Clinical presentation

Breast cancer may be asymptomatic, occurring as an impalpable lesion on screening mammogram. (Upto 70% of important mammographic lesions are impalpable)

In other cases, patients may present with:

• palpable breast lump:
  • 40-50% in the upper outer quadrant
  • 70-80% scirrhous i.e. hard and encapsulated
  • may be tethered to superficial or deep structures
  • does not fluctuate or transilluminate
  • 15-40% multicentric
  • bilateral in up to 30% of cases of lobular carcinoma
  • frequently, patient detected
    
    
• skin changes:
  • dimpling
  • peau d'orange
  • nipple "eczema" in Paget's
  • visible lump
  • surface ulceration; neglected carcinoma in elderly
    
    
• recent nipple inversion
  
  
• bloodstained nipple discharge - uncommon
  
  
• non-cyclic breast pain - usually, a late sign
  
  
• disseminated disease:
  • bone pain, pathological fracture
  • dyspnoea, pleural effusion
  • hepatomegaly, jaundice