Expert: Claes-Gustaf Nordquist, M.D. - 10/1/2007

Question
QUESTION: Hello,

I have a burning sensation in my right breast and pain in my right shoulder. The pain in my shoulder is worse when I have my arm bent for a period of time. The burning sensation in my breast is off and on. My menstrual cycle does not seem to have anything to do with it. About 5 months ago, I found a lump in my right breast and had a mammo and ultrasound. I was told it was jut a nodule and the shape and size looked fine so nothing to worry about. It seems odd that now I am having pain in that breast and the same side shoulder. I also have a prickly feeling in my nipple area from time to time. If the doctors were wrong and it was in fact a cancerous lump, could it have spread in only 5 months? Could that cause pain in my shoulder? I know I am jumping the gun here but I live in Budapest Hungary and I am not that confident of the medical treatment here so lately I have become very worried about the pain I am having. Any advice you have would be greatly appreciated.
Thank you.

ANSWER: The pain etc. you describe is not anything I associate with breast cancer! I think the pains in your shoulder and breast probably are associated with each other and probably originate in your right shoulder - at least based on your description! You should let an orthopedic surgeon check your shoulder etc. Such a surgeon can probably help you with this problem! If your breast lump troubles you demand a needle biopsy of it so you will know precisely what it is! It is probably not a cancer. Good luck!

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QUESTION: Thank you so much for your quick reply. I have one more question for you. At the  time they found the nodule. They decided to do a Fine needle aspiration on it. They were unable to get any fluid from it but since the shape and size looked good, they said it was fine.
I have since read that anytime you are unable to obtain fluid for a lump a biopsy should be done. Is this true? How accurate can their conclusion be just by judging the size and shape? Should they have done a biopsy? What exactly does a cancerous lump feel like?
Thanks so much

ANSWER: A fine/thin needle aspiration biopsy does not need to get any fluid out to be useful (in general you only get fluid from cysts - fluid filled rouded spaces), but any lesion you stick the needle into will provide cells that can be studied under a microscope. It is that cell study by a pathologist/cytologist that gives the diagnosis. One of my former bosses Professor, Dr. Sixten Franzén, M.D., Ph.D. was one of the inventors and developers of this technique. These cells are in themselves a biopsy specimen useful for diagnosis. Demand a new needle biopsy in order to reach a diagnosis! Size & shape do give some indications of the nature of a lesion but can NOT replace a biopsy! A needle biopsy is the easiest & simplest for you! There is NO sure way of diagnosing a cancerous lesion just by the way it feels! Though of course an experienced clinician may become more suspicious just by touching certain lesions. But to develop that takes time and experience AND it is NOT certain!


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QUESTION: Thanks so much.
I have but yet another question for you. I have been on the internet all day today driving myself crazy. It seems I have every symptom to every type of cancer there is. I did stumble across information on Pagets disease of the breast and it startled me. I have itching of the breast off and on. This has been going on for 3 or 4 months. Sometimes they itch so badly they turn bright red. I put some lotion on them and the next day they seem to be fine. But after reading about Pagets disease I am concerned. I read that people can have symptoms like that for 8 or 9 months and not even know anything is wrong. Is this true? Would the cells from the FNA detect that type of cancer? Should I be worried. I guess I am just really freaked out because pain and itchiness are going on in the same breast I have the nodule in. I am also experiencing shoulder, back and arm pain on the same side. I have also been reading about cancer spreading to the bones and brain. How quickly could that happen? If the doctors were wrong 6 months ago about my results being benign could it have spread that quickly?
Thanks so much for you help

Answer
Since I have not examined you myself I can only base my advice here on your own descriptions. However NOTHING in those makes me suspect that you have cancer in ANY way! I can not state that in any more clear way! The symptoms you describe indicate that you probably have an orthopedic problem in your right shoulder. Paget's disease of the nipple is easily diagnosed if it is there once you look for it and can easily be confirmed or excluded by a local nipple biopsy! Just follow my advice here and above and I think all will be taken care of! Good luck!