Clinical signs of breast disease

Signs that can occur in breast cancer are described in detail again below. All the changes mentioned give an indication of a disease of the breast. Your doctor must determine the nature of this disease by other diagnostic means.

If you notice any of the following changes, make an appointment with your gynaecologist. The clinically most important sign is the palpable coarse lump. Every palpable lump in the breast must always be examined to determine whether it is a malignant tumour or whether the diagnosis “breast cancer” can be ruled out.

The size of a lump can vary from pea-sized to the size of a lime, depending on the stage of the cancer. Sometimes the nodules can be painful to the touch or lead to a painful pulling sensation, but there are also findings that are completely painless. Breast cancer nodes are usually fused with their surroundings, which is caused by the decomposing growth of the cancer.

They are therefore often difficult to move within the tissue and do not follow the pressure of the hand during palpation. Depending on the size of the breasts and the node, a conspicuous increase in the size of a breast can occur. Irregularities in the size between the two breasts, which on the other hand have always existed, are quite natural and do not require further clarification.

On average, the size of the lumps, which are palpated in the self-examination, is slightly more than 2 cm. By mammography, lumps as small as 1 cm can be detected. However, 15 % of palpable tumours are not detectable in mammography due to the nature of the tissue and thus breast cancer.

Nodules can also be palpated on the edge of the breast muscle or in the armpits. These are probably enlarged lymph nodes in the armpit. They are usually about the size of a lens and cannot usually be palpated.

A distinction is made between benign and malignant lymph node enlargements. Benign enlargements are caused by infectious diseases, such as a simple cold, but also by skin infections or various viral diseases. The enlargement is then due to the activation of the immune system.

These lymph node swellings usually occur suddenly and the palpable lymph nodes feel soft, can be moved easily and are pressure painless. Malignant enlargements can occur, for example, in leukaemias but also in other types of cancer (e.g. breast cancer). The lymph nodes can become very large and usually feel hard, cannot be moved easily and are sensitive to pressure.

Nodules in the breast can lead to visible bulges due to their volume alone. More often, however, they lead to retractions of the skin (also called plateau phenomenon), which are usually particularly noticeable when the arm is raised. Retraction is caused by tumour-related adhesions of connective, fatty and skin tissue.

Even very small lumps that are hardly or not at all palpable can lead to such adhesions and thus to retractions or protrusions. Orange peel skin, also known as orange peel phenomenon or French peau d’oranges, is a symptom that tends to occur in more advanced stages. The term clearly describes the change in the skin above the tumour.

The skin is slightly reddened and the pores are enlarged and emphasized. The orange peel skin is caused by the accumulation of fluid in the skin, which causes it to swell. This is due to a disturbance of the outflow via the lymphatic system through the tumour.

At this stage, breast cancer is easier to detect. Like orange peel skin, the retraction of the nipple is a symptom that tends to occur in the late stages of the disease. Clear or bloody discharge from the nipple also indicates an advanced stage.

Adhesions of the milk ducts with the tumour cause the nipple to retract. In some women the nipples are at the same level as the areola, they are then called inverted or hollow nipples. If this is not a one-sided or sudden change, this is not a cause for concern.

Bloody discharge from the nipple occurs when the tumour damages tissue through its growth and thus creates a connection between a blood vessel and the milk ducts. These changes can also occur in earlier stages, for example, when the tumour is located directly behind the nipple. As mentioned above, these changes, which may be frightening, can also occur due to other diseases of the breast.

The breast (in the majority of cases only one side is affected) feels red and warm, is swollen and sensitive to touch. A breast inflammation, called mastitis, can be caused by a special type of breast cancer, the inflammatory breast carcinoma. Other types of breast inflammation can be found under benign breast tumours and other diseases of the breast.

Paget’s carcinoma is a special subtype of ductal breast cancer. Here the tumour has grown into the nipple. The nipple is swollen, reddened and sore.

There is discharge and crust formation around the nipple. Especially when breastfeeding, there are many other reasons that can lead to nipple eczema. Women over 35 years of age should always have an examination if they have had breast pain for a longer period of time in order to be able to exclude breast cancer as the cause.

In as many as 10% of women affected by breast cancer, pain can be the only first symptom and a sign of breast cancer. However, breast cancer is a disease that – especially in its early stages – very rarely leads to pain in the affected breast. If there is pain in the breast, it is usually due to another underlying cause rather than a manifest breast cancer.

In rare cases, however, if the pain is accompanied by other signs of inflammation, such as redness, warming and swelling of the affected area, it may be a special form of breast cancer (inflammatory breast cancer), but often it is more likely to be an inflammation of the breast (mastitis). Much more often the cause of feelings of tension, pressure pain and stinging in the breast is a hormonal change, e.g. in the second half of the cycle or before/during the menopause. This is also called mastopathy.

Cysts in the breast can also cause pain: Cysts are fluid-filled cavities in the glandular tissue of the breast, which can cause a painful feeling of pressure due to their swelling. As a rule, they are benign and can be punctured (removal of the fluid with a fine needle) and thus relieved in the event of severe pain. In addition, so-called papillomas, benign neoplasms in the mammary gland duct, can also cause pain.

This tumour is often conspicuous by the one-sided secretion of fluid from only one nipple, which can rarely be accompanied by pain. This tumour is usually no cause for concern either, but should be regularly checked and examined or, if necessary, removed surgically. In some cases, calcium deposits in the mammary gland tissue can also cause pain, although this can also be an indication of a malignant disease.

For this reason, pain in the breast must generally be clarified more and more precisely (ultrasound, mammography), as the so-called microcalcification cannot be palpated, but is an important marker in the early detection of breast cancer. Symptom:

Palpable lump 37%
Painful lump 33%
Pain alone 10%
Outflow from the nipple 5%
Retraction of the nipple 3%. – Breast deformation 2%
Breast “inflammation” 2%
Nipple “inflammation” 1%