{"id":26729,"date":"2026-02-10T14:37:33","date_gmt":"2026-02-10T14:37:33","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=26729"},"modified":"2026-02-26T08:51:06","modified_gmt":"2026-02-26T08:51:06","slug":"axillary-symptoms","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/axillary-symptoms\/","title":{"rendered":"Axillary Symptoms"},"content":{"rendered":"\n<p>Many axillary issues are innocent and can be managed without referral to Secondary Care. Breast cancer rarely presents with <strong>axillary nodes<\/strong> alone. If a patient presents with axillary node(s) it is important to examine the patient to rule out other signs and symptoms, including skin changes or lumps that the patient may not have identified and that would indicate that the patient should have a USC referral.<\/p>\n\n\n\n<p>(Details of other indications for Breast USC referral can be found under pages for <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/breastdisease\/breastskinchanges\/\" target=\"_blank\" rel=\"noreferrer noopener\">Skin Changes<\/a>, <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/breastdisease\/nipplesymptoms\/\" target=\"_blank\" rel=\"noreferrer noopener\">Nipple Symptoms<\/a>, <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/breastdisease\/breastlump\/\" target=\"_blank\" rel=\"noreferrer noopener\">Breast Lumps<\/a> and <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/breastdisease\/breastabscess\/\" target=\"_blank\" rel=\"noreferrer noopener\">Breast Abscess<\/a>).<\/p>\n\n\n\n<p><strong><u>However, the following is an indication for a USC referral:<\/u><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>New, unexplained axillary lump (2 cm or more in size, persisting for six weeks or more, or increasing in size)<\/li>\n<\/ul>\n\n\n\n<p>For patients with axillary LN <strong>not<\/strong> suggestive of BC then consider other malignant or non-cancer causes of lymphadenopathy such as, connective tissue disease, eczema, and HIV infection. Consider other causes of axillary lumps, for example, skin lesions or accessory breast tissue.<\/p>\n\n\n\n<p>The <a href=\"https:\/\/nhscfsd.co.uk\/media\/4czb4tjo\/axillary-issues-pathway.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Modernising Patient Pathways Programme summarises best practice for managing axillary symptoms<\/a>.<\/p>\n\n\n\n<p><strong>TF, EC, LP &amp; JB FEB 26<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who to refer<\/h4>\n\n\n\n<p><\/p>\n\n\n\n<p><strong>Urgent Suspicion of Cancer Referral<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>New, unexplained axillary lump (2 cm or more in size, persisting for six weeks or more, or increasing in size)<\/li>\n<\/ul>\n\n\n\n<p><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Who not to refer<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Those with skin cysts which are not troublesome<\/li>\n\n\n\n<li>Those with hidradenitis. See guidance under Dermatology for <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/dermatology\/hidradentis-suppurativa\/\" target=\"_blank\" rel=\"noreferrer noopener\">Hidradenitis Suppurativa<\/a>.<\/li>\n\n\n\n<li>Patients with axillary breast tissue not suggestive of BC<\/li>\n\n\n\n<li>Axillary pain is usually arising from the muscles in the chest wall. Patients can be reassured and given usual MSK advice. Please see further guidance re <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/breastdisease\/breastpain\/\" target=\"_blank\" rel=\"noreferrer noopener\">Breast Pain on RefHelp<\/a><\/li>\n<\/ul>\n\n\n\n<p><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer<\/h4>\n\n\n\n<p><\/p>\n\n\n\n<p><strong>Edinburgh, Midlothian, and East Lothian Patients<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Please refer via SCI Gateway to WGH<\/li>\n<\/ul>\n\n\n\n<p>Western General Hospital &gt;&gt; General Surgery \u2013 Breast &gt;&gt; LI Breast \u2013 Urgent<br>OR<br>Western General Hospital &gt;&gt; General Surgery \u2013 Breast &gt;&gt; LI Breast \u2013 Non Urgent<\/p>\n\n\n\n<p><\/p>\n\n\n\n<p><strong>West Lothian Patients<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Please refer via SCI Gateway to SJH<\/li>\n<\/ul>\n\n\n\n<p>St John\u2019s Hospital &gt;&gt; General Surgery \u2013 Breast &gt;&gt; LI Breast \u2013 Urgent<br>OR<br>St John\u2019s Hospital &gt;&gt; General Surgery \u2013 Breast &gt;&gt; LI Breast \u2013 Non Urgent<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p>Guidance on managing Axillary issues not suggestive of breast cancer is summarised in the MPPP linked to below.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/nhscfsd.co.uk\/media\/4czb4tjo\/axillary-issues-pathway.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Modernising Patient Pathways Programme: Axillary Issues<\/a><\/li>\n<\/ul>\n\n\n\n<p>The same information is available on the RDS:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/www.rightdecisions.scot.nhs.uk\/breast-pathways\/axillary-issues\/\" target=\"_blank\" rel=\"noreferrer noopener\">Axillary Issues on RDS<\/a><\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/nhscfsd.co.uk\/media\/4czb4tjo\/axillary-issues-pathway.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Modernising Patient Pathways Programme: Axillary Issues<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.rightdecisions.scot.nhs.uk\/breast-pathways\/axillary-issues\/\" target=\"_blank\" rel=\"noreferrer noopener\">Axillary Issues on RDS<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Sexual-Health-HRT-Further-Info-Incr-Risk-Breast-Ca-MHRADDL_HRT_30.08.19.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">HRT: further information on the known increased risk of BC with HRT and its persistence after stopping MHRA<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.macmillan.org.uk\/cancer-information-and-support\/breast-cancer\" target=\"_blank\" rel=\"noreferrer noopener\">Breast Cancer at MacMillan<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.cancerresearchuk.org\/about-cancer\/breast-cancer\" target=\"_blank\" rel=\"noreferrer noopener\">Breast Cancer at Cancer Research UK<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/breastcancernow.org\/#main-content\" target=\"_blank\" rel=\"noreferrer noopener\">Breast Cancer at Breast Cancer Now<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.rightdecisions.scot.nhs.uk\/scottish-referral-guidelines-for-suspected-cancer\/breast-cancer\/?searchTerm=scottish%20referral%20guidelines%20for%20suspected%20cancer\" target=\"_blank\" rel=\"noreferrer noopener\">Breast Cancer section of Scottish Referral Guidelines for Suspected Cancer on RDS<\/a><\/li>\n<\/ul>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Many axillary issues are innocent and can be managed without referral to Secondary Care. Breast cancer rarely presents with axillary nodes alone. If a patient presents with axillary node(s) it is important to examine the patient to rule out other signs and symptoms, including skin changes or lumps that the patient may not have identified<\/p>\n","protected":false},"author":20,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[49],"class_list":["post-26729","page","type-page","status-publish","hentry","category-breastdisease"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"mariamazoysaavedra","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/mariamazoysaavedra\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/breastdisease\/\" rel=\"tag\">Breast Disease<\/a>","rttpg_excerpt":"Many axillary issues are innocent and can be managed without referral to Secondary Care. Breast cancer rarely presents with axillary nodes alone. If a patient presents with axillary node(s) it is important to examine the patient to rule out other signs and symptoms, including skin changes or lumps that the patient may not have identified","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/26729","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/20"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=26729"}],"version-history":[{"count":4,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/26729\/revisions"}],"predecessor-version":[{"id":26756,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/26729\/revisions\/26756"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=26729"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=26729"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}