Breast Cancer

A sign is something that can be observed and recognized by a doctor or healthcare professional (for example, a rash). A symptom is something that only the person experiencing it can feel and know (for example, pain or tiredness). The signs and symptoms of breast cancer can also be caused by other health conditions. It is important to have any unusual symptoms checked by a doctor.

• A lump in the breast – the most common first sign.
  • The woman usually finds the lump
    • Sometimes the lump is seen on a screening mammogram before it can be felt.
  • The lump is present all the time and does not get smaller or go away with the menstrual cycle.
  • The lump may feel like it is attached to the skin or chest wall and cannot be moved.
  • The lump may feel hard, irregular in shape and very different from the rest of the breast tissue.
  • The lump may be tender, but it is usually not painful.
  • Pain is more often a symptom of a non-cancerous (benign) condition, but should be checked by a doctor.
• A lump in the armpit (axilla)
  • Sometimes small, hard lumps in the armpit may be a sign that breast cancer has spread to the lymph nodes. Although these lumps are often painless, they may be tender.
• Changes in breast shape or size
• Skin changes
  • The skin of the breast may become dimpled or puckered. A thickening and dimpling of the skin is sometimes called orange peel skin, or peau d’orange.
  • Redness, swelling and increased warmth (signs that look like an infection) may be a sign of inflammatory breast cancer.
  • Itching of the breast or nipple may be a sign of inflammatory breast cancer.
  • Itchiness is often not relieved by ointments, creams or other medications.
• Nipple changes
  • Some people’s nipples are always pointed inward (inverted). Normal nipples that suddenly become inverted should be checked by a doctor.
  • Discharge from the nipples can be caused by many conditions, most of which are non-cancerous (benign).
  • Discharge from one nipple may be a sign of breast cancer, especially if it appears without squeezing the nipple (is spontaneous) and is blood-stained.
  • Crusting, ulcers or scaling on the nipple may be a sign of some rare types of breast cancer, such as Paget disease of the nipple.
  • Late signs and symptoms
  • Late signs and symptoms occur as the cancer grows larger or spreads to other parts of the body, including other organs.
• Bone pain
• Nausea
• Loss of appetite
• Weight loss
• Jaundice
• Buildup of fluid around the lungs (pleural effusion)
  • Shortness of breath
• Cough
• Headache
• Double vision
• Muscle weakness

Treatment for breast cancer is given by cancer specialists (oncologists). Some specialize in surgery, some in radiation therapy and others in chemotherapy (drugs). These doctors work with the person with cancer to decide on a treatment plan.

Treatment plans are designed to meet the unique needs of each person with cancer. Treatment decisions for breast cancer are based on:

• The stage of the breast cancer

• If the woman has reached menopause
• The hormone receptor status of the cancer
• The HER2 status of the cancer
• The risk for recurrence (with early stage breast cancer)
• The overall health of the woman
• The woman’s personal decision about certain treatments

• Surgery
  • In most cases, a woman will be given a choice of what type of breast surgery she would prefer:
    • Breast-conserving surgery, followed by radiation therapy
    • Modified radical mastectomy
  • Other surgical procedures that may be done include:
    • Axillary lymph node dissection
    • Sentinel lymph node biopsy – offered in certain situations
• Radiation therapy
  • External beam radiation therapy is always given after breast-conserving surgery. It is sometimes given after a mastectomy
  • Systemic radiation therapy may be offered for women with breast cancer that has spread to large areas of the bone (bone metastases)
• Chemotherapy
  • Chemotherapy is offered for breast cancer that is:
    • Early stage with a high risk of recurrence
    • Locally advanced, advanced or recurrent
  • The chemotherapy drugs used depend on the stage of breast cancer
  • Chemotherapy may include a combination of drugs or single chemotherapy drugs
  • Most breast cancer is treated with an anthracycline, a taxane or both types of drugs
• Hormonal therapy
  • Hormonal therapy is offered for hormone receptor–positive breast cancer (ER+, PR+ or both) that is either:
    • Early stage with a low risk of recurrence
    • Locally advanced, advanced or recurrent
  • The type of hormonal therapy offered will depend on whether or not the woman has reached menopause.
• Biological therapy
  • The type of biological therapy offered will depend on the HER2 status of the breast cancer.
  • Colony-stimulating factors may be offered to lessen the side effects of chemotherapy
• Bisphosphonates
  • Bisphosphonates may be offered for bone metastases
• Follow-up after treatment is finished
  • It is important to have regular follow-up visits, especially in the first 5 years after treatment.