What are the symptoms of breast cancer?

A breast lump
The usual first symptom is a painless lump in the breast. But note: most breast lumps are not cancerous. Most breast lumps are fluid filled cysts or fibroadenomas (a clumping of glandular tissue) which are benign. However, you should always see a doctor if a lump develops to check it out as the breast lump may be cancerous.

Other symptoms
Other symptoms which may be noticed in the affected breast include:

• Changes in the size or shape of a breast.
• Dimpling or thickening of some of the skin on a part of a breast.
• The nipple becomes inverted (turns in).
• Rarely, a discharge from a nipple occurs (which may be bloodstained).
• A rare type of breast cancer causes a rash around the nipple which can look similar to a small patch of eczema.
• Rarely, pain in a breast. But note, pain is not a usual early symptom. Many women develop painful breasts (mastalgia), and this is not usually caused by cancer.

The first place that breast cancer usually spreads to is the lymph nodes in the armpit (axilla). If this occurs you will develop a swelling or lump in an armpit. If the cancer spreads to other parts of the body (advanced breast cancer), various other symptoms can develop.

How is breast cancer diagnosed?

Initial assessment
If you develop a lump or symptoms which may be breast cancer, a doctor will usually examine your breasts and armpits (axillae) to look for any lumps or other changes. You will normally be referred to a specialist. Sometimes a biopsy of an obvious lump (see below) is arranged, but other tests may be done first such as:

• Mammography. This is a special x-ray of the breast tissue which can detect changes in the density of breast tissue which may indicate a tumour.
• Ultrasound scan of the breast.

Biopsy - to confirm the diagnosis
A biopsy is when a small sample of tissue is removed from a part of the body. The sample is then examined under the microscope to look for abnormal cells. A specialist may take a biopsy with a fine needle which is pushed into the lump and some cells are withdrawn. Sometimes the doctor may be guided as to where to insert the needle with the help of a mammogram or ultrasound scan. Sometimes a small operation is needed to obtain a biopsy sample.

The biopsy sample can confirm or rule out breast cancer. Also the cells from a tumour can be assessed and tested to determine their grade and hormone responsiveness (see above).

Assessing the extent and spread
If you are confirmed to have breast cancer, further tests may be needed to assess if it has spread. For example, blood tests, an ultrasound scan of the liver, chest x-ray, a bone scan, other types of scan, etc. (There are separate leaflets which describe each of these tests in more detail.) This assessment is called 'staging' of the cancer. The aim of staging is to find out:

• How large the tumour has grown.
• Whether the cancer has spread to local lymph nodes in the armpit.
• Whether the cancer has spread to other areas of the body (metastasized).

See separate leaflet called 'Cancer Staging and Grading' for details.

By finding out the stage of the cancer, the grade of the cells, and whether the cancer is hormone responsive, it helps doctors to advise on the best treatment options. It also gives a reasonable indication of outlook (prognosis).

What is the treatment for breast cancer?

Treatment options which may be considered include surgery, chemotherapy, radiotherapy and hormone treatment. Often a combination of two or more of these treatments are used. The treatments used depend on:

• The cancer itself - its size and stage (whether it has spread), the grade of the cancer cells, and whether it is hormone responsive or not, AND
• The women with the cancer - your age, whether you have had your menopause, general health, and personal preferences for treatment.

You should have a full discussion with a specialist who knows your case. They will be able to give the pros and cons, likely success rate, possible side-effects, and other details about the various possible treatment options for your type of cancer.

You should also discuss with your specialist the aims of treatment. For example:

• Treatment aims to cure the cancer in many cases. In particular, the earlier the stage of the cancer, the better the chance of a cure. Because of routine mammography, many women are diagnosed with breast cancer in the early stages and have a good chance of a cure. (Doctors tend to use the word 'remission' rather than the word 'cured'. Remission means there is no evidence of cancer following treatment. If you are 'in remission', you may be cured. However, in some cases a cancer returns months or years later. This is why doctors are sometimes reluctant to use the word cured.) 医学全在线www.med126.com
• Treatment may aim to control the cancer. If a cure is not realistic, with treatment it is often possible limit the growth or spread of the cancer so it progresses less rapidly. This may keep you free of symptoms for some time.
• Treatment may aim to ease symptoms in some cases. Even if a cure is not possible, treatments may be used to reduce the size of a tumour which may ease symptoms such as pain. If a cancer is advanced then you may require treatments such as nutritional supplements, painkillers, or other techniques to help keep you free of pain or other symptoms.

Surgery
The types of operation which may be considered are:

• Breast-conserving surgery. This is often an option if the tumour is not too big. A 'lumpectomy' is one type of operation where just the tumour and some surrounding breast tissue is removed. A partial mastectomy is another type of operation which removes more breast tissue than a lumpectomy. It is also usual to have radiotherapy following these operations. This aims to kill any cancer cells which may have been left in the breast tissue.
• Removal of the affected breast (mastectomy). This may necessary if there is a large tumour or a tumour in the middle of the breast. It is often possible to have breast reconstruction surgery following a mastectomy. This involves using a breast implant (for example, a silicone implant) and using flaps of skin and muscle to recreate the shape of a breast.

Whatever operation is done it is also usual to remove one or more of the lymph nodes in the armpit, or to have radiotherapy to these lymph nodes. These lymph nodes are where breast cancer usually first spreads to. The lymph nodes which are removed are examined under the microscope to see if they contain any cancer cells. This helps to accurately stage the disease and helps to guide the specialist as to what treatment to advise following surgery.

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