Mary is 45 years old.
While she was having a shower, she felt a lump in her breast.
She’s very scared.
Ann is 38 years old.
When shaving her armpit, she noticed a lump. She then started to worry.
Martha is 65 years old.
After being cured of a breast cancer 10 years ago, her lower back is in pain.
She feels no improvement.
Except in case of very aggressive tumours that can be detected for the first time outside the breast, breast cancer is detected most often in the breast itself. If breast cancer is confined to the breast, it can appear in several forms.
Most often the tumour is in the middle of the breast, in its glandular area. The woman usually feels it when showering or having a bath. And if she’s following an early detection program of breast cancer, usually she discovers it before it causes symptoms. Most often breast cancer appears in the area located at the upper outer quadrant of the breast where most of the breast tissue is.
When located near the nipple, breast cancer can produce two different symptoms.
- The first symptom is a nipple deformity.
The tumour may make the nipple twist and change its form, and therefore appears asymmetric with respect to the other breast’s nipple.
The tumour can also pull the nipple inward the breast, causing its invagination.
- The second symptom is the appearance of a bloody discharge from the nipple. When there is blood coming from the nipple it is very important to consult a doctor as soon as possible.
When the tumour is located very close to the skin, as it progressively grows, it can produce two different symptoms.
- The first one appears when the tumour reaches the skin, breaking it and producing an ulcer that doesn’t heal. That is associated with bad odour, because the ulcer usually gets infected with normal skin bacteria.
- The second symptom happens without breaking the skin. The tumour compresses the lymphatic drainage that goes below the skin, which make fluid accumulate. The “orange peel” appears with a bunch of little holes in the skin, caused by the cellulite beneath.
When the tumour grows inward it can infiltrate the pectoral muscle, which is deep in the breast, fixing the breast to this muscle.
- To observe this fact the woman must lean forward, dangling breasts. The breast where the tumour is infiltrating the pectoral muscle, will be moving less.
- However, the unaffected breast who hangs freely, unattached.
- We could feel a lump in the hole situated above the first rib in the lower neck, and if it’s large enough it could compress the brachial plexus nerves, causing strange sensations in the arm, loss of sensation in the fingers, or even cramping or feeling a throbbing pain.
- Another way of discovering them is by performing a scanner. A less frequent travel site of tumour cells through the lymphatic vessels is the supraclavicular area.
When cancer reaches blood, breaking a nearby blood vessel, tumour cells travel throughout the body and can get to places where they like to live due to their special conditions.
We have seen symptoms due to cancer in the breast itself. But what happens when the tumour escapes from the breast, either through the lymph system or through the blood?
When the tumour is already out of the breast it may be because it has followed two different paths: the lymphatic system or blood.
When breast cancer chooses lymph vessels to travel to other parts of the body, it can follow two paths.
- The first one, the most common, is to go to the axilla. There are many axillary nodes that can collect tumour cells. These cells accumulate there and make the size of the axillary nodes get bigger. Eventually they will become palpable. If many tumour cells accumulate in the armpit and affect many lymph nodes, they can disrupt the collection of lymphatic fluid from the arm, which will gradually start to swell, although this is very rare.
- The second path, the least frequent, is to go to the internal mammary chain, which is in the thoracic cavity, just below the breastbone. Although cancer cells accumulate in these nodes, as they are situated inside the chest, we have no clinical way to detect these enlarged nodes.
- when tumour cells grow in the bone and metastases are very big, they can break the layer that covers bone. This layer, when breaks will cause pain to appear. This cancer growth compromises bone strength, and especially if bone must bear weight and then cause it to break.
- A special case of bone metastases occurs when vertebrae are affected. It can cause back pain. When vertebrae break, it can cause neurological symptoms known as medullary compression syndrome.
- When tumour cells get to the lungs, they usually create separate cell groups. Sometime later, multiple metastases will appear. If they obstruct the lung function, shortness of breath (a symptom called “dyspnoea”) appears. If they touch a breathing tube (known as bronchus), they irritate it, causing a very troublesome dry cough.
- If placed near a blood vessel, they may break it, pouring a little blood with that cough.
- When groups of tumour cells get to live within the brain, metastases will appear to be increasingly large. As they push neighbouring neurons, these neurons begin to operate in an altered way. In such case, two types of symptoms may occur: “irritative” symptoms, in which pushed neurons fire uncontrolled flashes: the woman can have seizures; or “deficit” symptoms, in which the neurons stop functioning and their work is left undone. We can have loss of mobility, loss of vision, loss of sensibility, and so on.
In both cases, there will be too much tumour in the head.
As the skull is a closed cavity with a single large outlet which has not enough room for many cells (including neurons and tumour cells), we will start having headaches, gradually growing up in intensity and frequency.
- When breast cancer cells get to the liver, they begin to grow wildly and begin to crush liver cells. If the liver cells break, their contents, transaminases, will access the blood, thus increasing their blood levels (we can detect that in a blood test).
If they compress small bile conduct inside the liver, bile may accumulate, and the patient’s skin gets a yellow tint (phenomenon called jaundice).
In conclusion, breast cancer can be the cause of many signs and symptoms.
In the breast itself most often we find the tumour through an early diagnostic test, or it is palpated when woman performs self-examination of her breasts or finds it in the shower. Less often a bloody discharge from the nipple, ulceration of the skin,“orange peel”, or breast fixation to the pectoral muscle can occur. In regions of lymphatic drainage, the most common way of discovering breast cancer is finding a lump in the armpit.