Armpit Lumps: When to Seek Medical Advice and Next Steps

Q: Armpit Lumps: When to Seek Medical Advice and Next Steps

1. <br>Which department should I consult? A： General Surgery or Breast Surgery. <br> <br>2. <br>Why did the breast surgeon not detect the lump, only stating that the lymph nodes are not enlarged? A： Just because the breast surgeon did not see it in July does not mean it won't be

Axillary lump

In July, I discovered a lump in my armpit.
It is painless, not visible externally, and I feel no discomfort, but it can be slightly moved.
An ultrasound examination by a breast surgeon revealed a breast cyst, with no lymph node enlargement.
The doctor advised monitoring it.
However, since the lump persisted, I went to an external clinic in September for another ultrasound of my breast and armpit.
The lymph nodes were normal, and I was advised to follow up on the breast cyst and adenoma.
Concerned about the lump, I visited a dermatology clinic where the doctor performed an ultrasound and confirmed the presence of the lump I mentioned, but was unsure what it was, confirming it was not a lipoma and located deeper.
I was prescribed anti-inflammatory medication to monitor it, but the lump did not decrease.
I then went to a general surgery clinic where the doctor performed a physical examination and noted that it was not too hard and movable, but could not make a determination and advised me to follow up.
Recently, at the end of November, I felt the lump more prominently, with a slight bulge in the skin.
I feel it has increased in size (about 2-3 cm) and coincidentally, during my menstrual period, I experienced occasional mild cramping.
I would like to ask: 1.
Which specialty should I consult? 2.
Why did the breast surgeon not detect the lump even though it is present, only stating that the lymph nodes are not enlarged? 3.
Is it necessary to surgically remove it for examination? 4.
Which type of doctor should I seek assistance from, or should I just continue to monitor it? 5.
Can an ultrasound examination detect the lump? Thank you for your help, doctor.

Aa, 30~39 year old female. Ask Date: 2022/11/29

Dr. Chen Sirong reply Oncology

1.
Which department should I consult? A: General Surgery or Breast Surgery.

2.
Why did the breast surgeon not detect the lump, only stating that the lymph nodes are not enlarged? A: Just because the breast surgeon did not see it in July does not mean it won't be visible from September to November.
If you see the same physician, they may still not detect it.

3.
Do I need to have it surgically removed for examination? A: 3.1 I recommend finding a physician you trust (either a general surgeon or a breast surgeon, not a dermatologist) and consistently seeing that physician to monitor whether the tumor is growing and if it needs to be addressed.
3.2 Generally, online consultations cannot provide definitive answers without a physical examination.

4.
Which specialist should I seek assistance from? Should I just monitor it? A: General Surgery or Breast Surgery, with the decision to monitor or biopsy being made by the examining physician.

5.
Can an ultrasound detect the lump? A: 5.1 Generally, it can be detected.
5.2 Every type of examination has a margin of error: (false positive - a non-tumor is identified as a tumor) and (false negative - a tumor is missed).

Wishing you health and happiness, Taoyuan Hospital, Dr.
Chen Sih-Rong.

Reply Date: 2022/11/29

More Info

When it comes to understanding armpit lumps, it is essential to approach the situation with a clear understanding of the potential causes and the appropriate steps to take. Based on your description, you have already undergone several evaluations, including ultrasounds and consultations with various specialists. Here’s a comprehensive response to your questions:
1. Which Department to Consult?
Given your symptoms and the nature of the lump, it would be advisable to consult a breast surgeon or a general surgeon who specializes in soft tissue masses. These specialists are trained to evaluate and manage lumps in the breast and surrounding areas, including the axilla (armpit). If you have concerns about the lump being related to lymphatic issues, a consultation with a hematologist or an oncologist may also be warranted.

2. Why Was the Lump Not Detected by the Breast Surgeon?
The breast ultrasound may not have captured the lump due to its location or depth. Some lumps can be situated deeper within the tissue, making them harder to visualize on standard imaging. Additionally, breast ultrasound primarily focuses on breast tissue and may not always provide a comprehensive view of adjacent structures like lymph nodes or deeper soft tissues. It’s also possible that the lump is benign and does not exhibit characteristics that would raise concern during imaging.

3. Is Surgery Necessary for Biopsy?
Whether or not to proceed with surgery to remove the lump for biopsy depends on several factors, including its size, characteristics, and any changes you have noticed. If the lump is growing, changing in texture, or causing discomfort, a surgical consultation is advisable. A biopsy can provide definitive information about the nature of the lump, whether it is benign or malignant. If the lump is stable and not causing any symptoms, your doctor may recommend continued observation.

4. Which Specialist to Seek Help From?
As mentioned earlier, a breast surgeon or a general surgeon would be the most appropriate specialists to consult regarding your lump. They can perform a thorough examination, review your imaging studies, and determine if further diagnostic procedures, such as a biopsy, are necessary. If there are concerns about lymphatic involvement, an oncologist may also be involved in your care.

5. Can Ultrasound Detect the Lump?
Ultrasound is a valuable tool for evaluating soft tissue masses, including lumps in the armpit. However, its effectiveness can depend on the size, depth, and characteristics of the lump. If the lump is not easily visualized on ultrasound, other imaging modalities such as MRI or CT scans may be recommended for a more detailed assessment.

Additional Considerations:
- Monitoring Symptoms: Keep track of any changes in the lump, such as size, shape, or associated symptoms like pain or tenderness. This information can be crucial for your healthcare provider in making decisions about your care.

- Follow-Up Appointments: Regular follow-ups with your healthcare provider are essential, especially if the lump is stable. If you notice any changes, do not hesitate to seek immediate medical attention.

- Understanding Your Concerns: It’s completely normal to feel anxious about a lump, especially when it changes or causes discomfort. Open communication with your healthcare provider about your concerns can help alleviate anxiety and ensure you receive the appropriate care.

In conclusion, while it is understandable to be concerned about the lump in your armpit, it is essential to follow up with the appropriate specialists and consider further evaluation if necessary. Early detection and intervention can significantly impact outcomes, so staying proactive about your health is crucial.

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