Breast Cancer Detection
The presence or absence of involved axillary lymph nodes is the single best predictor of survival of breast cancer. Both the number of nodes involved and the level of involvement predict survival. Consequently, the examination of the axilla is very important, however, the sensitivity of the examination is in the order of 50%. Following examination of both breasts, the axillae should be carefully assessed. Axillary node involvement occurs in up to 50% of symptomatic breast cancers and small screen detected breast cancers (<1cm) have a substantially lower incidence of metastases to nodes. Axillary surgery can be used to stage the axilla or to treat axillary disease or both. Radiotherapy may be given to the axilla where positive nodes have been removed by an axillary sampling procedure. However, routine radiotherapy following axillary clearance may lead to unacceptable rates of lymphoedema.
Unilateral breast distension may occur either due to a large tumour occupying the affected breast or following conservative surgery and radiotherapy for breast cancer. Distension may be present with or without distortion. Careful inspection and examination is required on presentation. The commonest cause of bilateral breast distension is pregnancy.
Breast distortion may occur as a consequence of the presence of a tumour, nipple retraction, skin changes or a combination of all three. Distortion due to oedema may occur after surgery and radiotherapy, causing peau d’orange changes to the skin. Careful inspection and examination is essential on presentation. Subtle changes can be seen on close scrutiny.
A breast lump is probably the most common presentation of breast cancer. The lump is usually found either by self-examination or by a health professional as part of a routine examination. Breast lumps represent a significant percentage of all symptoms in patients attending a breast clinic. A lump can be rarely associated with pain.