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Main Clinical Manifestations of Breast Cancer

Breast cancer arises from the terminal duct-lobular unit and may remain in-situ or invade surrounding tissue. Symptom patterns reflect tumour biology, anatomical location, and host response. Early recognition improves oncological outcome; therefore, any new, persistent breast change warrants triple assessment.

  1. Painless palpable mass
    A solitary, firm-to-hard nodule with irregular or spiculated borders is most common. Fixation to pectoral fascia or skin reduces mobility and creates tethering.
  2. Nipple-areolar changes
    Recent nipple inversion, persistent eczematous scaling (Paget disease), or spontaneous serosanguinous/bloody discharge indicates underlying malignancy. Ulceration or fungation denotes locally advanced disease.
  3. Skin alterations
    Dimpling along Cooper ligaments, peau d’orange from lymphatic obstruction, or erythematous induration covering > one-third of the breast (inflammatory carcinoma) are pathognomonic signs.
  4. Axillary and supraclavicular lymphadenopathy
    Firm, non-tender, matted nodes ≥1 cm imply regional metastasis; fixation to skin or deep structures signals extra-nodal extension.
  5. Constitutional features
    Unintentional weight loss >5 % within 6 months, persistent fatigue, and low-grade night sweats reflect tumour cachexia and cytokine release.
  6. Metastatic syndromes
    Bone: pathological fracture or intractable pain from lytic lesions.
    Lung: productive cough, pleuritic pain, or malignant pleural effusion.
    Liver: right-upper-quadrant discomfort, hepatomegaly, or cholestasis.
    Brain: progressive headache, focal neurological deficits, or seizures.
  7. Paraneoplastic signs
    Dermatomyositis, hypertrophic osteoarthropathy, or thrombophlebitis migrans may precede overt tumour detection and mandate systemic evaluation.
Symptom / SignTypical Presentation
Palpable massFirm, irregular, painless, may be fixed
Nipple changesInversion, eczema, bloody discharge
Skin signsDimpling, peau d’orange, erythema
Lymph nodesFirm, matted, axillary/supraclavicular
ConstitutionalWeight loss, fatigue, night sweats
Bone metastasisBone pain, pathological fracture
Lung metastasisCough, pleuritic pain, effusion
Liver metastasisRUQ discomfort, hepatomegaly
Brain metastasisHeadache, focal deficits, seizures
ParaneoplasticDermatomyositis, thrombophlebitis

Related articles：

  1. Main Clinical Manifestations of Hilar Cholangiocarcinoma
  2. Main Clinical Manifestations of Biliary Tract Tumours
  3. Main Clinical Manifestations of Lithiasis
  4. Main Clinical Manifestations of Hepatic Ascites
  5. Main Clinical Manifestations of Portal Vein Thrombosis
  6. Main Clinical Manifestations of Acute Cholecystitis

Main Clinical Manifestations of Biliary Tract Tumours

Biliary tract tumours comprise neoplasms of the gall-bladder, cystic duct, extra-hepatic bile ducts, and intra-hepatic bile ducts. Most are malignant (gall-bladder carcinoma, cholangiocarcinoma) and present late; benign lesions are rare and usually detected incidentally. Symptom patterns reflect anatomical location, growth morphology, and degree of biliary obstruction.

  1. Painless obstructive jaundice
    Progressive conjugated hyper-bilirubinaemia with scleral icterus, dark urine, and acholic stools is the hallmark of hilar or distal cholangiocarcinoma and of advanced gall-bladder carcinoma. Pruritus is often intense and may precede visible icterus.
  2. Right-upper-quadrain pain
    A constant dull ache or vague heaviness is typical of gall-bladder cancer; intermittent colicky pain suggests concomitant cholelithiasis or cholangiocarcinoma mimicking biliary colic.
  3. Systemic features
    Fatigue, early satiety, unintentional weight loss, and low-grade night sweats reflect tumour cachexia and chronic cholestasis.
  4. Recurrent cholangitis
    Intermittent fever with rigors, elevated C-reactive protein, and right-sided tenderness occur when malignant obstruction becomes super-infected, fulfilling Charcot triad.
  5. Palpable gall-bladder (Courvoisier sign)
    A distended, non-tender gall-bladder may be felt below the right costal margin in distal bile-duct obstruction where the cystic duct remains patent.
  6. Hepatomegaly and lobar atrophy–hypertrophy complex
    The obstructed lobe atrophies while the contralateral lobe enlarges, producing a firm, nodular liver edge and visible abdominal asymmetry.
  7. Laboratory cholestasis
    Serum alkaline phosphatase and γ-glutamyl transferase are elevated in > 90 % of cases; total bilirubin climbs steadily as ductal involvement extends.
  8. Advanced disease indicators
    Persistent fever, ascites, palpable left-supraclavicular node, or rapidly rising bilirubin suggests unresectable disease or distant spread.
Symptom / SignTypical Presentation
Painless jaundiceProgressive, conjugated, with pruritus
RUQ painDull ache or intermittent colic
SystemicFatigue, weight loss, night sweats
CholangitisFever + RUQ pain + rising bilirubin
Courvoisier signNon-tender, distended gall-bladder
HepatomegalyFirm, nodular, lobar asymmetry
Laboratory↑ ALP, ↑ GGT, ↑ total bilirubin
AdvancedAscites, fever, distant nodes

Related articles：

  1. Main Clinical Manifestations of Biliary Tract Diseases
  2. Main Clinical Manifestations of Congenital Biliary Malformations
  3. Main Clinical Manifestations of Hilar Cholangiocarcinoma
  4. Main Clinical Manifestations of Hepatic Ascites
  5. Main Clinical Manifestations of Acute Cholecystitis
  6. Main Clinical Manifestations of Chronic Cholecystitis

Main Clinical Manifestations of Hilar Cholangiocarcinoma

Hilar cholangiocarcinoma (Klatskin tumour) arises at or near the confluence of the right and left hepatic ducts. Because the lesion obstructs the central bile ducts early, symptoms are usually biliary and appear while the tumour is still relatively small.

  1. Painless jaundice
    Conjugated hyper-bilirubinaemia develops insidiously, producing progressive yellowing of skin and sclera, dark urine and clay-coloured stools; pruritus is often intense and may precede visible icterus.
  2. Right-upper-quadrant discomfort
    A dull, non-colicky ache or sensation of fullness is common; pain is usually mild and does not parallel the degree of jaundice.
  3. Cholangitis episodes
    Intermittent fever with rigors, right-sided tenderness and elevated C-reactive protein occur when malignant obstruction becomes infected, fulfilling Charcot triad.
  4. Systemic features
    Fatigue, early satiety, unintentional weight loss and low-grade night sweats reflect chronic cholestasis and tumour cachexia.
  5. Palpable gallbladder (Courvoisier sign)
    A distended, non-tender gallbladder may be felt below the right costal margin if the cystic duct remains patent—more frequent in distal tumours but occasionally present in hilar lesions.
  6. Hepatomegaly and lobar atrophy–hypertrophy complex
    The obstructed lobe atrophies while the contralateral lobe compensates, leading to a firm, nodular liver edge and visible abdominal asymmetry.
  7. Laboratory cholestasis
    Serum alkaline phosphatase and γ-glutamyl transferase are elevated in > 90 % of cases; total bilirubin climbs steadily as ductal involvement extends.
  8. Advanced disease indicators
    Persistent fever, ascites, palpable left-supraclavicular node or rapidly rising bilirubin suggest unresectable disease or distant spread.
Symptom / SignTypical Presentation
Painless jaundiceProgressive, conjugated, with pruritus
RUQ discomfortDull ache, mild, non-colicky
CholangitisFever + RUQ pain + rising bilirubin
SystemicFatigue, weight loss, night sweats
Palpable gallbladderNon-tender, distended (Courvoisier)
HepatomegalyFirm, nodular, lobar asymmetry
Laboratory↑ ALP, ↑ GGT, ↑ total bilirubin
AdvancedAscites, fever, distant nodes

Related articles：

  1. Main Clinical Manifestations of Hepatic Hydatid Disease
  2. Main Clinical Manifestations of Biliary Tract Diseases
  3. Main Clinical Manifestations of Congenital Biliary Malformations
  4. Main Clinical Manifestations of Biliary Tract Tumours
  5. What Are the Symptoms of Cholangiocarcinoma?
  6. What Are the Symptoms of Intrahepatic Cholangiocarcinoma?