Breast cancer symptoms vary from person to person and there is no exact definition of what a lump or mass feels like. The best thing to do is to be familiar with your breasts so you know how “normal” feels and looks. If you notice any changes, tell your doctor. While regular self-exams are important, many breast cancers are found through regular screening mammograms before any symptoms appear.

Breast cancer symptoms may include:

• Lump or mass in the breast
• Lump or mass in the armpit
• Breast skin changes, including skin redness and thickening of the breast skin, resulting in an orange-peel texture
• Dimpling or puckering on the breast
• Discharge from the nipple
• Scaliness on nipple, which sometimes extends to the areola
• Nipple changes, including the nipple turning inward, pulling to one side, or changing direction
• An ulcer on the breast or nipple, sometimes extending to the areola
• Swelling of the breast

These symptoms do not always mean you have breast cancer. However, it is important to discuss any symptoms with your doctor since they may also signal other health problems.

If you notice changes to your breasts, experience symptoms of breast cancer, or have an abnormal mammogram result, your doctor will need to investigate further to make a diagnosis. Your doctor may start by performing a breast exam, which involves manually checking your breasts and armpit for lumps and abnormalities. If your doctor suspects breast cancer, they may order imaging tests to take a better look.

Imaging
Most breast imaging is carried out with a mammogram or ultrasound.

• In a mammogram, x-ray pictures will be taken of the breasts from a few different angles. Your doctor can examine these images for signs of breast cancer.
• In an ultrasound, a device bounces high-energy sound waves off your tissue. The echo patterns create a picture referred to as a sonogram, which can be seen on the ultrasound machine.

Occasionally, doctors will use magnetic resonance imaging (MRI) or other specialized examinations.

Biopsy
If the imaging exam shows an unusual or suspicious mass or skin thickening, doctors will need a tissue sample to make a definitive diagnosis. The process of retrieving and examining this tissue under a microscope is called a biopsy.

For breast cancer, patients usually undergo an image-guided core needle biopsy. During this procedure, a live image of the breast tissue is used help doctors guide the needle to the suspected cancer tissue.

If the biopsy reveals cancerous tissue, additional images and biopsies may be needed to determine the exact scope of the disease. This part of the diagnosis shows whether the cancer has spread to nearby lymph nodes or other parts of the body.

Molecular diagnosis
If the patient is diagnosed with breast cancer, doctors will also analyze the cancer cells to determine the disease’s molecular receptor subtype. By understanding the subtype, they can develop a comprehensive, personalized treatment plan.

Broward Health and the Lillian S. Wells Women’s’ Health Center provides multidisciplinary care. As a cancer patient, a medical oncologist, radiation oncologist, surgical oncologist, and reconstructive surgeon work together as a team to achieve the best possible outcome for you. They coordinate care and develop a comprehensive treatment plan that’s unique to each patient’s disease and needs.

Surgery
Many patients undergo some form of surgery as part of their breast cancer treatment.

Some will receive chemotherapy or targeted therapy before surgery. The goal of these treatments is to shrink the tumor and affected lymph nodes to make the procedure and recovery easier on the patient. This also allows the treating team to assess how cancer has responded to treatment, which can be important for some breast cancer subtypes.

There are two categories of breast cancer surgery:

• Lumpectomy: In a typical lumpectomy surgery, the tumor and a small amount of surrounding normal tissue are removed. This procedure may be appropriate for early breast cancer cases where the tumor is still small. Lumpectomies are generally outpatient procedures and have shorter recovery times. These procedures are usually followed by radiation therapy.
• Mastectomy: In a typical mastectomy surgery, the tumor and the entire breast are removed. There are several different types of mastectomies, including procedures that spare the breast’s skin and nipple/areola. Often a mastectomy and breast reconstruction can be performed in the same procedure.

In some cases, both breasts are removed (double mastectomy). This can help prevent the development of new breast cancer. It is typically done for patients who have an elevated risk of developing breast cancer due to family history or their own genetic profile, such as a BRCA mutation.

In both lumpectomies and mastectomies, surgeons may also remove nearby lymph nodes. Breast cancer can spread through nearby lymph nodes. Doctors will study the ones that are removed to determine if there are cancer cells within the nodes. This information can help determine the risk of the disease spreading to distant organs, as well as the need for chemotherapy and radiation therapy.

Like all surgeries, breast cancer surgery is most successful when performed by a specialist with a great deal of experience in a particular procedure. Here at Broward Health we have specialist breast cancer surgeons that perform surgery using the least-invasive and most-effective techniques.

Radiation therapy
Radiation therapy uses powerful beams of energy carefully designed to kill breast cancer cells.

For breast cancer patients, radiation therapy can be used before surgery to shrink large tumors and make the surgery easier on the patient. Radiation therapy can also be used after surgery to kill any remaining breast cancer cells that cannot be seen by the naked eye. After a lumpectomy, patients often receive three to four weeks of daily radiation therapy. In some cases, one to two weeks may be appropriate. When the lymph nodes are involved or a mastectomy was needed, patients usually need six weeks of daily radiation therapy.

In metastatic breast cancer cases, radiation therapy can also be used as a palliative treatment to reduce symptoms caused by cancer spreading to other parts of the body and improve the patient’s quality of life.

There are different techniques used in radiation therapy. Your doctors and radiation oncologist will collaborate to make sure you receive the most effective and precise dose of treatment.

Targeted therapy
Cancer cells rely on specific molecules (often in the form of proteins) to survive, multiply and spread. Targeted therapies stop or slow the growth of cancer by interfering with, or targeting, these molecules or the genes that produce them.

In recent years, targeted therapy has become a major weapon in the fight against breast cancer. Breast cancer subtypes that once had poor prognoses are now highly treatable.
One type of targeted therapy is endocrine therapy (also known as hormone therapy), which is given to patients with hormone receptor-positive breast cancer. This can be given before surgery to shrink the tumor. It is also given after surgery for five to 10 years to prevent a recurrence. Patients with the metastatic form of this disease are also given endocrine therapy to prevent disease progression.

Patients with HER2-positive breast cancer also receive targeted therapies. These patients may receive a different set of targeted therapy drugs both before and after surgery. Since about half of patients with HER2-positive breast cancer also have hormone receptor-positive tumors, they are also given endocrine therapy.

While there are no targeted therapies for triple-negative breast cancer, researchers are studying the disease to identify possible drug targets.

Chemotherapy
Chemotherapy uses powerful drugs to directly kill cancer cells, control their growth or relieve pain. It is often given to patients before surgery to shrink the tumor and simplify the procedure. Breast cancer patients can receive chemotherapy either orally or intravenously.