Breast Cancer

What Are the Symptoms of Breast Cancer?

If you have any symptoms that worry you, be sure to see your doctor right away.

Different people have different symptoms of breast cancer. Some people do not have any signs or symptoms at all.

Some warning signs of breast cancer are—

1. • New lump in the breast or underarm (armpit).
2. • Thickening or swelling of part of the breast.
3. • Irritation or dimpling of breast skin.
4. • Redness or flaky skin in the nipple area or the breast.
5. • Pulling in of the nipple or pain in the nipple area.
6. • Nipple discharge other than breast milk, including blood.
7. • Any change in the size or the shape of the breast.
8. • Pain in any area of the breast.

Keep in mind that these symptoms can happen with other conditions that are not cancer.

If you have any signs or symptoms, be sure to see your doctor right away.

What Is a Normal Breast?

No breast is typical. What is normal for you may not be normal for another woman. Most women say their breasts feel lumpy or uneven. The way your breasts look and feel can be affected by getting your period, having children, losing or gaining weight, and taking certain medications. Breasts also tend to change as you age.

After someone is diagnosed with breast cancer, doctors will try to figure out if it has spread, and if so, how far. This process is called staging. The stage of a cancer describes how much cancer is in the body. It helps determine how serious the cancer is and how best to treat it. Doctors also use a cancer's stage when talking about survival statistics.

The earliest stage breast cancers are stage 0 (carcinoma in situ). It then ranges from stage I (1) through IV (4). As a rule, the lower the number, the less the cancer has spread. A higher number, such as stage IV, means cancer has spread more. And within a stage, an earlier letter means a lower stage. Although each person’s cancer experience is unique, cancers with similar stages tend to have a similar outlook and are often treated in much the same way.

How is the stage determined?

The staging system most often used for breast cancer is the American Joint Committee on Cancer (AJCC) TNM system. The most recent AJCC system, effective January 2018, has both clinical and pathologic staging systems for breast cancer:

1. • The pathologic stage (also called the surgical stage) is determined by examining tissue removed during an operation.
2. • Sometimes, if surgery is not possible right away or at all, the cancer will be given a clinical stage instead. This is based on the results of a physical exam, biopsy, and imaging tests. The clinical stage is used to help plan treatment. Sometimes, though, the cancer has spread further than the clinical stage estimates, and may not predict the patient’s outlook as accurately as a pathologic stage.

In both staging systems, 7 key pieces of information are used:

1. • The extent (size) of the tumour(T): How large is the cancer? Has it grown into nearby areas?
2. • The spread to nearby lymph nodes (N): Has the cancer spread to nearby lymph nodes? If so, how many?
3. • The spread (metastasis) to distant sites (M): Has the cancer spread to distant organs such as the lungs or liver?
4. • Oestrogen Receptor (ER) status: Does the cancer have the protein called an estragon receptor?
5. • Progesterone Receptor (PR) status: Does the cancer have the protein called a progesterone receptor?
6. • HER2 status: Does the cancer make too much of a protein called HER2?
7. • Grade of the cancer (G): How much do the cancer cells look like normal cells?.Grade of the cancer (G): How much do the cancer cells look like normal cells?.

Examples using the full staging system

Because there are so many factors that go into stage grouping for breast cancer, it's not possible to describe here every combination that might be included in each stage. The many different possible combinations mean that two women who have the same stage of breast cancer might have different factors that make up their stage.

Here are 3 examples of how all of the factors listed above are used to determine the pathologic (surgical) breast cancer stage:

Example #1

If the cancer size is between 2 and 5 cm (T2) but it has not spread to the nearby lymph nodes (N0) or to distant organs (M0) AND is:

1. • Grade 3
2. • HER2 negative
3. • ER positive
4. • PR positive

The cancer stage is IB.

Example #2

If the cancer is larger than 5 cm (T3) and has spread to 4 to 9 lymph nodes under the arm or to any internal mammary lymph nodes (N2) but not to distant organs (M0) AND is:

1. • Grade 2
2. • HER2 positive
3. • ER positive
4. • PR positive

The cancer stage is IB.

Example #3

If the cancer is larger than 5 cm (T3) and has spread to 4 to 9 lymph nodes under the arm or to any internal mammary lymph nodes (N2) but not to distant organs (M0) AND is:

1. • Grade 2
2. • HER2 negative
3. • ER negative
4. • PR negative

The cancer stage is IIIB.

These are only 3 examples out of many possible combinations of factors. To understand what your breast cancer stage is, and what it means, talk to your doctor.

What Is Breast Cancer?

Breast cancer is a type of cancer that starts in the breast. It can start in one or both breasts.

Cancer starts when cells begin to grow out of control. (To learn more about how cancers start and spread, see What Is Cancer?) Breast cancer occurs almost entirely in women, but men can get breast cancer, too.

It’s important to understand that most breast lumps are benign and not cancer (malignant). Non-cancer breast tumours are abnormal growths, but they do not spread outside of the breast. They are not life threatening, but some types of benign breast lumps can increase a woman's risk of getting breast cancer. Any breast lump or change needs to be checked by a health care professional to find out if it is benign or malignant (cancer) and if it might affect your future cancer risk. See Non-cancerous Breast Conditions to learn more.

Where breast cancer starts

Breast cancers can start from different parts of the breast. The breast is an organ that sits on top of the upper ribs and chest muscles. There is a left and right breast and each one has mainly glands, ducts, and fatty tissue. In women, the breast makes and delivers milk to feed newborns and infants. The amount of fatty tissue in the breast determines the size of each breast.

The breast has different parts:

1. • Lobules are the glands that make breast milk. Cancers that start here are called lobular cancers.
2. • Ducts are small canals that come out from the lobules and carry the milk to the nipple. This is the most common place for breast cancer to start. Cancers that start here are called ductal cancers.
3. • The nipple is the opening in the skin of the breast where the ducts come together and turn into larger ducts so the milk can leave the breast. The nipple is surrounded by slightly darker thicker skin called the areola. A less common type of breast cancer called Paget disease of the breast can start in the nipple.
4. • The fat and connective tissue (stroma) surround the ducts and lobules and help keep them in place. A less common type of breast cancer called phyllodes tumour can start in the stroma.
5. • Blood vessels and lymph vessels are also found in each breast. Angiosarcoma is a less common type of breast cancer that can start in the lining of these vessels. The lymph system is described below.

A small number of cancers start in other tissues in the breast. These cancers are called sarcomas and lymphomas and are not really thought of as breast cancers.

Types of breast cancer

There are many different types of breast cancer. The type is determined by the specific kind of cells in the breast that are affected. Most breast cancers are carcinomas. The most common breast cancers such as ductal carcinoma in situ (DCIS) and invasive carcinoma are adenocarcinomas, since the cancers start in the gland cells in the milk ducts or the lobules (milk-producing glands). Other kinds of cancers can grow in the breast, like angiosarcoma or sarcoma, but are not considered breast cancer since they start in different cells of the breast.

Breast cancers are also classified by certain types of proteins or genes each cancer might make. After a biopsy is done, breast cancer cells are tested for proteins called oestrogen receptors and progesterone receptors, and the HER2 gene or protein. The tumour cells are also closely looked at in the lab to find out what grade it is. The specific proteins found and the tumour grade can help decide the stage of the cancer and treatment options.