. What’s worse, cancer cells spread to sites in the body where it is not supposed to be.

13 comments so far

  1. eve October 20, 2006 6:41 pm

    she waited for 2 yrs…becos she dowan to reduce her breast size fr C cup to A cup..haiya..total ignorance la…wat else can i say….

  2. CSH October 20, 2006 8:37 pm

    First Guess:
    I guess not. Main reason: very nicely encapsulated la. Side reason: the way u asked the question. he he…

    2nd Guess:
    Fibroadenoma. somehow it struck my mind, but i forgotten exactly what is that ard. let me check the dic…
    Fibroadenoma: a benign neoplasm derived from glandular epithelium, in which there is a conspicuous stroma of proliferating fibroblasts & conective tissue element.
    Hmmm… u said breast lump? Yeah! i think i’m right. Bingo!!! *perasannya :-)

  3. Bernard October 21, 2006 12:45 am

    eve, but… but… must take into account the cup size for the other side too, right?

    CSH, welcome back!! Good to be back online? Heheh. Wah, you’ve got a good dictionary, horr? ;-)

  4. hoiling October 21, 2006 12:44 pm

    Oh my! .. Those “thingss” taken from 1 side of the breast? I wonder she having lopsided size for 2 years? Feel sorry for her. So young.

    The tumor (am I correct to refer it as tumor?) grown to this size for 2 years and she still alive, my take would be benign. If its cancerous, I think she might be in critical condition, yes?

  5. yenjai October 22, 2006 10:25 am

    I tend to agree with CSH.
    Nice demarcation. No break in the capsule.

  6. Bernard October 22, 2006 11:59 pm

    guys and girls, a few things argue for benign disease…

    … she’s young, but young women with breast cancer is not unknown.

    … it’s been there a long time, but some less aggressive cancers can be there for quite some time too.

    … it’s looks well demarcated and encapsulated. That’s because I cut it without taking a margin of normal breast. Because I think the probability of cancer is low too.

    I’m waiting for the pathological examination report, but I’m quite sure it’s a benign giant fibroadenoma.

    A gentle giant of sorts. :-)

  7. George October 23, 2006 12:21 am

    Well here is what sifu uncle George thinks (like it is important)

    - 2 possibilities:
    1. Fibroadenoma
    2. Phylloides tumour

    - how come no FNAC? Sorry to ask

  8. Bernard October 23, 2006 8:44 am

    Sifu George, thank you for your wise answers to my humble question. I agree with the possibilities.

    Re: I perform FNAC (Fine Needle Aspiration Cytology, for the uninitiated) or core needle biopsy in 2 situations:

    1. It would be useful if the lesion was suspicious of malignancy/cancer to avoid an excisional biopsy just as I had performed in this patient before a proper cancer-clearing operation.
    2. If the patient wanted to keep the tumour (as some patients might be undecided about removing it) then FNAC would be useful to rule out a cancer and the patient may be allowed to keep it under watchful eyes.

    This young lady’s tumour was clinically benign and she was not thinking of keeping it anymore because of the ache caused by the weight. So, excision of the tumour was performed as the first procedure. This avoids an FNAC, the discomfort and the cost, which has to be calculated in private practice.

    Good reason, sifu? Any comments about that ah?

  9. hoiling October 24, 2006 12:52 pm

    Err .. the breast size back to original shape after the procedure??

  10. Bernard October 24, 2006 6:17 pm

    I don’t think she can remember the original shape before the lump appeared. But.. it’s fairly balanced when compared the other side.

  11. Bernard October 26, 2006 11:58 pm

    The results of the pathology is back… it’s giant fibroadenoma. That’s benign. Good for her.

  12. Hijackqueen October 27, 2006 9:11 am

    My sister had something like a lump in her breast too. Can’t remember the scientific name. She said it is like the size of kidney bean. Doc just ask her to hold on. Lately she felt some pain and doc said it’s the muscle that is pressing against the lump. The lump is there for about a year plus now. Do you think we should wait longer for the worst to come? Oh, doc said it’s not cancerous.

  13. Bernard October 27, 2006 11:27 pm

    HQ, i would refrain from giving specific advice for specific patients. As a general rule, however, all lumps should be assessed in three ways:

    1. clinically, by history and examination.
    2. radiologically, i.e. an imaging method, either by mammography or ultrasound.
    3. pathologically, by needle or excisional biopsy.

    An assessment based on all three aspects together would be 99% accurate.

    Noteworthy points, however, are that:

    1. The presence or absence of pain does not help to differentiate between cancer and benign lump.
    2. Small lumps may be just part of a “lumpy” breast. A biopsy would be the way to go if there really is a discrete lump instead of a “lumpy” breast. Otherwise, a “watch and see” policy may be adopted. Either way, steps 1 and 2 should be taken as well.

    I hope this helps.

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