This month I’m running through the common sorts of lumps anyone can get, before getting into lumps that affect women only.
If you notice a lump anywhere on your body for the first time, the best thing to do is go see your GP to figure out what it is. If a lump is new, red, hot, throbbing and tender; it is infected, and you should see a GP in the next one to two days, as it is likely antibiotics are needed. If it is not painful, then this is not an urgent issue and will wait one to three weeks for a routine GP appointment.
Common things are common…
Lymph nodes: When we have any flu-like infection or sore throat, you will notice that your glands in your neck swell up and become painful; this is a good thing.
Lymph nodes or glands are small bean-shaped nodules that contain millions of infection-fighting lymphocyte cells. They are found at intervals along the lymphatic vessels, like beads on a string. The lymph nodes filter out harmful organisms and abnormal cells before the lymph reaches the blood stream.
These often worry patients who assume it is a sign they need antibiotics. Not true and invariably the opposite is true: The lymphocytes in the glands multiply like mad in response to an infection, resulting in a huge increase in the size of that gland. This happens quickly, often overnight, causing pain and tenderness in the enlarged glands. So, the sudden appearance of large painful lymph nodes is a sign that your body is doing a good job dealing with an infection. Your glands will remain enlarged for seven to 10 days. Glands can come up on one side only and are found in different sites around the body: the neck, the arm pit, along the clavicle, and in the groin.
When should I worry about an enlarged gland? If a gland remains enlarged for more than six weeks, see your GP.
The exception to that rule is a lymph gland in the armpit; it is advisable to see your GP for a chest and breast exam rather than wait the six weeks.
Lipomas: A lipoma is a lump of fatty tissue that grows just under the skin. Lipomas move easily when you touch them and feel rubbery, not hard. Most lipomas aren’t painful and don’t cause health problems, so they rarely need treatment. It is advisable to see your GP only to log that you have a lipoma. However, will need to have the lipoma reviewed if it starts to grow or if larger than 7cm.
Sebaceous cysts: Sebaceous cysts are non-cancerous, slow-growing bumps that develop in the skin. They often occur due to blocked sebaceous glands and can be uncomfortable or unsightly; they tend to look like a small, firm egg attached to the skin. They are usually not painful and are completely benign. Generally, if it is not bothering you – leave it alone. Resist the temptation to squeeze it, as this might cause infection.
Hernias: A hernia usually happens in your abdomen or groin, when one of your organs pushes through the muscle or tissue that contains it usually due to a weakness in that muscle layer. It may look like an odd bulge that comes and goes during different activities or in different positions. It may or may not cause symptoms, such as discomfort or pain. Some hernias may need surgical repair.
Women’s lumps
Breast lumps: Finding a lump in your breast is one of the scariest things a woman can encounter. She instantly assumes cancer. It needs to be emphasised that most breast lumps turn out to be benign in women under the age of 45 years.
Types of benign breast lumps:
The size and shape of breasts vary, and everyone’s breasts are different. They’re mostly made up of fatty tissue and glandular tissue. The glandular tissue produces milk when you’re breastfeeding. Tiny milk ducts carry milk from the glandular tissue to the nipple. A tail of breast tissue goes up into your armpit; breasts are pear not apple-shaped.
In women, breasts are affected by hormones. They change size and shape throughout your monthly cycle and when you’re pregnant. This means breasts can feel tender, heavy, and lumpy. This usually happens just before your period and goes back to normal once it starts. It’s normal for many women to feel lumpy areas in their breasts, which come and go, as their hormones change.
Fibroadenomas are solid, benign growths of tissue and do not ever transform into cancer. They are painless and not tender. They usually feel firm to touch and may move underneath your fingers when you check your breast. This resulted in the old-school term of ‘breast mice’, as they seem to ping away from your touch when self-examining. Fibroadenomas are the most common type of benign breast lump and you’re most likely to get one when you’re under 30. These do not need to be surgically removed and do not increase the risk of breast cancer.
Breast Cysts are round sacs of fluid that can build up in your breast tissue. You can have one or more cysts, and they vary in size. You’re most likely to get them after 35 and they can come and go. These tend to appear in the week or two before your period then completely resolve. They can be sore and tender to touch. They are completely benign and do not increase the chances of getting breast cancer later in life.
I found a breast lump! I recommend the following three steps if you are under 45, having regular periods and you notice a breast lump:
1. DO NOT PANIC! – most breast lumps are benign Make a note of where you are in your cycle; nine times out of 10 a new breast lump appears during the week before your period. If, however, you are breastfeeding and find a painful tender breast lump, this is likely to be an infection called mastitis and does require an urgent GP appointment.
2. Leave it alone – then re-examine yourself again at a different time in the following cycle.
3. If the lump persists book a routine appointment to see your GP.
Of course, many women will choose to book a GP appointment straight away. Try to remember, most breast lumps felt under the age of 45 are benign.
How can I tell if the lump is breast cancer? Breast cancer is a very common cancer with a one in eight lifetime risk.
It is more common in older women with only one in 2000 prevalence in women under 30 but it will affect one in 15 women over the age of 70. However, most women do not die of their breast cancer; strokes and heart attacks are the big killers. This is because advances in breast cancer treatment plus early detection through screening programmes mean that 85 per cent of women will be alive, well, and disease-free, five years after a diagnosis of breast cancer.
What is a dodgy lump? If a breast lump feels very hard; is fixed, or hard to waggle around when you examine yourself, is associated with any changes to the overlying skin – don’t ignore it: these are features more often seen with a cancerous lump.
In Cork the HSE system for getting a woman checked out with a worrying breast lump is excellent: most are seen in two weeks or less.
Down-below lumps
Sebaceous cysts can occur in the skin of the external genital area.
Bartholin’s cysts: Bartholin’s glands are small pea-sized glands located at the entrance of the vagina, behind the lips (labia minora). Secretions of these glands provide some of the lubrication during sexual intercourse. A Bartholin’s cyst is formed when the duct of these Bartholin’s gland is blocked, and the secretions collect behind the blocked duct forming a cyst.
What you notice is a non-painful lump at or just inside the opening of the vagina. This is usually on one side only.
The cyst can become infected and then will get much bigger and become painful and tender – walking can be an issue. This generally settles with antibiotics. Rarely, infections become recurrent and require referral to a gynaecologist for surgery. This is an entirely benign condition.
I found a lump that comes out my vagina!
This invariably turns out to be a prolapse, a topic of a previous article but one I am happy to revisit again.
In summary; If you find a new lump anywhere go see your GP.
Your GP can usually tell you from the history and examination findings what the lump is. Blood tests are rarely required. If your GP is uncertain as to the nature of the lump they may arrange a soft tissue ultrasound.
Any woman wishing to see me in the Gynaecology Clinic in Bantry needs to ask her GP for a referral to CUMH Cork Gynaecology outpatients, then choose the consultant ‘Dr Aenne Helps’ who runs the clinic in Bantry hospital.
I also see patients in Bantry gynaecology clinic two days per month. However, because of HSE IT and other issues, the system does not allow for direct referral to myself, a GP; your GP needs to choose the named gynaecology consultant for Bantry, Dr Aenne Helps.
