lump does not show up on tests

[promethius]

Hi. I have a small hard nodule, 3-4 mm that is clearly palpable by myself and my GYN, upper outer quadrant. It's been there at least 3 months. I am 47 years old, still with regular cycles. I went for diagnostic mammogram and ultrasound at an expert center that does only breast imaging, but neither test could find the lump. I have very fibrocystic breasts. Their recommendation is that I follow up with a "breast specialist" to see what he/she wants to do next. They also said that lobular cancer can manifest as a palpable lump but not be visible on scans.

    One question I have is that is it possible it's not showing up just because it's small and below the resolution of the imaging, especially given that my breasts are dense? I guess I want to know if there's any way of estimating the liklihood that it's cancer. Does the fact that it doesn't show up on imaging change the probability that it's cancer? Does the fact that it's hard to the touch make it more likely to be cancer? (I would have thought tht if it was a fibrous adenoma it would have showed up on the scan). Could it still be normal tissue? How much more info would an MRI give? I'd hate to get one unless it's very useful. Under what circumstances will the oncologist want a biopsy given that it's not showing up on on tests? Again, would hate to get one (lots of medical problems) if i didn't need it, but would hate not too if there's a high probabilty of cancer.

    Sorry for all the low level questions. This isn't a topic I know much on. (In terms of risk for breast cancer, I have variants in the MTHFR gene (along with alot of the population) that increase the risk of breast cancer with estrogen, I have GSTM1 deletion which increase probabilty of cancer, some think breast cancer. Never had children and period began at age 11. Not enough female relatives to know of history. mother died of cancer of unknown origin, father died of prostate cancer at age 53).

Thanks much.

[alarson]

I would not suggest just a plain biospy.  2006, I had a plain biopsy (not ultrasound guided) on a lump that was 7mm and they told me it was not cancer.  I had that lump removed a few weeks ago because after the biospy it was painful.  Once it was removed they tested it and it was cancer.    When he removed that lump there was another lump at 5mm he found by accident.  It was also cancer.  The 5mm lump was NOT on the ultrasound or mammogram.  So to give insight to your question - my 5mm lump was not found on my tests.

I would ask to have it tested with a MRI and if you are willing and the lump is easy to get to (have it just removed) or an ultrsound biosy.  I had a lump removed in the office by the breast surgeon with him  numbing the area around the lump and cutting it out.  THE BEST THING THAT I EVER DID FOR MYSELF!  I tell you this because I am 34 years old and they told me at 32 I was too young for breast cancer and after the biospy he told me I did not have cancer.  If I would have listed to him I would never have know that I infact had 2 lumps that were both breast cancer.  

I know that an MRI is important to finding cancer.  In 2007 I found another lump on top my implants (I had a double mast in 2006).  They thought it was implant related.  I had an MRI that was not normal and the lump was noticed on the MRI - they said that MRI can report other problems and not just cancer.  They thougth that the spot on the MRI was implant related that is why is was shown on MRI.  My implants were giving me problems and I decided to have an implant exchange last summer.  The spot was tested and it was cancer once again.  

A biospy is VERY easy - have one or ask to have it removed.  I think it is VERY important to have it tested.  Chances are you do not have cancer.  I have been told that lumps can act and look like cancerous lumps that are not cancer.  However you will never know until it the lump is tested.  I believe that there is really no test out there to tell you 100% it is cancer.  The only was you can tell 100% that something is cancer is to test the lump itself.

I have always had cysts in my breasts.  I had all lumps tested.  My cysts never shown on mammo.  My breast cancer did show on mammo.  Both the cysts and cancer lumps all felt the same to me.  You asked if it's hard to touch is it cancer - can only tell you by my experience all of my lumps felt the same.

Good luck and hope my non-medical but personal experience helps.

[promethius]

Hi everyone-
thanks for your messages.
Interestingly, I narrowly avoided cervical cancer 15 years ago. Had severe grade cervical dysplasia which an expert said was just about CIS, that a very fine line divided them. Had laser ablation. BUT, in the last 4 years, all of my paps have been abnormal. Since it's just "atypia" and I test negative for HPV, they don't want to follow it up with colposcopy. Anolther case where I should insist - get so damn tired of having to insist. I read an article that those treated for cancerous or precancerous cervical lesions are more likely to get other cancers, esepecailly gynecological cancers 15 or 20 years later. I posted about it about 6 months ago on one of these forums.
Having trouble finding a breast surgeon I trust- the person I wanted no longer sees breast lump patients...Pisses me off they didn't skip the mammo and go straight to MRI. lost too much time. and can't get rid of this sore throat-cold-cough I picked up from the gyn office 9 days ago.  

[promethius]

Thanks for the reply but you didn't really answer the questions. Of course I know you cannot diagnose someone without seeing them or their test results. And yes, I know to follow up with a specialist. But what about the questions I asked that don't require such knowledge; for example, what's the resolution of the breast sonogram? (i.e. how small a mass can it detect) Does a palpable biopsy that does not show up on mammogram or sonogram change the probability of it being cancer? Please don't be afraid to give more technical answers to people's posts. People who make it to this forum are pretty sophisticated. Platitudes can be found on many sites, but medhelp.org is usually the place we can count on to get expert technical info that goes well beyond "see your doctor".

[bjkatz]

A related discussion, lup in breast not showing up on mamo or u/s was started.

[pammy808]

A related discussion, papable lump did not show on mam or us was started.

[Penda]

Hi,
I had my Dr.'s appt. yesterday,..I guess they will get in touch with me on Monday, I have a ? I always called it a birthmark(they are going to remove)..and need my Gall bladder out,..and now I need a lump removed??? I am requesting they do it all in the same shot??? WE'll see?? Any how, I find it very interesting, that my newest lump is the only one this DR. feels, but I am glad they are going to check it out! I do wish they would find the other two spots that I swear I feel,..Actually another DR. the sergen said that one of those was a cyst, and unless it got bigger, not to worry about it??? now this one, the DR. says does not feel like a cyst,..on the other hand,..this lump / lumpy area? hurts, and he assures me if they hurt they are not cancerous, anyone ever here that before? Thanks!

[sher21855]

I also had cervical cancer at age 21. (I'm 52)  I felt my lump 3 years ago, it did not show up on mamogram until this past year. I have since had bilateral mastectomys and right node dissection. (in July)  I would say get another opinion, and definately ask for a biopsy. They have now found a nodule on my lung that is new as well as a fatty infilitration of the liver, (I am not obese or an alcoholic) I am very concerned at this point that I have mets. I wish you the best. Also, don't only request an MRI, demand the breast MRI.

[Penda]

Thank You, for your question,..I feel like it so much like what I am going through,..I am sitting here debating on calling a DR. and try to get an MRI,..but with me, when I had the mamo and ultra sound, they said there was thickened tissue in a section?? Now I think a new bump is  located in a new spot, on the same breast,..very disconcerning,..and also I have already at age 29 had a complete hysterectomy, for cervical cancer, and breast cancer runs high in my dads side of the family,...

[Cleveland Clinic]

Dear promethius:  Without reviewing the mammogram and ultrasound and performing a clinical breast examination, it is impossible to speculate on what this might be.  In general, the rule of thumb is that if there is a palpable lump, further evaluation is necessary.  If it cannot be characterized either by examination or imaging, there is no way to speculate on the probability of it being cancer or something benign.  An MRI may or may not help to clarify.  MRI’s are best used in conjunction with mammogram, ultrasound and examination because they have a high false positive rate resulting in unnecessary biopsies.  It is probably reasonable to pursue evaluation with a surgeon who can help determine whether MRI, biopsy or monitoring would be the best approach in your situation.