What are the clinical manifestations of breast cancer?

Although the clinical manifestations of breast cancer are not consistent, there are still some rules to follow.

Generally speaking, it can be summarized as "lump, pain, wrinkle, contraction and blood", which is mainly manifested in breast, nipple, local skin, lymph and distant metastasis.

(1) Breast lump. Because cancer is characterized by the infinite proliferation of a large number of immature cells, lumps and occupations have become one of the main clinical manifestations of most cancers.

According to incomplete statistics, about 80% of breast cancer patients come to see a doctor with breast lump as the main complaint. What are the characteristics of breast cancer lump?

① location. In order to facilitate the description of breast masses, it is artificially stipulated in medicine that:

With the nipple as the center, the vertical line and horizontal line intersect vertically, and the breast is divided into four quadrants: upper inner side, lower inner side, upper outer side and lower outer side. The most common site of breast cancer is the outer upper quadrant (that is, near the armpit), followed by the inner upper quadrant.

2 numbers. Single breast mass is the most common breast cancer, followed by bilateral or unilateral multiple breast masses.

Size 3. There are no specific boundaries. It is often related to the duration of onset and the time of discovery.

④ Surfaces and boundaries. Breast cancer is generally an irregular spherical mass with unclear boundaries, and sometimes it can be flat. The surface is nodular with no obvious boundary. However, we should be alert to those solitary nodules with small masses, clear boundaries, sometimes flat sheets and smooth surfaces, which are very similar to benign masses.

⑤ Hardness. Breast cancer is mostly a solid mass, so it often feels hard or rock-solid when palpated. But some cases also have cystic changes. Some elderly or obese breast masses are easily surrounded by adipose tissue, which is difficult to find early.

6 activities. At the beginning of the disease, the mass is small and has a large activity, but this activity is characterized by the mass moving with its surrounding soft tissue, which is different from the extensive advancement of benign fibroadenoma. In advanced tumors, breast cancer often adheres to the chest wall and is completely fixed.

⑦ Pain. Breast cancer lumps are usually painless, and less than 10% of patients feel slight discomfort in the affected area. In some cases, even if the lump is small, it will cause pain.

Pain occurs when terminal cancer invades the nerves.

(2) nipple discharge. There are many reasons for nipple discharge. According to the literature, the incidence of breast cancer in nipple discharge cases is 1% ~ 45%, with an average of 14.3%. The clinical manifestations of breast cancer with nipple discharge ranged from 65438 0.8% to 65438 0.4%, with an average of 4%.

Therefore, based on the results of various materials, it is considered that nipple discharge with the following factors is a high-risk group: the patient is over 40 years old, especially over 59 years old; Bloody or watery; Unilateral and single-hole catheter overflow; Accompanied by a breast lump.

Nipple discharge with the following factors is more likely to be benign: the patient is under 40 years old; The nipple has follicles or purulent fluid; Bilateral porous discharge; No breast lumps.

It is worth noting that nipple discharge can be considered as an early manifestation of ductal carcinoma of the breast without breast mass. Before the clinical mass is formed, the thickening of local glands in the breast can be considered as the manifestation of the mass. Its characteristic is that it can touch a "membrane" substance with no clear boundary, and its range is difficult to determine and measure. Especially when this localized gland thickening, accompanied by nodular feeling and obvious expansion trend, occurs over 50 years old and has high risk factors for breast cancer, we should be especially vigilant and must not be misdiagnosed as breast hyperplasia.

(3) abnormal skin. The changes of breast surface skin are closely related to the depth, infiltration degree and tumor development of breast cancer.

① Skin adhesion. Refers to the tumor invading and shortening the ligament between the gland and the skin, involving the skin to form a skin depression, like a "dimple." This phenomenon can be one of the early clinical manifestations of breast cancer.

② Superficial varicose veins of skin. It is common when the tumor grows rapidly or has a large volume. The skin on the tumor surface is thin, and superficial blood vessels, especially veins, are tortuous and dilated.

③ The skin is red and swollen. This is a common sign of inflammatory breast cancer. With the skin edema, the color changes from light red to deep red. It began to be limited and soon spread to most breast skin.

④ Skin edema. Skin edema of breast cancer is described as "orange peel degeneration". That is, many punctate holes are formed in the hair follicles on the skin surface, which look like orange peel. This is often due to cancer cells blocking the lymphatic vessels under the breast, or tumor infiltration in the central area of the breast, which hinders the reflux of breast lymph. Tangerine peel degeneration is often a typical late manifestation.

⑤ Skin ulcer. The skin is broken, forming an ulcer, which is a plant pattern and will not heal for a long time. Satellite nodules can appear around the lesion. When small nodules fuse with each other to form a dark red diffuse membrane, it is often one of the skin changes in the late stage of breast cancer.

⑥ nipple changes. Breast cancer nipple abnormalities mainly include nipple desquamation, erosion, retraction and fixation.

(4) Lymphatic metastasis. The most common site of lymphatic metastasis of breast cancer is ipsilateral axillary lymph nodes, followed by ipsilateral internal mammary lymph nodes, which can spread to ipsilateral supraclavicular lymph nodes or even contralateral supraclavicular lymph nodes in the late stage. The clinical manifestations of lymphatic metastasis can be seen that the lymph nodes at the metastatic site are swollen, hardened and even fused into a ball and fixed. Late axillary lymph nodes can compress veins, affect lymphatic reflux of upper limbs and cause edema of upper limbs. Such as supraclavicular lymph node metastasis, several scattered or fused masses with diameters ranging from 0.5 to 5 cm to 5 cm can be touched at the clavicle fossa.

At the initial stage of metastasis, the lymph nodes are small and hard, and there is a "sandy feeling" when they are fused.

(5) Transfer in different places. When cancer cells transfer to distant tissues or organs through blood circulation, corresponding symptoms and signs may appear, which is the main cause of breast cancer death. The common metastatic sites are chest organs (lung, pleura, mediastinum), bone, liver and brain.