The key to the diagnosis and treatment of breast cancer lies in “three early stages”, i.e. early detection, early diagnosis and early treatment. According to research, it is a slow process from the beginning of cancer in a certain part of breast tissue to the appearance of certain clinical symptoms and signs, which is a gradual process from quantitative to qualitative changes. This process is called “pre-cancer” in medical science. And this period is also the stage with the best treatment effect. Therefore, if we can pay attention to the early manifestations of breast cancer, it is conducive to early detection and early treatment. Therefore, if we can pay attention to the early manifestations of breast cancer, it will be beneficial to early detection and early treatment, so that we can prevent the disease before it happens. Therefore, the following people should be more alert: those who have family history of breast cancer or other tumors or those who are stimulated by adverse external factors should go to hospital for treatment in time if they have any discomfort.
Breast lumps
Breast lump is the most common symptom of breast cancer, and about 90% of the patients come to the hospital with this symptom. With the popularization of tumor knowledge and cancer screening, this percentage will probably increase. If a lump appears in the breast, the following aspects should be understood.
1. Location: With the nipple as the center and a cross, the breast can be divided into 5 zones: upper inner, upper outer, lower inner, lower outer and central (areola). Breast cancer is more common in the upper part of the breast, followed by the upper part of the breast. Lower internal and lower external areas are less common.
2.Number: Breast cancer is most common in unilateral breast with a single lump, unilateral multiple lumps and primary bilateral breast cancer are not common clinically. However, with the improvement of tumor prevention and treatment, patients’ survival period will be prolonged, and the chance of second primary cancer in the opposite breast will increase after surgery of one side of breast cancer.
3.Size: The lump of early breast cancer is usually small and sometimes it is not easy to distinguish 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 screening, there is an increase of early breast cancer in clinical practice.
4.Morphology and boundary: Most of the breast cancers are infiltrative in growth and the boundary is not clear. 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 swollen growth, showing smooth, active and clear borders, which are not easily distinguished from benign tumors.
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 mass is small, the mobility is larger, but this activity is the mass moving together with its surrounding tissues, while the mobility of fibroadenoma is different. If the tumor invades the fascia of the pectoralis major muscle, the activity will be weakened; if the tumor involves the pectoralis major muscle, the activity will disappear. If the tumor involves the pectoralis major muscle, the activity will be lost. If the patient is asked to cross her arms and raise her chest, the pectoralis muscle will be contracted. In advanced stage, breast cancer may invade the chest wall, then it is completely fixed, the lymph nodes around the tumor are invaded, the skin edema can be orange peel-like, called “orange peel disease”, 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. Lobular hyperplasia rarely forms a clear lump, but is mainly a thickening of the local breast tissue, with a tough texture and no sense of envelope, often with swelling and pain 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, a closer examination of the thickened area with some skin adhesions should be noted and a breast radiograph can be taken.
Breast pain
Although breast pain can be seen in many breast diseases, pain is not a common symptom of breast tumors, whether benign or malignant, and is usually painless. Some studies have shown that postmenopausal women with breast pain and glandular thickening have a higher detection rate of breast cancer. Of course, tumors with inflammation can be painful with swelling or pressure. In advanced stage, if the tumor invades the nerve or enlarged axillary lymph nodes compress or invade the brachial plexus nerve, there may be swelling and pain in the shoulder.
Nipple overflow
There are physiological and pathological nipple discharge. Physiologic nipple discharge is mainly seen in women during pregnancy and lactation. Pathological nipple discharge refers to the secretion of fluid from the milk ducts in a non-physiological state. The latter is commonly referred to. Nipple overflow can be caused by a variety of breast diseases and is also easier for patients to notice. It is one of the main reasons why about 10% of patients come to the clinic, and its incidence is second only to breast lumps and breast pain among the symptoms of various breast diseases.
1. Nipple discharge can be classified according to its physical properties: bloody, serous, plasma, watery, purulent, and milk-like. Among them, plasma, watery and lactic-like overflows are more common, and bloody overflows account for only 10% of overflows. When the lesion is located in the large duct, the overflow is mostly bloody; when it is located in the smaller duct, it can be light blood or plasma; if the blood stays in the duct for too long, it can be dark brown; when there is inflammation combined with infection in the duct, it can be mixed with pus, liquefied necrotic tissue can be watery, lactic or brown liquid; the fluid of ductal dilatation is often plasma. Most of the hemorrhagic overflow is caused by benign lesions, but a few breast cancers can also be hemorrhagic. Physiological nipple overflow is mostly bilateral, and the overflow is often lactic or watery.
The causes of nipple overflow are mainly divided into extramammary factors and intramammary factors.
In breast cancer patients, 5%-10% have nipple overflow, but only 1% have nipple overflow as the only symptom. The discharge is often monoductal and can have a variety of characteristics, such as bloody, plasma, watery or colorless. It is more common for breast cancer to originate from large ducts or to have intraductal carcinoma in combination with nipple discharge, such as malignant intraductal papilloma and eczema-like carcinoma of the nipple. It is worth noting that although most people believe that breast cancer is rarely associated with nipple discharge, and even if it occurs, it almost always occurs after or at the same time as a lump, and it is rarely considered as cancer without a lump. However, recent studies have shown that nipple discharge is an early manifestation of some breast cancers, especially intraductal carcinomas, and can be present alone before the formation of an obvious lump.
Intraductal papilloma is a disease that occurs more often in nipple discharge, accounting for the first of all nipple discharge lesions, among which intraductal papilloma in the areola area is the most common, either solitary or multiple, with age distribution ranging from 18 to 80 years old, but mainly common in 30-50 years old. The diameter of the tumor varies from 0.3 to 3.0 cm, with an average of 1.0 cm, and more than 3.0 cm is often malignant. The nature of the overflow is mostly bloody or plasma, but others are rare. It is generally believed that papillomas occurring in large ducts are mostly solitary and rarely carcinogenic, while those in small and medium ducts are often multiple and can be carcinogenic. The two are similar lesions, but the site of occurrence and growth process are different.
Although cystic hyperplasia is not a tumor, 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%.
(1) Nipple erosion: there is a typical manifestation of Paget’s disease of the breast, often with pruritus, and about 2/3 of patients may have a lump 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 erosion that persists 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 breast lump first and then a nipple lesion later.
(2) Nipple retraction: 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, making it sunken, deflected or even completely retracted into the back 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 can appear early; if the tumor is located in the deeper tissues of the breast, far away from the nipple, this sign is usually advanced. Of course, nipple retraction and indentation are not always malignant lesions, but some of them can be caused by congenital dysplasia or chronic inflammation, in which case, the nipple can be pulled out by fingers and not fixed.