2nd opinion

Many people had asked me about the result of my consultation with the Dr here in Singapore so I thought I'll write about it here. The Dr sent me for another ultrasound scan because all I had with me was a brief report from the Dr in UK with no scans or dimensions. Today I returned to KKH to review the scans I had on Tuesday.

The UK report stated that a total of 5 fibroadenomas were seen on ultrasound. However, the scan I had 2 days ago showed one duct on the left, 2 nodules and another duct on the right. The biggest lump which was biopsied in UK is now 1.3cm. I remembered the Dr in UK telling me all the lumps detected were less than 1cm. So for the lump to have grown this big in 2mth is quite worrying. It didn't help when the local Dr said that biopsy tests are not 100% accurate. Tissues may be taken from the lump but the cancerous part can be missed. The only way of knowing for sure is to have them excised which is normal practice here if the lumps are bigger than 1cm.

According to the KKH doctor, there are 3 predominant types of breast lumps (taken from mayoclinic.com).

1. Fibroadenomas

They are round, firm, rubbery masses that arise from excess growth of glandular and connective tissue. These masses can grow to the size of a small plum, but they're benign and usually painless. If you have a fibroadenoma, it may bounce or move slightly when you press the area.

Fibroadenomas respond to hormonal changes and tend to enlarge during pregnancy and shrink after menopause. Women of any age may have them, but they're usually detected in women in their 20s or 30s. Your doctor can't tell from a clinical breast exam alone whether a breast lump is a fibroadenoma. Mammography and ultrasound may help with the diagnosis, but the only way to be certain of a fibroadenoma is to take a sample of tissue for lab analysis (biopsy). Your doctor may also recommend surgery to remove the lump completely.

Fibroadenomas sometimes disappear spontaneously. But your doctor may recommend surgical removal if a fibroadenoma persists, gets larger or you're anxious about it.

2. Phyllodes tumor

A phyllodes tumor develops as a painless breast lump within the connective tissue of your breast. In rare instances, some phyllodes tumors are cancerous, but most are benign. Benign phyllodes tumors grow rapidly and may become very large.

Often it's difficult for your doctor to distinguish between a phyllodes tumor and a fibroadenoma — even after imaging tests and a needle biopsy. However, phyllodes tumors are much less common than fibroadenomas. Rapid growth of the mass may signal to your doctor that your breast lump is a phyllodes tumor.

Treating a phyllodes tumor usually involves surgery to remove the mass. After surgical removal, recurrence of the tumor remains a possibility.

3. Breast cancer

A cancerous (malignant) breast lump is often painless, hard and irregularly shaped. It feels different from surrounding breast tissue. If the breast lump is attached to underlying muscle, it may not move when you press on it. Overlying skin on your breast may be dimpled or red.

Other signs include:
A spontaneous clear or bloody discharge from your nipple
Retraction or indentation of your nipple
A change in the size or contours of your breast
Any flattening or indentation of the skin over your breast
Pitting of the skin over your breast, like the skin of an orange

Treatment depends on the type of cancer, its stage and the appearance of cancer cells under the microscope. Options include surgery, radiation, chemotherapy and hormone therapy. Detecting breast cancer in its earliest possible stage — by having regular mammograms and clinical breast exams — gives you the best chance for successful treatment.

If indeed the biggest lump I have (which was termed as indeterminate in the ultrasound scan report from KKH) is growing at this rate, it could be a Phyllodes tumour or even the unthinkable (unlikely though). Since I just had a core biopsy in October, the Dr didn't recommend me to have another one. I was due for another follow-up in UK in April with a repeat ultrasound scan to see if any of the lumps are growing or changing. My KKH doctor, seeing that mine is a borderline case (just over 1cm), told me that I could not have the surgery but suggested I have the follow-up in February instead. I have contacted the UK clinic for my detailed medical report before deciding if I should have the surgery. But even if I go ahead with it, the lumps may return which happened to me. I had one big one removed when I was 16. My mother-in-law is suggesting I should have all of them removed as soon as I get back from Hong Kong.