• Breast lump or breast mass noted upon breast exam -- usually painless, firm to hard and usually with irregular borders
• Lump or mass in the armpit
• A change in the size or shape of the breast
• Abnormal nipple discharge
  • Usually bloody or clear-to-yellow or green fluid
  • May look like pus (purulent)
• Change in the color or feel of the skin of the breast, nipple, or areola
  • Dimpled, puckered, or scaly
  • Retraction, "orange peel" appearance
  • Redness
  • Accentuated veins on breast surface
• Change in appearance or sensation of the nipple
  • Pulled in (retraction), enlargement, or itching
• Breast pain, enlargement, or discomfort on one side only
• Any breast lump, pain, tenderness, or other change in a man
• Symptoms of advanced disease are bone pain, weight loss, swelling of one arm, and skin ulceration

Any worrisome breast changes should be confirmed and investigated by a medical professional. After getting as much information as possible about the symptom and any risk factors, the physician performs a physical examination including both breasts, armpits, and the area of the neck and chest. Additional tests and treatment may then be recommended:

• X-ray mammography may help identify the breast mass.
• Ultrasound (sonogram) can show whether the lump is solid or fluid-filled.
• Needle aspiration or needle biopsy of breast lumps can demonstrate if they are fluid-filled and provide material to send to the laboratory for analysis. In the case of very small abnormalities visible only on mammography, special techniques are necessary.
• A surgical biopsy or breast lump removal provides a portion or all of a breast lump for laboratory study.

If breast cancer is diagnosed, additional testing is performed, including chest X-ray and blood tests. Surgery, radiation, chemotherapy, or a combination of these may then be recommended, not only for treatment, but also to help determine the stage of disease. Staging is important to help guide future treatment and follow-up, and to give some idea of what to expect in the future.

Stages of Breast Cancer (from the American Joint Committee on Cancer):

• STAGE 0. In Situ ("in place") disease in which the cancerous cells are in their original location within normal breast tissue. Known as either DCIS (ductoral carcinoma in situ) or LCIS (lobular carcinoma in situ) depending on the type of cells involved and the location, this is a pre-cancerous condition, and only a small percentage of DCIS tumors progress to become invasive cancers. There is some controversy within the medical community on how to best treat DCIS.
• STAGE I. Tumor less than 2 cm in diameter with no spread beyond the breast
• STAGE IIA. Tumor 2 to 5 cm in size without spread to axillary (armpit) lymph nodes or tumor less than 2 cm in size with spread to axillary lymph nodes
• STAGE IIB. Tumor greater than 5 cm in size without spread to axillary lymph nodes or tumor 2 to 5 cm in size with spread to axillary lymph nodes
• STAGE IIIA. Tumor smaller than 5 cm in size with spread to axillary lymph nodes which are attached to each other or to other structures, or tumor larger than 5 cm in size with spread to axillary lymph nodes
• STAGE IIIB. The tumor has penetrated outside the breast to the skin of the breast or of the chest wall or has spread to lymph nodes inside the chest wall along the sternum
• STAGE IV. A tumor of any size with spread beyond the region of the breast and chest wall, such as to liver, bone, or lungs

Many additional factors besides staging can influence the recommended treatment and the likely outcome. These can include the precise cell type and appearance of the cancer, whether the cancer cells respond to hormones, and the presence or absence of genes known to cause breast cancer.

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Romond EH, Perez EA, Bryant J, et al. Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. N Engl J Med. 2005 Oct 20;353(16):1673-84.

Menard S, Pupa SM, Campiglio M, Tagliabue E. Biologic and therapeutic role of HER2 in cancer. Oncogene. 2003 Sep 29;22(42):6570-8.