1.Lumps in the outer upper quadrant of the breast are the preferred site of breast cancer. The lump is often painless, single, irregular, mostly solid, hard and less mobile.
What does the outer upper quadrant of the breast mean?
In fact, it is similar to the quadrant in mathematics, simply speaking, if you look at it yourself, the upper quarter of the breast near the armpit is the outer upper quadrant of the breast.
2.Local skin changes caused by breast tumor are related to the location, depth and degree of invasion of the tumor, and usually have the following manifestations.
Skin adhesion: Breast is located between deep and superficial fascia, superficial layer of superficial fascia is connected with skin, deep layer is attached to superficial surface of pectoralis major muscle. The superficial fascia forms lobular intervals within the breast tissue, i.e. breast suspensory ligaments. When the tumor invades these ligaments, it can shrink and shorten them and pull the skin to form a depression, which is like a dimple, so it is called “dimple sign”. When the tumor is small, it can cause very slight skin adhesion, which is not easy to detect.
When the tumor invades these ligaments, it can contract and shorten, pulling the skin to form a depression, like a dimple, so it is called “dimple sign”.
Redness of the skin: In acute and chronic mastitis, the skin of the breast can be red and swollen. However, in breast cancer, it is mainly seen in inflammatory breast cancer. The skin color is light red to dark red, which is limited at the beginning and soon extends to most of the breast skin, accompanied by skin edema, thickening and increase in skin temperature.
Skin edema: Due to the blockage of subcutaneous lymphatic ducts by tumor cells or the infiltration of tumor cells in the central area of the breast, the lymphatic reflux of the breast is blocked and the lymphatic fluid in the lymphatic ducts accumulates, the skin thickens and the opening of the hair follicle is enlarged and deepened, showing “orange peel-like changes”. In addition, advanced breast cancer can also directly invade the skin and cause ulcers, and if combined with bacterial infection, the odor can be unpleasant. If the cancer cells infiltrate into the skin and grow, they may form scattered hard nodules in the skin around the main lesion, known as “skin satellite nodules”.
If a patient with breast cancer has abnormal nipple changes, it usually appears as nipple erosion or nipple retraction.
Nipple erosion: there is a typical manifestation of breast Paget’s disease, often accompanied by itching, and about 2/3 of patients may have lumps in the areola or other parts of the breast. Initially, only nipple desquamation or small nipple fissures are present. Nipple desquamation is often accompanied by a small amount of discharge and crusting, and removal of the crust reveals a bright red vesicular surface that does not heal over time. When the entire nipple is involved, it can invade the surrounding tissues, and as the lesion progresses, the nipple can disappear as a result. Some patients may also develop a nipple lesion after the appearance of a breast lump.
When the tumor invades the nipple or the subareolar area, the fibrous tissue and duct system of the breast may shorten and pull the nipple, causing it to be depressed, deflected, or even completely retracted into the posterior part of the areola. In this case, the affected nipple is often higher than the healthy side. It may appear in early breast cancer, but is sometimes a late sign, depending on where the tumor is growing. When the tumor is under or near the nipple, it may appear at an early stage; if the tumor is located in the deeper tissues of the breast, farther away from the nipple, this sign is usually already advanced.
Of course, nipple retraction and indentation are not always malignant lesions, but can be caused by congenital dysplasia or chronic inflammation, at this time, the nipple can be pulled out by fingers and not fixed.
4, nipple overflow nipple overflow is physiological and pathological. Physiological nipple overflow is mainly seen in women during pregnancy and lactation. Pathological nipple overflow refers to the non-physiological state of breast duct secretion. The latter is commonly referred to. Nipple discharge can be caused by a variety of breast diseases and is more easily noticed by patients. It is one of the main reasons why about 10% of patients come to the clinic, and is second only to breast lumps and breast pain among the symptoms of various breast diseases.
Nipple discharge can be classified according to its physical nature: bloody, serous, plasma, watery, purulent, and milk-like.
Among them, plasma, aqueous and lactic overflows are more common, while bloody overflows account for only 10% of cases. When the lesion is located in large ducts, the overflow is mostly bloody; when it is located in smaller ducts, it can be light blood or plasma; if the blood stays in the ducts for too long, it can be dark brown; when there is inflammation combined with infection in the ducts of bloody overflow, it can be mixed with pus, liquefied necrotic tissue can be watery, lactic or brown liquid; the fluid of dilated ducts of breast is often plasma. Most hemorrhagic overflows are caused by benign lesions, but a few breast cancers can also be hemorrhagic. Physiologic nipple discharge is mostly bilateral and the fluid is often lactic or watery.
Cystic hyperplasia is not a tumor, but it is the most common benign lesion of the breast tissue, mostly seen around the age of 40 and rarely after menopause. Among them, three pathological changes, cysts, ductal epithelial hyperplasia, and papillomatosis, are the basis of its overflow. The nature is mostly plasmacytic, and the combined overflow of this disease accounts for only 5%.
Painful breast pain can be seen in many kinds of breast diseases, but pain is not a common symptom of breast tumor, no matter benign or malignant breast tumor is usually painless.
In early stage of breast cancer, there are occasional cases where pain is the only symptom, which may be dull pain or pulling sensation, especially when lying on the side. Some studies have shown that postmenopausal women with breast pain and glandular thickening will have a higher detection rate of breast cancer. Of course, if the tumor is accompanied by inflammation, there may be swelling pain or pressure pain.
In advanced stage, if the tumor invades the nerve or the axillary lymph node enlarges and compresses or invades the brachial plexus nerve, the shoulder may be swollen and painful.
6.Increased axillary lymph nodes can invade the lymphatic vessels and metastasize to the local lymphatic drainage area when breast cancer develops gradually. The most common site of lymphatic metastasis is the ipsilateral axillary lymph nodes. The most common site of lymphatic metastasis is the ipsilateral axillary lymph node. It can also metastasize to the contralateral axillary lymph node through the intercommunication between the anterior chest wall and the internal breast lymphatic network. In addition, advanced breast cancer may also have ipsilateral supraclavicular lymph node metastasis or even contralateral supraclavicular lymph node metastasis.
At first, the enlarged lymph nodes can be pushed, but finally they fuse with each other and become fixed. If the enlarged lymph nodes invade and compress the axillary vein, they often cause edema in the ipsilateral upper limb; if they invade the brachial plexus nerve, they cause shoulder pain.
Once it metastasizes to the lymphatic area, then in most cases, there is only one miserable result …… II The most common symptom of breast cancer – breast lump Breast lump is the most common symptom of breast cancer, and about 90% of patients come to the clinic with this symptom. With the popularization of tumor knowledge and cancer prevention screening, this percentage may increase. If a lump appears in the breast, the following aspects should be understood.
1. Location.
With the nipple as the center, the breast can be divided into 5 zones: upper inner, upper outer, lower inner, lower outer and central (areola). Breast cancer is mostly found in the upper part of the breast, followed by the upper part of the breast. Lower inner and lower outer are less common.
2. Number.
Breast cancer is mostly seen as a single lump in the unilateral breast. Unilateral multiple lumps and primary bilateral breast cancer are not common in clinical practice. However, with the improvement of tumor prevention and treatment level, the patient’s survival period is continuously prolonged, and the chance of second primary cancer occurring in the contralateral breast will increase after surgery of one side of breast cancer.
3.Size.
The lumps of early stage breast cancer are usually small and sometimes not easily distinguishable from lobular hyperplasia or some benign lesions. However, even a small lump can sometimes involve the suspensory ligament of the breast and cause symptoms such as local skin indentation or nipple retraction, which are easier to detect at an early stage.
In the past, due to poor health care, lumps were often larger when they came to the clinic. Nowadays, with the popularization of breast self-examination and the development of screening, early breast cancer has increased clinically.
4.Morphology and boundary.
Most of the breast cancers show infiltrative growth with poorly defined borders. Some of them may be flattened, with an unsmooth surface and nodular feeling. However, it should be noted that the smaller the lump is, the less obvious the above mentioned symptoms are. Moreover, a few special types of breast cancer can be less infiltrated and have a swelling growth, showing smooth, active and clear borders, which are not easily distinguished from benign tumors.
5.Fibroadenoma with clear boundary is not considered as malignant tumor 5.Hardness.
Breast cancer lumps are hard in texture, but cell-rich medullary carcinoma can be slightly soft, and individual can be cystic, such as cystic papillary carcinoma. A few lumps are surrounded by more fatty tissues and have a tender feeling when palpated.
6.Mobility.
When the lump is small, it is more mobile, but this activity is together with its surrounding tissues, which is different from the mobility of fibroadenoma. (Fibroadenoma is usually detected when a woman unintentionally touches her breast and feels a lump that slides around in the breast, usually pressing it does not produce pain and the form is isolated.) If the tumor invades the fascia of the pectoralis major muscle, the activity will be reduced; if the tumor involves the pectoralis major muscle in one part, the activity will disappear. If the tumor invades the pectoralis major muscle fascia, the mobility is reduced.
If the lymph nodes around the tumor are invaded, the skin edema can be orange peel-like, which is called “orange peel sign”, and the nodules under the skin around the tumor are called “satellite nodes”.
Among benign breast tumors, breast lumps are not uncommon, and the most common one is breast fibroadenoma. The disease is more common in young women and has a low incidence over the age of 40. The tumor is often solid, tough, with an intact envelope, smooth surface, and a sliding sensation to the touch, usually without skin adhesions, and does not cause nipple retraction. In intraductal papilloma, the mass is often small and not easily palpable. In slightly larger cases, small nodules can be found around the areola, with nipple discharge as the main clinical symptom.
Removed fibroadenomas rarely form clear masses, but are mainly thickened local breast tissue, with a tough texture and no peri-implantation, and are often distended and painful before menstruation.
Some of them only show localized glandular thickening and no obvious lumps without clear borders, and most of them are diagnosed as “mammary gland hyperplasia”. However, careful examination of the thickened area should be noted when it is limited and accompanied by a little skin adhesion, and breast radiographs can be taken.