Characters of the Tumour. – It is sometimes assumed that a cancer of the breast necessarily presents the characters of an infiltrating tumour, and that it will therefore always be fixed in the surrounding tissues. But this is by no means always so in the early stages, and many a cancer has started as a freely mobile nodule of growth bearing a very close resemblance to a fibro-adenoma. If the patient is under 20 the chances are of course enormously in favour of the simpler diagnosis, but after 25 the likelihood of confusion becomes serious.
Since both tumours may be elastic in consistency, it may be almost impossible to distinguish between them with the fingers alone, and more direct evidence must be obtained. With the modern technique of electro-surgery reasonably wide excision of any doubtful lump is fully justified, and the further procedure may be allowed to depend on the microscopic section. Cutting into any lump in the breast is to be depreciated.
Illustrative Case. – A patient, aged 38, became conscious that she had a painless lump in the right breast near the axillary tail. It was a small circumscribed mass 2 cm. in diameter, and was freely movable in the surrounding tissues. Apart from its solid consistency it had no malignant characters, but the patients age made a diagnosis of fibro-adenoma improbable.
It was excised and proved to be a mass of malignant epithelium with little surrounding infiltration. The excision was followed by radium treatment, and six years later the patient is quite well and her breast appears normal.