Breast cancer symptoms and treatments

The symptoms of breast cancer can be varied, the most common ones include: breast lumps, breast pain, nipple discharge, erosion or skin depression, and swollen axillary lymph nodes. Although these symptoms are not necessarily specific, understanding them and recognizing their manifestations will help us detect, diagnose, and treat breast cancer early. Of course, the appearance of certain symptoms indicates that the disease is no longer in the early stages, so a comprehensive and in-depth understanding and mastery of these symptoms can prevent us from being heartbroken by missing the opportunity for treatment, and prevent us from worrying too much and affecting our normal life.

1. Breast lumps

Breast lump is the most common symptom of breast cancer, and about 90% of patients seek medical treatment with this symptom. With the popularization of tumor knowledge and the implementation of cancer prevention surveys, this proportion may increase. If a lump appears in the breast, you should understand the following aspects.

1. Location: With the nipple as the center, the breast can be divided into five areas by making a cross: upper inner, upper outer, lower inner, lower outer and central (areola). Breast cancer is most common on the outer side, followed by the inner side. Inner-lower and outer-lower are less common.

2. Number: Breast cancer is most commonly seen as a single lump in one breast. Multiple unilateral masses and primary bilateral breast cancer are not common clinically. However, with the improvement of tumor prevention and treatment, the survival period of patients continues to increase. After surgery for breast cancer on one side, the chance of a second primary cancer developing in the contralateral breast will increase.

3. Size: The lumps of early breast cancer are generally small and sometimes difficult to distinguish from lobular hyperplasia or some benign lesions. However, even a very small lump may sometimes affect the suspensory ligaments of the breast, causing symptoms such as local skin indentation or nipple retraction, which are easier to detect early. In the past, due to poor medical care, lumps were often larger when patients sought medical treatment. Nowadays, with the popularization of breast self-examination and the development of screening work, the number of early breast cancer cases has increased clinically.

4. Morphology and boundaries: Most breast cancers grow invasively with unclear boundaries. Some may be flat, with an uneven surface and a nodular feel. However, it should be noted that the smaller the lump, the less obvious the above symptoms. In addition, a few special types of breast cancer may have mild infiltration and expansive growth, appearing smooth, mobile, and with clear boundaries, making them difficult to distinguish from benign tumors.

5. Hardness: Breast cancer lumps are relatively hard, but cellular medullary carcinoma may be slightly softer. Some lumps may also be cystic, such as cystic papillary carcinoma. A few lumps are surrounded by a large amount of fat tissue and feel flexible when palpated.

6. Mobility: When the tumor is smaller, its mobility is greater, but this activity is that the tumor moves together with its surrounding tissues, which is different from the activity of fibroadenoma. If the tumor invades the pectoralis major fascia, the range of motion will be weakened; if the tumor further involves the pectoralis major muscle, the mobility will disappear. Ask the patient to put his hands on his hips and straighten his chest to contract the pectoral muscles, and you will see that the breasts on both sides are obviously asymmetrical. Advanced breast cancer may invade the chest wall, which is completely fixed. The lymph nodes around the tumor are invaded, and the skin edema may appear like orange peel, called "orange peel sign". Nodules appear under the skin around the tumor, called "satellite nodules".

Among benign breast tumors, it is not uncommon to present as breast lumps, the most common of which is breast fibroadenoma. The disease is more common in young women, and the incidence rate is low in people over 40 years old. The tumor is usually solid, tough, has a complete capsule, a smooth surface, and feels slippery to the touch. It generally has no skin adhesion and does not cause nipple retraction. Intraductal papilloma, the mass is often very small and difficult to palpate. In slightly larger cases, small nodules may be felt around the areola, and nipple discharge is the main clinical symptom. Lobular hyperplasia of the breast rarely forms a clear lump, but is mainly characterized by local thickening of breast tissue with a tough texture and no sense of capsule, and often causes swelling and pain before menstruation.

Some only show local thickening of the breast glands without obvious lumps and clear boundaries, and most are diagnosed as "breast hyperplasia." However, if a careful examination shows that the thickening area is limited and accompanied by a small amount of skin adhesion, you should pay attention and have a breast X-ray.

2. Breast pain

Although breast pain can be seen in a variety of breast diseases, pain is not a common symptom of breast tumors. Whether benign or malignant, breast tumors are usually painless. In early breast cancer, pain is occasionally the only symptom, which may be a dull ache or a pulling sensation, especially when lying on the side. Studies have shown that the detection rate of breast cancer will increase in postmenopausal women who experience breast pain accompanied by gland thickening. Of course, when the tumor is accompanied by inflammation, there may be swelling or tenderness. If the advanced tumor invades the nerves or the axillary lymph nodes compress or invade the brachial plexus, shoulder pain may occur.

3. Nipple discharge

Nipple discharge can be divided into physiological and pathological. Physiological nipple discharge is mainly seen in pregnant and lactating women. Pathological nipple discharge refers to the secretion of mammary ducts under non-physiological conditions. The latter is usually referred to. Nipple discharge can be caused by a variety of breast diseases and is easily noticed by patients. It is one of the main reasons why about 10% of patients come to the hospital for treatment. Among the symptoms of various breast diseases, its incidence is second only to breast lumps and breast pain.

1. Nipple discharge can be divided into bloody, serum-like, serous, watery, purulent, and milky types according to its physical properties. Among them, serous, watery and milky discharges are more common, and bloody discharge accounts for only 10% of discharge cases. When the lesion is located in the large duct, the discharge is mostly bloody; when located in the smaller duct, it may be light bloody or serous; if the blood stays in the duct for too long, it may be dark brown; when there is inflammation and infection in the duct, it may be mixed with pus, and liquefied necrotic tissue may be watery, milky or brown; the fluid of mammary duct ectasia is often serous. Bloody discharge is mostly caused by benign lesions, and a few breast cancers can also be bloody. Physiological nipple discharge is mostly bilateral, and the discharge is often milky or watery.

2. The causes of nipple discharge are mainly divided into: external breast factors and internal breast factors.

5% to 10% of breast cancer patients have nipple discharge, but only 1% have nipple discharge as the only symptom. The discharge is usually unitubular and can have a variety of properties, such as bloody, serous, watery or colorless. Breast cancer that originates in large ducts or has the morphology of intraductal carcinoma is more likely to be accompanied by nipple discharge. Malignant transformation of intraductal papilloma and eczematoid carcinoma of the nipple can also cause nipple discharge. It is worth noting that although most people believe that breast cancer is rarely accompanied by nipple discharge, and even if discharge occurs, it almost always occurs after or at the same time as a lump appears, and those without a lump are rarely considered to be cancer. However, recent studies have shown that nipple discharge is an early clinical manifestation of certain breast cancers, especially intraductal carcinoma, and can exist alone before a noticeable mass forms.

Intraductal papilloma is a disease that causes nipple discharge most frequently, accounting for the first place among all nipple discharge lesions. Among them, intraductal papilloma in the areola area is the most common. It can be single or multiple, and the age distribution ranges from 18 to 80 years old, and is mainly seen in 30 to 50 years old. The diameter of the tumor varies from 0.3 to 3.0 cm, with an average of 1.0 cm. Tumors larger than 3.0 cm are often malignant. The nature of the discharge is mostly bloody or serous, others are rare. It is generally believed that papillomas occurring in large ducts are mostly solitary and rarely become cancerous, while those occurring in small and medium-sized ducts are often multiple and may become cancerous. Both are similar lesions, but they occur in different locations and have different growth processes.

Although cystic hyperplasia is not a tumor, it is the most common benign lesion of breast tissue. It is more common around the age of 40 and is rare after menopause. Among them, three pathological changes, cysts, hyperplasia of the milk duct epithelium and papillomatosis, are the basis of the discharge. The disease is mostly serous in nature, and only 5% of the cases are complicated by discharge.

4. Nipple changes

If breast cancer patients have abnormal nipple changes, they usually manifest as nipple erosion or nipple retraction.

1. Nipple erosion: A typical manifestation of Paget's disease of the breast, often accompanied by itching. About 2/3 of patients may have lumps in the areola or other parts of the breast. Initially, there is only nipple desquamation or small nipple fissures. Nipple desquamation is often accompanied by a small amount of secretion and scab. When the scab is removed, a bright red eroded surface can be seen, which does not heal for a long time. When the entire nipple is affected, it may further invade the surrounding tissues. As the disease progresses, the nipple may disappear entirely. Some patients may first develop breast lumps and then nipple lesions.

2. Nipple retraction: When the tumor invades the nipple or the area under the areola, the fibrous tissue and duct system of the breast may shorten, pulling the nipple, causing it to become sunken, deflected, or even completely retracted behind the areola. At this time, the nipple on the affected side is often higher than the healthy side. It may be an early sign of breast cancer, but it is sometimes a late sign, depending on where the tumor grows. When the tumor is under or near the nipple, it can appear in the early stage; if the tumor is located in the deep breast tissue, far away from the nipple, this sign usually appears in the late stage. Of course, nipple retraction and depression are not all malignant diseases. Some may be caused by congenital maldevelopment or chronic inflammation. At this time, the nipple can be pulled out with fingers without fixation.

5. Skin changes

Skin changes caused by breast tumors are related to the location, depth and degree of invasion of the tumor, and usually have the following manifestations:

1. Skin adhesion: The breast is located between the deep and superficial fascia. The superficial layer of the superficial fascia is connected to the skin, and the deep layer is attached to the superficial surface of the pectoralis major muscle. The superficial fascia forms the interlobular septa within the breast tissue, namely the suspensory ligaments of the breast. When the tumor invades these ligaments, it can cause them to shrink and shorten, pulling the skin to form a depression shaped like a dimple, hence the name "dimple sign." When the tumor is small, it may cause very slight skin adhesion, which is not easy to detect. At this time, it is necessary to gently support the affected breast under good lighting conditions to increase its surface tension. When moving the breast, slight pulling and depression of the skin on the surface of the tumor may be seen. If you have this symptom, you should be alert to the possibility of breast cancer, as benign tumors rarely have this symptom.

2. Superficial varicose veins of the skin: When the tumor is large or grows rapidly, the skin on its surface may become thinner, and the superficial blood vessels and veins underneath may often become varicose. It is clearer in LCD thermal images and infrared scans and is commonly seen in giant fibroadenomas and phyllodes cystosarcoma of the breast. Superficial varicose veins are also common in tumors during acute inflammation, pregnancy, and lactation.

3. Redness of the skin: In acute or chronic mastitis, the breast skin may become red and swollen. But in breast cancer, it is mainly seen in inflammatory breast cancer. Because the subcutaneous lymphatic vessels are completely occupied by cancer thrombi, it can cause carcinomatous lymphangitis. At this time, the skin color changes from light red to dark red. It is relatively limited at first, and soon spreads to most of the breast skin. It is also accompanied by skin edema, thickening, and increased skin temperature.

4. Skin edema: Because the subcutaneous mammary lymphatic vessels are blocked by tumor cells or the central area of ​​the mammary gland is infiltrated by tumor cells, the return of mammary lymphatic vessels is obstructed, lymph fluid accumulates in the lymphatic vessels, the skin becomes thicker, and the hair follicle openings become enlarged and sunken, showing "orange peel-like changes". In obese, sagging breasts, it is common to have mild skin edema on the outer and lower sides. If it is symmetrical on both sides, it is caused by local circulatory disorders; if it is unilateral, you should be cautious and beware of the possibility of cancer.

In addition, advanced breast cancer can directly invade the skin and cause ulcers. If combined with bacterial infection, it will have an unpleasant odor. If cancer cells infiltrate into the skin and grow, they may form scattered hard nodules, called "skin satellite nodules," in the skin around the main lesion.

6. Swollen axillary lymph nodes

Breast cancer gradually develops and can invade the lymphatic vessels and metastasize to its local lymphatic drainage area. Among them, the most common site of lymph node metastasis is the ipsilateral axillary lymph nodes. Lymph nodes often grow from small to large, and the number of lymph nodes gradually increases. At first, the enlarged lymph nodes can be moved, and finally they fuse and become fixed. If the swollen lymph nodes invade and compress the axillary vein, it can often cause edema of the upper limb on the same side; if it invades the brachial plexus, it can cause shoulder pain. When examining the axillary lymph nodes, the affected upper limb should be relaxed as much as possible so that the top of the axilla can be palpated. If enlarged lymph nodes can be felt, attention should be paid to the number, size, texture, mobility and surface condition of the lymph nodes to distinguish them from inflammation and tuberculosis.

If there is no lump in the breast, but the first symptom is enlarged axillary lymph nodes, patients rarely seek medical treatment. When the axillary lymph nodes are enlarged and pathology confirms metastatic cancer, in addition to a careful examination of the lymphatic drainage area, lung and digestive tract tumors must also be ruled out. If the pathology suggests metastatic adenocarcinoma, pay attention to the possibility of "occult breast cancer". At this time, breast lesions are often not found, and mammography may help with diagnosis. The lymph nodes are tested for hormone receptors. If the results are positive, even if all other examinations fail to reveal lesions in the breast, a breast tumor should still be considered.

Breast cancer can metastasize to the ipsilateral axillary lymph nodes, and can also metastasize to the contralateral axillary lymph nodes through the mutual communication between the anterior chest wall and the internal mammary lymphatic network, with an incidence of about 5%. In addition, advanced breast cancer may metastasize to the ipsilateral supraclavicular lymph nodes or even the contralateral supraclavicular lymph nodes.