Dimpling in carcinoma breast is due to -
Ans- B Ref- Clinical manifestations Due to the lack of typical symptoms and signs, early-stage breast cancer (ESBC) is often neglected by patients and typically found during physical examination or breast cancer screening. The typical signs of breast cancer, as listed below, usually occur in the more advanced stages. 2.1.1. Breast Mass About 80% of breast cancer cases were first diagnosed with breast masses. Patients often recognize their breast mass unintentionally, and the mass tends to be single and hard, with irregular margins and less smooth surface. Most breast cancers are manifested as a painless mass, and only a few had varied degrees of pain or tingling. 2.1.2. Nipple discharge Nipple discharge can be sanguineous (bloody), serous, mucinous, milky, or purulent. It can also occur half year after the termination of breastfeeding. Causes for nipple discharge vary but commonly include intraductal papilloma, breast hyperplasia, dilation of mammary duct, and breast cancer. The bloody discharge which is effused from unilateral single hole should be further examined; more attention should be paid if the nipple discharge is accompanied with breast mass. 2.1.3. Skin changes A variety of skin changes can occur in patients with breast cancer. Most commonly, the tumor invades the Cooper's ligament and then adheres to the skin, showing a "Dimple sign". When the cancer cells block the lymphatic vessels, an orange peel like texture of the skin occurs. In patients with advanced breast cancer, the cancer cells can infiltrate into the skin along the lymphatic vessels, glandular vessels, and/or fibrous tissue, and then proliferate to form satellite nodules of skin over breast. 2.1.4. Abnormalities of nipple and areola If the tumor is located deep inside nipple, it can cause the retraction of nipple. In some patients, although tumor is relatively far away from the nipple, it can invade and shrink the large ducts within the mammary gland, and thus cause the retraction or elevation of nipple. Eczematoid carcinoma of nipple, also known as Paget's disease, is clinically manifested as the itchy nipple, erosion, ulceration, crusting, scaling, which can be associated with causalgia; in addition, nipple retraction also can be found. 2.1.5. Axillary lymphadenectasis In patients with occult breast cancer, the mass usually is impalpable during physical examination, with axillary lymphadenectasis as the first symptom. The metastasis of axillary lymph node can be detected in one third or more inpatients. The ipsilateral axillary lymph node(s) may become swollen at the early stage, and some swollen lymph nodes can hard, scattered, and movable. With the progression of the disease, the lymph nodes fuse together gradually and adhere to and even fix with the skin and surrounding tissues. The metastatic lymph nodes can be palpable in the supraclavicular area or contralateral axilla in patients with advanced breast cancer. ]More on Ca Breast- TNM staging of breast cancer B.1 Primary tumor (T) The clinical and pathological definitions for the stages of primary tumors are same. If the size of a tumor is assessed during physical examination, it can be presented as T1, T2, or T3. When other measurements (such as mammography or pathology) are applied, the four subgroups of T1 can be used. The size of tumor is accurate to 0.1 cm. TX means that the tumor size cannot be assessed. T0: No evidence of primary tumor. Tis: Carcinoma in situ. Tis ductal carcinoma in situ Tis lobular carcinoma in situ Tis Paget's disease of the nipple with no associated tumor. Note: Paget's disease associated with a tumor is classified according to the size of the tumor. T1: Tumor 2.0 cm or less in greatest dimension T1mic: Microinvasion 0.1 cm or less in greatest dimension; T1a: Tumor more than 0.1 cm but not more than 0.5 cm in greatest dimension; T1b: Tumor more than 0.5 cm but not more than 1.0 cm in greatest dimension; T1c: Tumor more than 1.0 cm but not more than 2.0 cm in greatest dimension; T2: Tumor more than 2.0 cm but not more than 5.0 cm in greatest dimension; T3: Tumor more than 5.0 cm in greatest dimension; T4: Tumor of any size with direct extension to (a) chest wall or (b) skin. T4a: Extension to chest wall; T4b: Edema (including peau d'orange) or ulceration of the skin of the breast or satellite skin nodules confined to the same breast; T4c: Both of the above (T4a and T4b); T4d: Inflammatory carcinoma. B.2 Regional lymph nodes (N) Clinical NX: Regional lymph nodes cannot be assessed (e.g., previously removed); N0: No regional lymph node metastasis; N1: Metastasis to movable ipsilateral axillary lymph node(s); N2: Metastases in ipsilateral axillary lymph nodes that are clinically fixed or matted; or,metastases in clinically detected ipsilateral internal mammary nodes in the absence of clinically evident* axillary lymph node metastases. N2a: Metastases in ipsilateral axillary lymph nodes fixed to one another (matted) or to other structures. N2b: Metastases only in clinically detected ipsilateral internal mammary nodes and in the absence of clinically evident axillary lymph node metastases. N3: Metastases in ipsilateral infraclavicular lymph node(s) with or without axillary lymph node involvement; or, metastases in clinically detected ipsilateral internal mammary lymph node(s) with clinically evident* axillary lymph node metastases; or, metastases in ipsilateral supraclavicular lymph node(s) with or without axillary or internal mammary lymph node involvement. N3a: Metastases in ipsilateral infraclavicular lymph node(s). N3b: Metastases in ipsilateral internal mammary lymph node(s) and axillary lymph node(s). N3c: Metastases in ipsilateral supraclavicular lymph node(s). B.3 Distant Metastases (M) MX: Distant metastasis can not be assessed. M0: No distant metastasis M1: Distant metastasis. B.4 AJCC stage groupings
Edema
Contraction of Cooper's ligaments
Subdermal lymphangitis
Scaring