With almost 250,000 new cases in the United states and about 1,380,000 new cases throughout the world, breast cancer is the most common female malignancy, but it is also one of the most lethal tumors (almost 41,000 deaths estimated in the US in 2016) [1] [2]. Countries of the developing world exhibit a much higher mortality rate compared to the Western world, primarily because of a delayed diagnosis and late initiation of treatment [2] [3] [4] [5]. Studies have identified that between 3-8 months may pass from the onset of symptoms to the diagnosis in the developing world, compared to 30-48 days in Western countries [4]. As the majority of breast cancer tumors start as glandular tumors (adenocarcinomas), the term adenocarcinoma of the breast can be used to describe two main types of tumors - lobular and ductal carcinomas [6]. Numerous risk factors have been evaluated in the pathogenesis of breast cancer, but exposure to ionizing radiation, use of exogenous ovarian hormones, and excessive alcohol consumption have emerged as the most important ones [3] [7]. The main symptom of breast cancer is the presence of a lump in the breast, which may be accompanied by edema (either locally or in the armpit, suggesting dissemination of the tumor into the proximal lymph nodes) [6]. In addition, localized pain, inversion or retraction of the nipple, breast tenderness and discomfort are reported [6]. Constitutional complaints (fatigue, malaise, weakness) and distant pain (suggesting metastatic spread) are seen in more advanced stages of the disease [8].

• Axillary Lymphadenopathy

  Abstract Occult adenocarcinoma with clinically apparent axillary lymphadenopathy represents a challenging surgical problem. [ncbi.nlm.nih.gov]

  Needle biopsy Diff quik Images hosted on other servers: Ductal carcinoma, Figure A Poorly differentiated ductal carcinoma Images hosted on Flickr: 47 year old woman with 3 x 2 cm painless retroareolar mass and ipsilateral axillary lymphadenopathy, courtesy [pathologyoutlines.com]

  lymphadenopathy in more advanced cases breast skin edema with dimpling ( peau d' orange ) represents obstruction of the lymphatics by cancer Evaluation Fine needle aspiration can identify whether mass is solid or cystic can also retrieve sample for cancer [medbullets.com]

  Upon physical examination, the patient had bilateral discrete small cervical and axillary lymphadenopathy, and the breast examination was normal. Other systemic examination was not significant. [hindawi.com]

  Most patients present with a bulky palpable mass with axillary lymphadenopathy. [emedicine.medscape.com]

• Axillary Mass

  Diagnosis of breast cancer Clinical examination History This should include the following elements: • breast mass • breast pain • nipple discharge • nipple or skin retraction • axillary mass or pain • arm swelling • symptoms of possible metastatic spread [slideshare.net]

• Pleural Effusion

  The patient experienced a relapse of right pleural effusion 2 years later and received multimodal treatment. Now, March 30, 2000, the patient is doing well without local recurrence, 8 years after her first admission. [ncbi.nlm.nih.gov]

  DOI: 10.4103/2278-0513.162246 Background: Pleural effusions are common and devastating complication of advanced malignancies. Lung and breast cancers cause approximately 75% of all malignant pleural effusions. [ccij-online.org]

  Respiratory complications (eg, atelectasis, pleural effusion, pneumonia) and cardiac complications (eg, cardiac arrhythmias) usually occur in the first postoperative days. [emedicine.medscape.com]

  •Myelosuppression,Generalized pain, asthenia, and headache. pleural effusions 141. [slideshare.net]

• Thin Fingers

  Papillary carcinoma has well-defined borders and thin finger–like papillary projections which sometimes constitutes solid areas. Tumor cells have eosinophilic cytoplasms, round nuclei with moderate pleomorphism and frequent mitoses. [pubs.sciepub.com]

• Breast Mass

  Extensive evaluation revealed a 1-cm subareolar breast mass, with histopathological features identical to those of the orbital lesion. [ncbi.nlm.nih.gov]

  She had the left breast mass and cutaneous ulcer. In her past medical history, she had lumbar pain and paresis of limbs culminating in the diagnosis of lumbar mass on 6 th February with pathology report of metastatic adenocarcinoma [ Figure 1 ]. [pubs.sciepub.com]

  These are performed by inserting a needle into a breast mass and removing cells or tissues, for further examination. [dovemed.com]

  A common symptom of this cancer is intermittent pain and tenderness in the breast mass. It also tends to develop in the area of the nipple or areola. [rare-cancer.org]

  Signs and symptoms Characteristics Benign Malignant Breast mass – a dominant mass is a distinct mass that is asymmetric with the other breast. Benign findings are often associated with cysts, fibroadenomas, or fibrocystic changes. [pathophys.org]

• Nipple Retraction

  In advanced stages, one may observe the nipple retraction (due to the tumor infiltration of the lactiferous ducts), the "orange peel" aspect of the skin (due to lymphedema induced by tumor emboli in the lymphatics) and the immobility (fixation) of the [pathologyatlas.ro]

  retraction Gross images Contributed by Mark R. [pathologyoutlines.com]

  Also, MMG should be used in follow-up visits in patients selected for conservative treatment.[23] Mammographic findings include skin, nipple and areolar thickening, nipple retraction, subareolar or more diffuse microcalcifications and a discrete mass [ncbi.nlm.nih.gov]

• Large Breast

  Indications and Contraindications for Breast-Conserving Surgery Indications •T1, T2 ( 4 cm in large breasts •Single clinical and mammographic lesion Contraindications •T4, N2, or M1 (some localized T4 disease and some patients with limited metastatic [slideshare.net]

• Bloody Nipple Discharge

  Papillary carcinomas are centrally located in the breast and can present as bloody nipple discharge. They are strongly estrogen receptor (ER) positive and progesterone receptor (PR) positive. [emedicine.medscape.com]

A detailed patient history and a complete physical examination are considered to be essential steps in the initial workup of breast cancer patients. During the patient interview, physicians should obtain key information about the onset and progression of symptoms and assess whether any of the mentioned risk factors (exposure to ionizing radiation, previous biopsies of the breast, use of oral contraceptives or post-menopausal hormonal supplements, and alcohol consumption are present [3]. A thorough family history, which may identify breast cancer or a history of other malignancies within the family, is also important [3]. The physical examination, however, is essential. A full inspection and palpation of both breasts is necessary in order to confirm the exact site of the mass, exclude enlargement of axillary lymph nodes, and evaluate the appearance of both the nipples (discharge, or anatomical changes such as inversion or retraction) and the surrounding skin (peau d'orange is a highly specific finding in advanced breast cancer where the skin resembles an orange peel) [3] [6]. Once a presumptive diagnosis is made based on clinical findings, imaging studies should be employed. Mammography is by many authors still regarded as the principal method for detection of lesions in the breast, and its use is indicated in all women who present with a palpable mass on physical examination [3] [9]. Additional procedures that can be used are magnetic resonance imaging (MRI) and ultrasonography, both used to assess the exact size and determine the tumor stage [3] [9] [10]. To determine the exact type of the tumor, a biopsy (either fine needle, core needle or excisional) is necessary [9] [11].

• Right Pleural Effusion

  The patient experienced a relapse of right pleural effusion 2 years later and received multimodal treatment. Now, March 30, 2000, the patient is doing well without local recurrence, 8 years after her first admission. [ncbi.nlm.nih.gov]

• Thrombocytosis

  Research output: Contribution to conference without publisher/journal › Poster › Research › peer-review Thrombocytosis as a poor prognostic factor in ovarian cancer Jørgensen, T., Teiblum, S. T., Paludan, M., Poulsen, L. Ø., Jørgensen, A. Y. [vbn.aau.dk]

• Pleural Effusion

  The patient experienced a relapse of right pleural effusion 2 years later and received multimodal treatment. Now, March 30, 2000, the patient is doing well without local recurrence, 8 years after her first admission. [ncbi.nlm.nih.gov]

  DOI: 10.4103/2278-0513.162246 Background: Pleural effusions are common and devastating complication of advanced malignancies. Lung and breast cancers cause approximately 75% of all malignant pleural effusions. [ccij-online.org]

  Respiratory complications (eg, atelectasis, pleural effusion, pneumonia) and cardiac complications (eg, cardiac arrhythmias) usually occur in the first postoperative days. [emedicine.medscape.com]

  •Myelosuppression,Generalized pain, asthenia, and headache. pleural effusions 141. [slideshare.net]

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