Symptoms and signs The early stage of breast cancer may be asymptomatic, but as the disease progresses, it may show local and systemic symptoms.
(1) Lumps: It is the first symptom of breast cancer. Most of the lumps are located in the upper outer quadrant, followed by the upper inner and areolar areas of the nipple, and less frequently below. The size of the lump varies, with 2-3 cm being the most common size, mostly solitary, and occasionally multiple. Most of the lumps are round or oval in shape, with poorly defined borders, usually hard nodes and poor mobility.
(2) Pain: Most breast cancer patients lack pain symptoms. Due to the less occurrence of pain, breast cancer is not easily detected at an early stage. Pain is often manifested as tingling, swelling or hidden pain in the breast, and periodic pain may occur if the cancer is accompanied by cystic hyperplasia in the breast.
(3) Skin changes of breast: Breast tissue is surrounded by superficial fascia located under the skin, and the deep and superficial fascia are connected by Cooper’s ligament. Since the superficial fascia is connected with the skin, when the Cooper’s ligament is shortened by the invasion of breast cancer, it will pull the skin and make the local skin sunken like a dimple, which is called “dimple sign”. The dimple sign can also be caused by direct adhesion of the tumor to the skin. The dimple sign can appear at the early stage of breast cancer and is more obvious when the affected arm moves up and down.
①Redness and swelling: If the tumor is growing fast and large, superficial skin veins may appear and skin temperature may increase. If the tumor is close to the skin surface, the skin may become red. If the cancer cells block the subcutaneous lymphatic vessels, the skin may become edematous and “orange peel-like changes” may appear.
Skin redness is most typical in inflammatory breast cancer. The skin color is light red or dark red, and the redness extends from a limited area to most of the breast or even the whole breast. On palpation, the whole breast is thickened and hardened, the skin temperature is increased, and it is swollen and rough with clear ② Skin rupture: when the tumor develops to advanced stage, the lump grows up and can make the skin bulge, if the blood supply is insufficient, with the skin reddening and thinning, rupture can occur. Patients are often accompanied by pain, sometimes severe pain is unbearable. Due to the large amount of necrotic tissue and bloody secretions exuding from the wounded surface, patients often have wasting and anemia signs of orange peel-like changes.
The skin redness of breast cancer is most typical for inflammatory breast cancer. The skin color is light red or dark red, and it quickly extends from a limited area to most of the breast or even the whole breast. On palpation, the entire breast is thickened and hardened, with increased skin temperature, swelling and roughness, and obvious orange peel-like changes.
② Skin breakdown: When the tumor develops to advanced stage, the lump grows up and can make the skin bulge. If the blood supply is insufficient, with the skin reddening and thinning, breakdown can occur. Patients are often accompanied by pain, sometimes severe pain is unbearable. Due to the large amount of necrotic tissues and bloody secretions on the traumatic surface, the skin nodules: when the nodules are distributed in the skin around the lesion, they are called satellite nodules, which are caused by the direct infiltration of cancer cells into the skin along the lymphatic ducts, breast ducts or subcutaneous fascial cords. Satellite nodules can be single or several, and the latter are mostly scattered.
Armor carcinoma: Several skin nodules fuse together to form a sheet covering the entire affected chest wall, and may extend from the axilla to the back, or even beyond the midline of the sternum to the contralateral chest wall. The thick and hard skin resembles the armor worn by ancient soldiers, so it is called armor cancer.
Patients often show signs of emaciation and anemia as a result.
(4) Change of breast corridor: When the mass is large, there may be local elevation of breast and enlargement of breast. When the tumor involves the skin or pectoral muscle, it can make the breast harden and shrink. When the patient sits upright, the affected breast can be raised ……
(5) Nipple areola changes.
(1) Nipple retraction and orientation change: nipple flattening, retraction, depression, orientation change until it is completely retracted under the areola and the nipple cannot be seen. Nipple indentation due to breast cancer is different from congenital nipple invagination. The latter can often be raised by hand pulling, while nipple retraction due to breast cancer cannot be pulled out and lumps can be retrieved under or around the sunken nipple ……
(2) Eczema-like changes of the nipple: initially itching of the nipple, thickening of the nipple epithelium, desquamation, oozing, gradually erosion, erosion and repeated crusting, chopping off, red buds appear after the skin of the areola is exfoliated, the nipple can slowly flatten and finally disappear.
(6) Nipple overflow: breast cancer accounts for a larger proportion of nipple overflow with lumps. The overflow can be colorless, milky white, yellowish, brown, bloody, etc. It can be watery, blood-like, plasma-like or purulent; the amount of overflow can be more or less and the interval is not consistent.
(7) Regional lymph node enlargement.
(1) Axillary lymph node metastasis: the most common. When the metastases are small, the lymph nodes are not enlarged, or the enlargement is not obvious and is more difficult to palpate. Metastatic lesions usually involve the lateral lymph nodes of the pectoral muscle, which are more rigid, irregular and less mobile when touched.
(ii) Supraclavicular lymph nodes: metastatic lymph nodes are mostly located in the left supraclavicular fossa or the right supraclavicular fossa, and the lesions are more rigid and generally smaller.
③Internal breast lymph nodes: metastases are often not significant and there is no method to confirm the diagnosis before surgery. Only when the tumor is born in the inner half of the breast, then it can be found when super radical in surgery.
(4) Upper limb edema by extensive metastasis of axillary lymph nodes: fixed and fused enlarged metastatic lymph nodes can be palpated in the axilla or clavicle.
(8) Distant metastasis manifestation: Breast cancer can metastasize distantly through blood or lymphatic route, and the most common sites are lung, pleura, bone, liver, brain and soft tissue.
Pulmonary and pleural metastases: lung is the common metastatic site of breast cancer, which often appears as nodal multiple metastases, mostly bilateral. Cough and dyspnea, hemoptysis, chest pain, etc. may occur. Pleural metastasis mainly manifests as cough, fatigue, weakness, dyspnea, and some patients have chest pain.
②Bone metastasis: the most susceptible sites are spine, ribs, pelvis and long bones in order, and also in scapula and skull. The main manifestation is pain.
Liver metastases: When the liver metastases are small, there are no special symptoms. When the mass is large or extensive, liver enlargement, pain in the liver area, loss of appetite and abdominal distension may appear. In the late stage, jaundice and ascites may appear.
Brain metastasis: brain metastasis mainly manifests as meningeal and parenchymal metastasis, headache and mental status change are common symptoms, and brain dysfunction and visual impairment may occur. If the spinal membrane is invaded, back pain, sensory disorders, bladder dysfunction and difficulty in urination may occur.