breast cancer clinical presentation

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emedicine.medscape.com/article/1947145-clinical
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2/6emedicine.medscape.com/article/1947145-clinical

Benign breast conditions that increase the risk of breast cancer include the following:

Hyperplasia (unless mild)

Complex fibroadenoma

Radial scar

Papillomatosis

Sclerosing adenosis

Microglandular adenosis

Cervical cancer is associated with a decreased risk of breast cancer.

Physical Examination

If the patient has not noticed a lump, then signs and symptoms indicating the possible presence of breast cancer

may include the following:

Change in breast size or shape

Skin dimpling or skin changes (eg, thickening, swelling, redness)

Recent nipple inversion or skin change, or nipple abnormalities (eg, ulceration, retraction, spontaneous

bloody discharge)

Single-duct discharge, particularly if bloodstained

Axillary lump

To detect subtle changes in breast contour and skin tethering, the examination must include an assessment of

the breasts with the patient upright with arms raised. The following findings should raise concern:

Lump or contour change

Skin tethering

Nipple inversion

Dilated veins

Ulceration

Paget disease

Edema or peau d'orange

The nature of palpable lumps is often difficult to determine clinically, but the following features should raise

concern:

Hardness

Irregularity

Focal nodularity

Asymmetry with the other breast

Fixation to skin or muscle (assess fixation to muscle by moving the lump in the line of the pectoral muscle

fibers with the patient bracing her arms against her hips)

A complete examination includes assessment of the axillae and supraclavicular fossae, examination of the chest

and sites of skeletal pain, and an abdominal and neurologic examination. The clinician should be alert tosymptoms of metastatic spread, such as the following:

Breathing difficult ies

Bone pain

Symptoms of hypercalcemia

Abdominal distention

Jaundice

Localizing neurologic signs

Altered cognitive function

The clinical evaluation should include a thorough assessment of specific risk factors for breast cancer. Go to

Breast Cancer Risk Factors for more information on this topic.
http://emedicine.medscape.com/article/1945957-overviewhttp://emedicine.medscape.com/article/1101235-overview


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Contributor Information and DisclosuresAuthor

Alison T Stopeck, MD Associate Professor of Medicine, Arizona Cancer Center, University of Arizona Health

Sciences Center; Director of Clinical Breast Cancer Program, Arizona Cancer Center; Medical Director of

Coagulation Laboratory, University Medical Center; Director of Arizona Hemophilia and Thrombosis Center

Alison T Stopeck, MD is a member of the following medical societies:American Association for Cancer

Research,American College of Physicians,American Society of Clinical Oncology,American Society of

Hematology, Hemophilia and Thrombosis Research Society, and Southwest Oncology Group

Disclosure: Genentech Honoraria Speaking and teaching; AstraZeneca Honoraria Speaking and teaching;

AstraZeneca Grant/research funds Other

Coauthor(s)

Patricia A Thompson, PhD Assistant Professor, Department of Pathology, University of Arizona, Tucson

Disclosure: Nothing to disclose.

Chief Editor

Jules E Harris, MD Clinical Professor of Medicine, Section of Hematology/Oncology, University of Arizona

College of Medicine, Arizona Cancer Center

Jules E Harris, MD is a member of the following medical societies: American Association for Cancer Research,

American Association for the Advancement of Science,American Association of Immunologists,American

Society of Hematology, and Central Society for Clinical Research


Additional Contributors

Leona Downey, MD Assistant Professor of Internal Medicine, Section of Oncology and Hematology, University

of Arizona, Arizona Cancer Center

Leona Downey, MD is a member of the following medical societies: American Geriatrics Society,American

Society of Clinical Oncology, and Southwest Oncology Group


Manjit Singh Gohel, MD, MRCS, MB, ChB Specialist Registrar, Division of Breast and Endocrine Surgery,

Northwick Park Hospital


Harold Harvey, MD Professor, Department of Medicine, Pennsylvania State University


Kanchan Kaur, MBBS, MS (General Surgery), MRCS (Ed) Consulting Breast and Oncoplastic Surgeon,

Medanta, The Medicity, India


Julie Lang, MD Assistant Professor of Surgery and the BIO5 Institute, Director of Breast Surgical Oncology,

University of Arizona College of Medicine

Julie Lang, MD is a member of the following medical societies: American College of Surgeons, American

Society of Breast Surgeons,American Society of Clinical Oncology,Association for Academic Surgery, and

Society of Surgical Oncology

Disclosure: Genomic Health Grant/research funds Speaking and teaching; Agendia Grant/research funds

Speaking and teaching; Surgical Tools Grant/research funds Research; Sysmex Grant/research funds

Research

Robert B Livin ston MD Professor of Clinical Medicine and Director Clinical Research Shared Services
http://www.surgonc.org/http://www.aasurg.org/http://www.asco.org/http://www.facs.org/http://www.swog.org/http://www.asco.org/http://www.americangeriatrics.org/http://www.cscr.com/index.phphttp://www.hematology.org/http://www.aai.org/http://www.aaas.org/http://www.aacr.org/http://www.swog.org/http://www.htrs.org/http://www.hematology.org/http://www.asco.org/http://www.acponline.org/http://www.aacr.org/


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, , ,

Arizona Cancer Center

Robert B Livingston, MD is a member of the following medical societies: American Association for Cancer

Research, American Federation for Clinical Research, andAmerican Society of Clinical Oncology


Hanan Makhoul, MD Staff Physician, Department of Internal Medicine, University of Arkansas School of

Medicine


Issam Makhoul, MD Associate Professor, Department of Medicine, Division of Hematology/Oncology,

University of Arkansas for Medical Sciences

Issam Makhoul, MD is a member of the following medical societies: American Society of Clinical Oncology and

American Society of Hematology


Robert C Shepard, MD, FACP Associate Professor of Medicine in Hematology and Oncology at University of

North Carolina at Chapel Hill; Vice President of Scientific Affairs, Therapeutic Expertise, Oncology, at PRA

International

Robert C Shepard, MD, FACP is a member of the following medical societies: American Association for Cancer

Research,American College of Physician Executives,American College of Physicians, American Federation

for Clinical Research,American Federation for Medical Research,American Medical Association,American

Medical Informatics Association,American Society of Hematology,Association of Clinical Research

Professionals, Eastern Cooperative Oncology Group, European Society for Medical Oncology, Massachusetts

Medical Society, and Society for Biological Therapy


Hemant Singhal, MD, MBBS, FRCSE, FRCS(C) Senior Lecturer, Director of Breast Service, Department of

Surgery, Imperial College School of Medicine; Consultant Surgeon, Northwick Park and St Marks Hospitals, UK

Hemant Singhal, MD, MBBS, FRCSE, FRCS(C) is a member of the following medical societies: Royal College

of Physicians and Surgeons of Canada and Royal College of Surgeons of Edinburgh


Carl V Smith, MD The Distinguished Chris J and Marie A Olson Chair of Obstetrics and Gynecology,

Professor, Department of Obstetrics and Gynecology, Senior Associate Dean for Clinical Affairs, University of

Nebraska Medical Center

Carl V Smith, MD is a member of the following medical societies: American College of Obstetricians and

Gynecologists,American Institute of Ultrasound in Medicine,Association of Professors of Gynecology and

Obstetrics, Central Association of Obstetricians and Gynecologists, Council of University Chairs of Obstetrics

and Gynecology, Nebraska Medical Association, and Society for Maternal-Fetal Medicine


Wiley Souba, MD Chairman, Professor, Department of General Surgery, Pennsylvania State College of

Medicine; Chief Surgeon, The Milton S Hershey Medical Center


Rachel Swart, MD, PhD Assistant Professor of Medicine, Department of Hematology and Oncology, Arizona

Cancer Center, University of Arizona

Rachel Swart, MD, PhD is a member of the following medical societies: American Association for Cancer

Research,American Society of Clinical Oncology,Arizona Medical Association, and Southwest Oncology

Group

Disclosure: Roche Grant/research funds Other
http://www.swog.org/http://www.azmedassn.org/http://www.asco.org/http://www.aacr.org/http://www.smfm.org/http://www.nebmed.org/http://www.cucog.org/http://www.caog.org/http://www.apgo.org/home/http://www.aium.org/http://www.acog.org/http://www.rcsed.ac.uk/http://rcpsc.medical.org/index.php?pass=1http://www.socbiother.com/http://www.massmed.org/AM/Template.cfm?Section=Homehttp://www.esmo.org/http://ecog.dfci.harvard.edu/general/contact_info.htmlhttp://www.acrpnet.org/http://www.hematology.org/http://www.amia.org/http://www.ama-assn.org/http://www.afmr.org/http://www.acponline.org/http://www.acpe.org/http://www.aacr.org/http://www.hematology.org/http://www.asco.org/http://www.asco.org/http://www.aacr.org/


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Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center

College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Simon Thomson, MB, BCh, MD, FRCS Specialist Registrar, Department of Breast and Endocrine Surgery,

Northwick Park Hospital, UK

Simon Thomson, MB, BCh, MD, FRCS is a member of the following medical societies: British Medical

Association


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