Cancer / 28 May, 2020

Does a lump always mean cancer?

Dr Lau Pik Onn

Some cancers may present as a lump that you can feel, although this does not occur in all cancers.

Cancers that generally present as a lump include breast cancer, thyroid cancer, lymphoma and nasopharyngeal cancer.

Breast cancer

Breast lumps are common and most often benign (non-cancerous), particularly in younger women. It is important to know how your breast feels normally so that you can pick up on any changes early. This is why monthly self-examination of your breasts and regular screening is so important.

A benign breast lump can feel like a round, smooth rubber ball, while a cancerous lump may feel irregular, firm or hard.

The most common symptom for breast cancer is a breast lump felt by the women themselves or by the doctor during a routine examination.

If you feel a breast lump, don’t panic. It may not be cancerous. Please consult your doctor as soon as possible to have the lump examined. Diagnostic tests like an ultrasound of the breast and mammogram can be done for further evaluation.

Thyroid cancer

Thyroid cancer occurs more frequently in women than in men. It may present as a lump that can be felt at the front of the neck. However, not all thyroid lumps are cancerous. They may be benign cysts or solid benign lumps.

An ultrasound of the thyroid gland will be conducted to check if it is a cyst or solid lump. A biopsy is then needed for further evaluation and diagnosis.

Nasopharyngeal cancer (NPC)

NPC is one of the more common cancers in men and is often not detected until an advanced stage, as the symptoms are not specific.

One of the most common signs of NPC is the appearance of one or more lumps in the nose or neck.

Neck lumps can typically be felt on the side of the neck and just behind the ear towards the shoulder.

Tests to diagnose NPC include a nasoscope, biopsy of suspicious lesions or blood test to detect the presence of antibodies for the Epstein Barr virus (EBV).

Lymphoma

Lymphoma is the third most common cancer in young adults and children.

Common symptom include a swollen lymph node in the neck, armpit or groin. It may start as a painless lump that you can feel, which then persists or grows in size.

Diagnosis will include a physical examination, blood tests and biopsy.

Testicular cancer

The first sign of testicular cancer is normally an enlarged testicle or a painless lump felt in one or both of the testes. Testicular cancer makes up 1-2% of all cancers in males and is one of the most common cancers in young men (aged between 20 and 40).

Tests for diagnosis will include a physical examination, ultrasound of testes and blood tests.

If I feel a lump, does this mean it is cancer?

No, not every lump is cancerous. However, if you find or feel a new lump on your body, please seek medical attention.

A lump refers to any localised area of swelling and can occur anywhere in the body. It may or may not be painful. Some lumps that you may feel are:

Cysts

  • These are non-cancerous, closed pockets of tissue filled with fluid, pus or debris. They can appear anywhere in the body
  • Skin cysts can feel like small peas under the skin
  • Other cysts include Bakers cysts (a fluid filled bulge that forms behind the knee) or ganglion cysts, which are rounded lumps filled with a jelly-like fluid that develop along tendons and joints (most often at the top of the foot, top of the hand or back of the wrist)

Lipomas

  • These are benign tumours made up of fatty tissue
  • Lipoma feel like squishy balls of tissue that move easily, and occasionally can continue growing until a large size
  • They are found mostly on the legs, torso and arms

Lymph nodes

  • Lymph nodes are movable pea size lumps found throughout the body, mostly in the neck, groin, armpits and behind the collarbone
  • Lymph nodes may be enlarged due to bacterial or viral infection. They may feel soft, rubbery and sometimes tender, normally in the armpits, neck or groin
  • However, if the lymph node feels hard, rubbery or immovable, this may indicate a more serious condition (e.g. lymphoma or breast cancer which has spread to the lymph node)

Lumps in the breast

  • Breast lumps are the most common symptom of breast cancer
  • There are some benign conditions that can present as a lump in the breast, including cysts and fibroadenoma
  • If you feel a breast lump, you should see your doctor as soon as possible. Early diagnosis of breast cancer is crucial

Lumps in the neck

  • Lumps which can be felt or noticed when swallowing can be a benign thyroid lump or a sign of thyroid cancer. This lump is felt at the front of the neck.
  • A lump on the neck, typically on the side of the neck and just behind the ear towards the shoulder, may be a sign of nasopharyngeal cancer. 75% of newly diagnosed nasopharyngeal cancers present as a neck lump.

In general, lumps that are soft, mobile, located in the superficial or fat layer of skin, and grow large and painfully with activity and diminish in size with rest are usually benign lumps and not cause for concern.

Look out for the following red flags:

  • A lump that appears spontaneously
  • A hard immovable lump that is not tender
  • Any lump that persists or seems to be growing

Nevertheless, every lump should be evaluated by your doctor.

What is the difference between benign and malignant?

Benign lumps are not cancerous and rarely cause serious complications. They stay in one location and do not spread to other parts of the body. Benign lumps may cause a problem if they grow too big and press on nearby tissues, nerves or blood vessels (e.g. fibroids or lipomas). They usually grow slowly and if removed, generally do not return.

Malignant lumps are cancerous tumours. They usually grow rapidly, invading other normal tissue and spreading to distant parts of the body. Malignant lumps must be treated as soon as possible.

What tests can help determine if a lump is cancerous?

Please seek medical attention if you find a new lump on your body or have a lump that is growing or painful, irrespective of the location.

After a detailed medical history and physical examination by your doctor, you may be asked to undergo diagnostic imaging such as an ultrasound, CT scan, MRI or x-ray (e.g. a mammogram).

However, the only way to confirm whether a lump is benign or malignant is through a biopsy. A biopsy will involve surgically removing some or all of the lump to examine the tissue for cancer cells.

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