Breast tumor mass is located in the outer upper quadrant, followed by nipple, areola and inner upper quadrant. Because there are many unconscious symptoms, the lump is often found by the patient unintentionally (such as taking a shower and changing clothes). A few patients may have different degrees of tenderness or irritation and nipple discharge. Tumors grow faster, and invading surrounding tissues will cause changes in the shape of breasts and a series of signs will appear. Such as: skin depression on the tumor surface; The cancer adjacent to the nipple can pull the nipple towards the cancer; Nipple invagination etc. If the cancer mass is large, it can make the whole breast tissue contract and the mass protrude obviously. Cancer cells continue to grow, forming a so-called "orange peel" change. These are all important symptoms of breast tumors.
breast lump
Breast lump is the most common symptom of breast cancer, and about 90% patients come to see a doctor with this symptom.
1, location: The breast is centered on the nipple, making a cross, which can divide the breast into five areas: upper inside, upper outside, lower inside, lower outside and center (areola). Breast cancer is more common outside than inside. It is rare to see inside and outside.
2. Number: Single breast lump is the most common breast cancer, while multiple breast lumps and primary bilateral breast cancer are rare in clinic. However, with the improvement of the level of tumor prevention and treatment, the survival time of patients is prolonged, and after a breast cancer operation, the chance of another primary tumor in the contralateral breast will increase.
3. Size: The mass of early breast cancer is generally small, and sometimes it is not easy to distinguish it from lobular hyperplasia or some benign lesions. However, even a small lump sometimes involves the suspensory ligament of the breast, causing symptoms such as local skin depression or nipple invagination, which is easier to find early. In the past, due to the poor medical level, when I came to see a doctor, the lump was often very large. Nowadays, with the popularization of breast self-examination and the development of general survey, early clinical breast cancer has increased.
4. Morphology and boundary: The vast majority of breast cancer is invasive growth with unclear boundary. Some can be flat, the surface is not smooth, and there is a sense of nodules. However, it should be noted that the smaller the lump, the less obvious the above symptoms are. Moreover, a few special types of breast cancer can expand because of light infiltration, showing smooth, active and clear boundaries, which is not easy to distinguish from benign tumors.
5, hardness: breast cancer mass texture is hard, but the cell-rich medullary carcinoma can be slightly soft, and some can also be cystic, such as cystic papillary carcinoma. Around some lumps, there is more adipose tissue around them, which makes them feel flexible during palpation.
6. Mobility: When the mass is small, the mobility is large, but this mobility is that the mass moves with its surrounding tissues, which is different from that of fibroadenoma. If the tumor invades the fascia of pectoralis major, the activity will be weakened; When the tumor enters the pectoralis major muscle, the activity disappears. Let the patient put his hands on his hips, hold out his chest and contract his chest muscles. It can be seen that the breasts on both sides are obviously asymmetrical. Advanced breast cancer can invade the chest wall, then completely fix it and invade the lymph nodes around the tumor. The skin edema can be orange peel-like, which is called "orange peel sign", and the subcutaneous nodules around the tumor are called "satellite nodules".
In benign breast tumors, it is not uncommon to find breast masses, and the most common is breast fibroadenoma. The disease is more common in young women, and the incidence rate is low over 40 years old. Tumors are usually solid, tough, with a complete capsule, a smooth surface and a slippery feeling to the touch. Generally, there is no skin adhesion or nipple invagination. Intraductal papilloma, the mass is often very small and difficult to palpate. Slightly older patients can palpate small nodules around areola, with nipple discharge as the main clinical symptom. Breast lobular hyperplasia rarely forms a clear lump, mainly because the local breast tissue is thickened, the texture is tough, there is no envelope feeling, and there is often pain before menstruation.
Some only show thickening of local glands in the breast, no obvious mass and unclear boundary, and most of them are diagnosed as "hyperplasia of mammary glands". However, careful examination of the thickened area is limited. If there is a little skin adhesion, you should pay attention to it. You can take a mammogram.
breast pain
Although breast pain can be seen in many breast diseases, pain is not a common symptom of breast tumors, and both benign and malignant breast tumors are usually painless. In early breast cancer, occasional pain is the only symptom, which can be dull pain or pulling feeling, especially when lying on your side. Studies have shown that the detection rate of breast cancer will increase in postmenopausal women with breast pain and gland thickening. Of course, when the tumor is accompanied by inflammation, there may be swelling or tenderness. If the advanced tumor invades the nerve or the axillary lymph nodes swell and oppress or invade the brachial plexus, shoulder pain may occur.
Nipple discharge
Nipple discharge can be divided into physiological and pathological. Physiological nipple discharge is mainly found in pregnant women and lactating women. Pathological nipple discharge refers to the secretion of mammary duct in non-physiological state. What is usually said refers to the latter. Nipple discharge can be caused by a variety of breast diseases, and patients are easy to pay attention to it. It is one of the main reasons why about 10% patients come to see a doctor. Among the symptoms of various breast diseases, its incidence is second only to breast lump and breast pain.
1, nipple discharge can be divided into: bloody, serous, serous, watery, purulent and milky according to its physical properties. Among them, serous, watery and milky secretions are common, and bloody secretions only account for 10% of secretion cases. When the lesion is located in the large catheter, the extravasation is mostly bloody; When located in a small catheter, it can be pale blood or serous; If the blood stays in the catheter for too long, it can be dark brown; When there is inflammation or infection in the catheter, pus can be mixed, and the liquefied necrotic tissue can be water, milk or brown liquid; The fluid of mammary duct ectasia is often serous. Bloody secretions are mostly caused by benign lesions, and a few breast cancers can also be bloody. Physiological nipple discharge is mostly bilateral, and its secretion is often milky white or watery.
2. The causes of nipple discharge are mainly divided into external causes and internal causes.
5% ~ 10% of breast cancer patients have nipple discharge, but only 1% have nipple discharge as the only symptom. Overflow is often a single pipe, and its properties can be varied, such as bloody, serous, watery or colorless. It is more common in breast cancer patients with primary ductal carcinoma or intraductal carcinoma with nipple discharge, such as intraductal papilloma malignant transformation and papillary eczema-like carcinoma. It is worth noting that although most people think that breast cancer is rarely accompanied by nipple discharge, even if there is discharge, it appears almost after or at the same time as the lump, but people without the lump are rarely considered as cancer. However, recent studies have shown that nipple discharge is an early clinical manifestation of some breast cancers, especially intraductal cancers, which can exist alone before forming obvious masses.
Intraductal papilloma is a disease with more nipple discharge, accounting for the first place in all nipple discharge lesions, among which intraductal papilloma in areola area is more common, which can be single or multiple, with an age of 18 ~ 80 years, mainly 30 ~ 50 years old. Tumors vary in diameter from 0.3 to 3.0cm, with an average of 65438±0.0cm, and those larger than 3.0 cm are often malignant. Most exudation is bloody or serous, others are rare. It is generally believed that papillomas in large ducts are mostly single, with little canceration, while papillomas in small and medium ducts are often multiple, showing canceration. They are the same lesion, but the location and growth process are different.
Although cystic hyperplasia is not a tumor, it is the most common benign lesion of breast tissue, which is common in people over 40 years old and rare after menopause. Among them, cyst, mammary duct epithelial hyperplasia and papillomatosis are the basis of its discharge. Most of them are serous, and only 5% are accompanied by exudation.
Nipple change
If breast cancer patients have abnormal nipple changes, they usually show nipple erosion or nipple invagination.
1, nipple erosion: paget's disease of the breast has typical manifestations, often accompanied by itching, and about 2/3 patients may be accompanied by areola or other breast lumps. At first, it was just nipple desquamation or nipple fissure. Nipple desquamation is often accompanied by a small amount of secretion and scab, and the scab skin can be seen as bright red, rotten and not healed for a long time. When the whole nipple is involved, it can invade the surrounding tissues, and with the progress of the lesion, the nipple can disappear completely. Some patients can also have breast masses first, and then nipple lesions.
2. Nipple invades: When the tumor invades the nipple or areola, the fibrous tissue and catheter system of the breast can be shortened, pulling the nipple, making it concave, biased, or even completely retracted behind the areola. At this time, the nipple of the affected side is often higher than the healthy side. It may appear in early breast cancer, but sometimes it is also a late sign, mainly depending on the growth site of the tumor. When the tumor is under or near the nipple, it can appear in the early stage; If the tumor is located deep in the breast tissue, far from the nipple, this sign is usually late. Of course, nipple invagination and depression are not all malignant lesions, and some can be caused by congenital dysplasia or chronic inflammation. At this time, the nipple can be pulled out with your fingers and is not fixed.
Skin changes
Skin changes caused by breast tumors are related to the location, depth and degree of invasion of tumors, and usually have the following manifestations:
1, skin adhesion: the breast is located between the superficial fascia and the superficial fascia, the superficial fascia is connected with the skin, and the deep fascia is attached to the superficial surface of pectoralis major. Superficial fascia forms interlobular septum in breast tissue, which is the suspensory ligament of breast. When the tumor invades these ligaments, it can shorten their contraction and pull the skin to form a depression, which looks 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. 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, it is often seen that the skin on the surface of the tumor is slightly depressed. If you have this symptom, you should be alert to the possibility of breast cancer, which is rare in benign tumors.
2, superficial varicose veins of the skin: when the tumor is large or growing rapidly, the surface skin can be thinned, and the superficial blood vessels and veins below it can often be varicose. It is more clear in liquid crystal thermogram and infrared scanning, and is common in giant fibroadenoma and lobulated cystsarcoma of breast. Superficial varicose veins are also common in tumors during acute inflammation, pregnancy and lactation.
3, skin redness: acute and chronic mastitis, breast skin can be red and swollen. But in breast cancer, it is mainly seen in inflammatory breast cancer. Because subcutaneous lymphatic vessels are all tumor thrombi, it will cause cancerous lymphangitis. At this time, the skin color is reddish to dark red, which is limited at first, and soon spreads to most breast skin, accompanied by skin edema, thickening and skin temperature increase.
4. Skin edema: Because the subcutaneous lymphatic vessels of the breast are blocked by tumor cells or the central area of the breast is infiltrated by tumor cells, the reflux of the lymphatic vessels of the breast is blocked, the lymph in the lymphatic vessels accumulates, the skin becomes thicker, and the hair follicle mouth is enlarged and sunken, showing an "orange peel-like change". Obese and drooping breasts usually have mild skin edema below them, such as bilateral symmetry, which is caused by local circulation disorder; If it is unilateral, it is necessary to be cautious and mention the possibility of cancer prevention.
In addition, advanced breast cancer can directly invade the skin and cause ulcers. If it is combined with bacterial infection, it smells bad. If cancer cells infiltrate into the skin and grow, scattered hard nodules can be formed on the skin around the main focus, that is, "skin satellite nodules".
Axillary lymphadenopathy
Breast cancer develops gradually and can invade lymphatic vessels and transfer to its local lymphatic drainage area. Among them, the most common site of lymphatic metastasis is ipsilateral axillary lymph nodes. Lymph nodes often increase gradually from small to large, and the number of lymph nodes also increases gradually from small to large. At first, it can promote swollen lymph nodes, and finally fuse and fix them. If swollen lymph nodes invade and compress axillary veins, they can often make the ipsilateral upper limbs edema; If the brachial plexus is invaded, it will cause shoulder pain. When examining axillary lymph nodes, the upper limb of the affected side should be relaxed as much as possible so that the axillary apex can be reached. If you can feel swollen lymph nodes, you should pay attention to the number, size, texture, activity and surface condition of lymph nodes to distinguish them from inflammation and tuberculosis.
If there is no lump in the breast, but the first symptom is axillary lymph node enlargement, when axillary lymph node enlargement is pathologically confirmed as metastatic cancer, besides careful examination of its lymphatic drainage area, tumors in the lung and digestive tract should also be excluded. If the pathology suggests metastatic adenocarcinoma, we should pay attention to the possibility of "occult breast cancer". At this time, many breast lesions have not been found, and molybdenum target radiography may be helpful for diagnosis. If the hormone receptor test is positive for lymph nodes, even if all tests fail to find breast lesions, tumors from the breast should still be considered.
Breast cancer can metastasize to the ipsilateral axillary lymph nodes or to the contralateral axillary lymph nodes through the communication between the anterior chest wall and the internal mammary lymph network, with an incidence rate of about 5%. In addition, advanced breast cancer can still have ipsilateral supraclavicular lymph node metastasis, and even contralateral supraclavicular lymph node metastasis.