What Are the Symptoms of Breast Cancer and How Is It Treated?

The most common symptom of breast cancer is a painless, firm lump that you can feel in the breast or under the arm. The treatment of the disease is planned by combining methods such as surgery, chemotherapy, and radiotherapy, depending on the stage of the tumour, its genetic characteristics, and the patient's general health. It is well known that the treatment success rate is quite high in cases detected at an early stage; therefore, regular screening tests play a life-saving role.

• The most common symptom is a new lump felt in the breast or armpit.
• Monthly breast self-exams should be performed starting from the age of 20.
• For women aged 40 and over, annual mammography screening is the golden key to early diagnosis.
• The foundation of treatment is usually surgical intervention (breast-conserving surgery or mastectomy).
• For those with a family history, a genetic risk map can be drawn up using the BRCA gene test.

What is Breast Cancer?

Breast cancer is a malignant tumour disease that occurs when the cells making up the breast tissue multiply uncontrollably. It usually starts in the cells lining the milk ducts (ductal carcinoma) or in the milk-producing glands (lobular carcinoma). Although it is the most common type of cancer in women, it can also occur in men, albeit rarely. The course of the disease and the treatment plan are directly related to the stages of breast cancer, which indicate how far the cancer has spread.

Breast cancer stages are classified from zero to four based on the size of the tumour and its spread in the body. Stage 0 is the non-invasive phase where cancer cells are confined only within the milk ducts and have not spread to surrounding tissue. Stage 1 and Stage 2 represent the early stages where the tumour is relatively small and found only within the breast tissue or in nearby underarm lymph nodes. Stage 3 is the locally advanced stage where the tumour has grown and spread to the chest wall or a larger number of lymph nodes. Stage 4 is the metastatic stage where cancer cells have spread through the blood or lymph to distant organs such as the bones, liver, lungs, or brain. The chance of successful treatment is much higher when the disease is detected in its early stages.

Causes and Risk Factors

While the exact cause of breast cancer is not fully understood, it is accepted that damage to the DNA structure of cells leads to this condition. There are various risk factors that play a role in the development of the disease. Advancing age, being female, and having a family history of breast cancer are the most fundamental risk factors. Genetic predisposition plays a significant role, especially in individuals whose first-degree relatives were diagnosed with breast cancer at an early age.

Hormonal factors are also significant elements affecting risk. Starting menstruation before the age of 12, entering menopause after the age of 55, never giving birth, or having a first child after the age of 30 can increase the risk by causing the body to be exposed to oestrogen for a longer period. Additionally, obesity, a sedentary lifestyle, excessive alcohol consumption, and receiving long-term postmenopausal hormone replacement therapy are among the modifiable risk factors. For more detailed information on this topic, you can review our article titled Breast Cancer Risk Factors: The Uncontrollable and the Modifiable.

What Are the Symptoms of Breast Cancer?

In the initial stages of the disease, there may be no complaints at all. For this reason, screening tests performed before breast cancer symptoms appear are of great importance. However, as the tumour grows or presses against surrounding tissues, certain physical changes begin to be noticed. The most frequently encountered symptom is a lump felt in the breast or armpit, which is usually painless, firm, and has irregular borders. Sometimes, in advanced-stage tumours, pain may also accompany the lump.

Other important symptoms that can be observed in the breast aside from a lump include:

• Spontaneous discharge from the nipple, especially if it is unilateral (on one side) and bloody.
• The nipple turning inward or changing direction.
• Redness, scaling, crusting, or sore formation on the breast skin.
• An orange-peel appearance on the breast skin (thickening of the skin and prominent pores).
• A noticeable asymmetry or deformity between the two breasts that appears later on.

What Are the Diagnostic Methods for Breast Cancer?

Since breast cancer can occur at any age, knowing your own body and having awareness about it is a critical step in early diagnosis. Breast cancer diagnostic methods are determined by the physician based on the patient's age, complaints, and risk profile.

Breast Self-Exam and Imaging

Three basic steps should be followed for early diagnosis. First, women should perform a breast self-exam every month starting from the age of 20. Second, if there is any suspicion of a lump or deformity in the breast, a general surgery specialist should be consulted without losing time. The third and most important step is for women to have regular mammograms starting at age 40. Since breast tissue is denser in women under 40, breast ultrasound is the first-choice imaging method, whereas mammography is the gold standard for women over 40. You can check our guide titled Screening and Examination Calendar According to Your Age for information on which test should be done at what age.

Biopsy and Advanced Imaging Tests

If a suspicious lump is detected as a result of mammography or ultrasound, a biopsy is performed to make a definitive diagnosis. A biopsy is the procedure of taking a small tissue sample from the lump using a special needle and examining this sample under a microscope in a pathology laboratory. Breast MRI (Magnetic Resonance) and PET (Positron Emission Tomography) scans are not the first routine tests to be performed; they are generally used after a cancer diagnosis is made to determine the stage of the disease, check if there is a focus in the other breast, or investigate if it has spread to another part of the body.

Who Should Have a BRCA Gene Test?

It has been scientifically proven that breast cancer can be passed down genetically from generation to generation. Therefore, the genetic predisposition of individuals with a family history of breast or ovarian cancer should be investigated. For this purpose, a BRCA gene test (BRCA1 and BRCA2) checked via blood is applied. The situations where these genetic tests should be performed are as follows:

1. A diagnosis of breast cancer in three consecutive generations or at least three people in the same family.
2. The occurrence of breast cancer in a family member during the premenopausal (early age) period.
3. The development of both breast and ovarian cancer in the same individual.
4. The development of cancer in both breasts (bilateral) in the same individual.
5. The presence of breast cancer in a male family member.

A positive result in these tests indicates that the person's lifelong risk of developing breast or ovarian cancer is much higher than the average population. In this case, the development of the disease can be prevented or caught at a very early stage by planning preventive surgery (risk-reducing mastectomy) or stricter screening programmes under a physician's supervision.

How Is Breast Cancer Treated?

Breast cancer treatment is personalised according to the stage of the disease, the biological characteristics of the tumour (hormone receptor status, HER2 status), and the patient's age. The treatment process is usually planned by a multidisciplinary council where general surgery, medical oncology, radiation oncology, and plastic surgery specialists work together.

Breast Cancer Surgery Options

The cornerstone of treatment is surgery. The type of surgery is decided based on the stage of the disease and the ratio between the lump and breast volume. In early-stage breast tumours, breast-conserving surgery, where only the tumourous tissue and a small amount of surrounding healthy tissue are removed, is preferred. This procedure is usually accompanied by a sentinel lymph node biopsy (sampling) to evaluate the status of the underarm lymph nodes.

In advanced-stage tumours, in cases where the breast is small but the tumour is large, or when there are multiple foci in the breast, a mastectomy surgery is performed where the entire breast is removed. When necessary, simultaneous with the mastectomy, new breast reconstruction can be performed using skin-sparing techniques with a silicone implant or the patient's own tissue. If a spread to the underarm lymph nodes is detected, the lymph nodes in this area are cleared with an axillary lymph node dissection.

Chemotherapy and Radiotherapy Processes

Additional treatments may be needed before or after surgery to reduce the risk of the disease recurring. In advanced-stage or large tumours, treatment may begin with preoperative (neoadjuvant) chemotherapy to shrink the lump and allow for breast-conserving surgery. During chemotherapy, patients are regularly evaluated, and the surgical plan is clarified according to the tumour's response to the treatment.

All patients who undergo breast-conserving surgery should receive postoperative radiotherapy (radiation therapy) to prevent the disease from recurring in the remaining breast tissue. Furthermore, even if a mastectomy has been performed, radiotherapy is applied if the tumour diameter is large or if there is involvement in the underarm lymph nodes. If the pathological examination of the tumour reveals that the hormone receptors (oestrogen and progesterone) are positive, the patient is usually started on hormone-suppressing pill therapy that will last for 5 to 10 years.

Treatment Complications and Risk Groups

Since breast cancer treatments can affect healthy cells while destroying cancer cells, they can lead to various side effects. Hair loss, nausea, vomiting, loss of appetite, mouth sores, and the risk of infection due to a weakened immune system are common complications during the chemotherapy process. Radiotherapy, on the other hand, can cause redness, dryness, mild burn-like reactions on the skin in the application area, and a general feeling of fatigue.

The most important long-term complication of surgical intervention, especially in cases where the underarm lymph nodes are completely removed, is lymphoedema. Lymphoedema is characterised by swelling, a feeling of heaviness, and restricted movement in the arm as a result of impaired lymph fluid circulation. Those of advanced age or those with chronic conditions such as diabetes or heart disease are in a higher risk group for treatment complications. Therefore, it is necessary to strictly follow the nutrition, exercise, and skincare rules recommended by the physician throughout the treatment process.

When Should You See a Doctor?

When you notice an unusual situation regarding your breast health, you should consult a general surgery specialist without losing time. In particular, symptoms such as a newly noticed firm lump in the breast, bloody discharge from the nipple, skin retraction on the breast, or swelling in the armpit should never be ignored. Early application increases treatment options and raises the success rate.

In addition to this, patients undergoing breast cancer treatment (especially chemotherapy) must apply to the hospital immediately in certain emergency situations. If your fever rises to 38°C and above while receiving chemotherapy, or if you experience unstoppable severe vomiting or diarrhoea, sudden onset shortness of breath, severe chest pain, or confusion, you should call 112 without waiting or go to the emergency department of the nearest fully equipped hospital. Since infections can progress rapidly during this period when the immune system is suppressed, early intervention is of vital importance.

The Process at BHT CLINIC İstanbul Tema Hastanesi

At BHT CLINIC İstanbul Tema Hastanesi, breast cancer diagnosis and treatment processes are meticulously carried out by a multidisciplinary council consisting of expert physicians in their fields. Our general surgery, oncology, radiology, and pathology specialists create the most accurate and up-to-date treatment plan for you at every stage of your disease. Furthermore, against sudden side effects and infection risks you may experience during the chemotherapy or radiotherapy process, our Emergency Medicine department, which provides uninterrupted service 24/7, is always by your side with its expert staff.

Do not postpone your health; early diagnosis saves lives. To have your mammography screenings done, request a genetic risk assessment, or consult our expert physicians about a lump you have noticed in your breast, you can book an appointment right away.

Frequently Asked Questions

I felt a lump in my breast; is it definitely cancer?

No, the vast majority of palpable lumps in the breast are benign (non-cancerous) formations such as fibroadenomas or simple cysts. However, to fully understand the structure of the lump, it is absolutely essential that it is examined by a physician and the necessary imaging tests are performed.

Can breast cancer also occur in men?

Yes, although rare, breast cancer can occur in men. Since breast tissue is sparse in men, the lump is usually noticed just beneath the nipple. Because awareness is low among men, the disease is generally diagnosed at more advanced stages.

Is a mammography a painful procedure?

During a mammography, the breast needs to be compressed between two plates for a few seconds. Although this creates a slight feeling of pressure and discomfort, it generally does not cause severe pain. Having the procedure done in the week following the end of your period increases comfort, as this is the time when breast tenderness is at its lowest.

Does the entire breast have to be removed after breast cancer surgery?

No, today, breast-conserving surgery is mostly applied for breast cancers diagnosed at an early stage. By removing only the tumourous tissue and a small amount of healthy tissue around it, the natural appearance of the breast can be largely preserved.

There is no breast cancer in my family; am I still at risk?

Yes, approximately 80% of patients diagnosed with breast cancer have no family history of cancer at all. Since advancing age, being a woman, and hormonal factors constitute risks on their own, routine screening tests should not be neglected even if there is no family history.

This article is for informational purposes only; please consult your physician for diagnosis and treatment.