Breast tissue is one of the most heavily hormone-influenced tissues in the body. Because of the fluctuations in hormone levels that typically occur during a reproductive cycle, it is common for women to experience breast pain or tenderness. Still, the importance of staying vigilant regarding breast health and any suspicious changes cannot be overstressed.
As breast cancer is the most common type of cancer in women and has one of the highest rates of cancer deaths. And just like for other cancer types, such as prostate cancer, early detection can mean the difference between survival and death.
The tricky part about breast cancer is that it can present in a variety of forms, ranging from a painless increase in breast size to lumps and ulcers. Additionally, there are multiple types of breast cancers, and the type of cancer determines the kind of symptoms a person will experience. 1
Often, cancer can keep on growing silently without causing any noticeable symptoms. While mammographic screenings using X-rays have proven to be a breakthrough diagnostic tool for breast cancer patients in recent years, the importance of self-examination for early detection cannot be denied. Nearly 20% of all cases of breast cancer are detected on self-exams.
In addition, several cases of breast cancer come to attention during routine activities like taking a bath, applying deodorant, or idle scratching. By doing regular self-check-ups, you remain one step ahead of any worrying developments.
Following is a brief overview of some common symptoms of breast cancer that should never be neglected.
1. Swelling of breast skin
Swelling is the earliest sign of many inflammatory and chronic diseases, including cancer. Sometimes, the swelling is a direct result of the growing mass of tumor cells. In other cases, it is an indirect swelling caused by cancer cells blocking the lymphatic drainage of the overlying skin. This latter type of swelling commonly occurs in an aggressive variant of breast cancer called inflammatory breast cancer, in which the entire breast may appear enlarged and inflamed. 2
2. Discoloration of breast skin
Any abnormal skin discoloration, like the breast appearing a shade of brown, black or blue, should ring alarm bells. Inflammatory breast cancer may cause the breast to show red, pink or purple pigmentation in addition to causing the breast to feel firmer than usual. 2
3. Breast lumps
A breast lump is the commonest and earliest reported symptom in all types of breast cancers. 3 The lump can either feel firm and 'well-circumscribed' or appear more spread-out or 'diffuse' on palpation.
However, it should be noted that despite the typical association of lumps with breast cancer, most breast lumps are actually non-cancerous. Some common causes of benign breast lumps include fat necrosis, which is a damaged lump of breast tissue, usually resulting from mechanical trauma. Other causes include infection and fibrocystic breast disease ("lumpy, bumpy breasts").
Usually, a painful lump is an indication of benign breast condition. To fully rule out cancer, however, a biopsy is generally advised.
4. Breast skin thickening
The thickening of the skin is another hallmark of an underlying malignant process. In addition to many conditions like advanced cancer, infection, and generalized body edema, thickening can also indicate the recurrence of breast cancer in a previously-treated breast.
5. Pitting of breast skin
Pitting refers to the dimpling of the skin that leads it to have a texture like an orange peel. If pitting is single-sided, chances of it being breast cancer are higher than if you have pitting on both breasts. This is another symptom of inflammatory breast cancer, in which the skin may further appear red and swollen in addition to being pitted. 2
6. Increase in breast size
Breast enlargement is a natural process that occurs during many normal physiological states like pregnancy and puberty. However, if you notice an increase in size that is sudden and occurs outside of these normal processes, it may be a sign of an underlying disease.
Unilateral (affecting one breast) breast enlargement is more alarming than bilateral (affecting both breasts) increase in size. Still, a bilateral increase in breast tissue, although not a sign of cancer, may cause an increased risk of cancer later on. 5 It is best to consult a doctor in both cases.
7. Change in breast shape
It is normal for breasts to change shape as you age. Women in their 40s will often notice that their breasts may be becoming lax and pendulous.
Any abnormal or asymmetrical distortion that a mass may be causing, however, is a cause for concern.
8. Breast pain
Pain is usually a reassuring sign as it indicates that breast disease is most probably benign. Nevertheless, there are some types of breast cancer that may present with pain. 3
In cancer, however, the pain would have an accompanying symptom like a lump or nipple change.
9. Itchy breasts
Itchiness on breasts that is not accompanied by a rash (thus hinting at eczema or psoriasis) can sometimes be a sign of inflammatory breast cancer. 2 There is another type of cancer called Paget’s disease of the breast that may, in fact, present outwardly like eczema. However, both of these conditions will usually have other notable symptoms like breast tenderness and nipple discharge.
Some common conditions that may also cause breast itchiness are yeast infections and allergic reactions.
10. Changes in the consistency of the breast
Healthy breast tissue is a combination of fat and glandular tissue (that secretes milk), and this gives the breast its characteristic soft consistency. Breast cancer would alter this natural composition and may result in breast feeling firmer or more cystic (lumpy). 6
11. Change in breast skin temperature
The inflammatory processes and lymphatic blockage accompanying cancer cell invasion can lead to the breast skin feeling warm and tender.
12. Breast ulcers
Skin ulceration means a break in the continuity of skin. Advanced cancer can present as an ulcer by eroding through the overlying skin.
However, studies suggest that, despite ulceration, the extent of disease in some cases may be similar to early-stage cancer. 7
13. Changes in nipple appearance on one or both sides
The normal position of the nipple is such that it lies directly on top of the breast tissue, pointing downward and outwards. Asymmetry is usually common. However, any growing mass in the breast may cause a shift in the normal position of the nipple. Moreover, cancer may even cause a distortion in the shape of the nipple.
14. Nipple discharge
Discharge from the nipples is the earliest and most notable sign of many breast cancers, even those that cannot even be felt as a lump yet. 8 Nipple discharge in cancer is non-milky. It may be clear, brown, yellow, red, or bloody, and is composed of cancer and various inflammatory cells.
15. Rash on nipple
Nipple irritation and itching in combination with a rash and excoriation is also a frequently reported feature of breast cancer. This symptom is usually associated with nipple discharge. 8 The rash may extend outward to involve the areola (the pigmented skin around the nipple).
16. Peeling, flaking or crusting of the nipple skin
As we have already mentioned, breast cancer can present with rash and itchiness. This can be severe and excessive enough to lead to peeling, crusting, and flaking of the nipple skin. This is fairly common in Paget's disease of the breast, a rare form of cancer in which cancer cells 'spill' outside from small ducts in the nipple to involve the surrounding skin. 9
17. Nipple ulceration
Nipple ulceration and erosion is common in a type of breast cancer called Paget’s disease. 9 The condition is quite rare but should nevertheless be taken seriously.
18. Nipple retraction
Retracted nipples are nipples that do not have the typical appearance of erect nipples and lie on the level with or flat against the skin of the areola.
Breast cancer often presents with nipple retraction. This is because cancer invading the tissue underneath the nipple may cause it to contract and shrink, pulling the nipple inward. Cancer, in another part of the breast remote from the nipple, may also cause the same effect. 10
19. Lump in armpit
Lymphatic fluid draining the breast is directed into lymph nodes in the armpit. Many breast cancers present as lumps in and around the armpit and collar bone. This symptom can present without there being a noticeable lump in the breast. A lump in these areas is an indication that cancer has spread to the draining lymph nodes. 11
An armpit lump is a sign of advanced disease and should prompt an urgent visit to screening and diagnostic facilities.
20. Weight loss
Sudden and excessive weight loss is a defining feature of all advanced cancers. Many factors are implicated in cancer-related weight loss. For one, many people experience a decrease in appetite owing to the malignant process. This limits nutrient intake. On the other hand, the highly metabolizing cancer cells end up consuming all available nutrients. Cancer-associated nausea and vomiting may further play a part in causing weight loss.
21. Loss of appetite
Appetite loss is a common feature of all cancers, advanced-stage and otherwise. Metabolic processes, which are the body’s way of using nutrients to extract energy, take a heavy toll in the wake of a cancerous process. Moreover, the spread of cancer to abdominal organs may also result in a lack of appetite.
22. Extreme fatigue
Not only do cancer cells steal your nutrients for their own purpose of multiplication and advancement, but the presence of these cells also leads your body to launch an immune response against the "invasion." This inflammatory process results in the release of chemicals called 'cytokines,' and these cytokines may cause extreme fatigue. Hormonal changes may also cause fatigue in many cancers.
23. Bone pain
Bone pain means that the cancer has spread to bones. It is a feature of advanced disease. Common sites of bone pain in breast cancer include pain in the back, in the long bones of arms and legs, and pain in joints. About 65% to 75% of cases of breast cancer eventually spread to involve the bones, making bone pain a relatively common symptom of advanced cancer. 12
24. Difficulty in urination
As it has been mentioned, the cancer may spread to the spine in its advanced stages. This leads to the impingement of nerves that control urination and bladder function. This may cause uncontrolled and involuntary leakage of urine as well as other urinary problems.
25. Constant cough
A constant dry cough is an alarming feature: the lungs, lying in close approximation to the breast tissue, are organs to which breast cancer most commonly spreads. Cancer cells obstruct airways, causing the person to develop an irritating and persistent dry cough. 13
26. Difficulty in breathing
Similarly, cancer invading into the airways may lead to difficulty in breathing. It is again a feature of advanced-staged cancer. 13
27. Chest pain
Cancer that has invaded into the chest wall or chest cavity will irritate the sensitive nerve endings present at these sites and cause the person to experience chest pain. It is a feature of ‘metastatic’ cancer – the advanced-stage cancer that has spread to distant sites within the body, of which the chest wall and chest organs are one example. 13
28. Abdominal bloating, pain, or tenderness
Distant spread to abdominal organs may produce symptoms like bloating, pain, and tenderness.
29. Abdominal mass and jaundice
When the liver becomes involved, it shows a rapid increase in size, which can present as a mass in the abdomen. One of the first signs of liver involvement is jaundice, the yellow discoloration of skin and eyeballs that results from a buildup of bile in the body. 14
30. Headaches and confusion
Spread to the brain is also common in advanced breast cancer. A tumor pressing on normal brain matter may result in severe headaches, confusion, blurring of vision, nausea, and vomiting. 15
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