Symptoms And Diagnosis Of Cancer

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• Cancer that develops in the cells of the breast 12
• Diagnosis requires a tissue biopsy for microscopic examination to determine pathology

• The TNM classification is used for clinical staging of breast tumors. The American Joint Committee on Cancer (AJCQ 7th edition stages breast cancer as follows: 12 o TX: primary tumor cannot be assessed o TO: no evidence of primary tumor o Tis: cancer in situ
- Tis (DCIS): ductal carcinoma in situ
- Tis (LCIS): lobular carcinoma in situ
- Tis (Paget): Paget disease of the nipple not associated with DCIS/LCIS o T1: 20 mm but " '50 mm in greatest dimension o T3: >50 mm in greatest dimension o T4: regional invasion o NX: regional nodes cannot be
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• Stages o Stage 0: TisNOMO o Stage lA: T1NOMO o Stage IB: (TO-T1)N1miMO o Stage IlA: (TO-T1)N1 MO, T2NOMO o Stage liB: T2N1MO, T3NOMO o Stage lilA: (TO-T2)N2MO, T3(N1-N2)MO o Stage 1118: T4(NO-N2)MO o Stage IIIC: any T, N3, MO o Stage IV: any T, any N, M1


• History o Breast mass may not be detectable and found incidentally on screening mammography 21 o Mass in breast detected by patient or by screening mammography 21 o Personal and/or significant family history (First- or second-degree relatives) of breast and/or ovarian cancer, or atypia noted on prior biopsies 21 o There may be bone pain due to metastasis in advanced disease o Shortness of breath may be present if spread to the lungs
• Physical examination o Palpable breast lumps are detectable in 90% of cancers and are the most common sign 8 o Eczematous ulcer of the nipple
- Paget 's disease may mimic these findings

o Skin edema/erythema o Breast lymphedema (peau d 'orange) o Skin nodules o In advanced disease, there may be signs of pleural effusion, and/or hepatomegaly, and/or bone metastases as regional and generalized spread of the cancer ensues 2 o Bloody nipple discharge:unilateral, spontaneous
- Nipple discharge generally relates to a benign condition and its most common cause is an intraductal papilloma, a benign condition treated by excision alone 8 o Skin and/or nipple retraction o Eczematous ulcer of the nipple
- Paget 's disease may mimic these findings

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