WhatsApp
Official logo of Prof. Dr. Zahid Mahmood, laparoscopic and general surgeon in Lahore
Menu
Facebook Icon-instagram-1 Youtube Tiktok

Breast Cancer: Symptoms, Diagnosis, Stages & Treatment

  • Prof. Dr. Zahid Mahmood
  • August 11, 2026

Breast Cancer: Symptoms, Diagnosis, Stages & Treatment

Medically reviewed by Prof. Dr. Zahid Mahmood, MBBS, FCPS — General, Laparoscopic & Laser Surgeon, Lahore.

Breast cancer develops when abnormal breast cells grow uncontrollably. It may begin in the milk ducts or lobules and can remain confined, invade nearby tissue or spread through lymphatic channels and blood. Modern treatment is highly individualised according to the cancer’s size, lymph-node involvement, grade, hormone receptors, HER2 status, genetic features and the patient’s general health and preferences.

Many breast changes are benign, but a new lump or suspicious change should be assessed promptly. Earlier diagnosis usually provides more treatment choices.

Possible symptoms and warning signs

  • A new lump or area of thickening in the breast
  • A hard, irregular or fixed mass
  • A new lump in the armpit or above the collarbone
  • Change in the size, shape or contour of one breast
  • Skin dimpling, puckering or an orange-peel appearance
  • A newly inverted or pulled-in nipple
  • Spontaneous bloody or clear discharge from one nipple
  • Persistent crusting, ulceration or eczema-like change of the nipple
  • Redness, warmth or swelling that does not improve as expected
  • Persistent focal breast pain, especially with another change

Breast pain alone is not usually caused by cancer, and many cancers are painless. Do not wait for pain before seeking assessment of a lump.

Inflammatory breast cancer

Inflammatory breast cancer is uncommon but important. It can cause rapid enlargement, redness, warmth, heaviness and orange-peel skin, sometimes without a clear lump. Infection is more common, but symptoms that are extensive, rapidly progressive or fail to improve promptly with appropriate antibiotics need urgent breast-specialist assessment.

Paget’s disease of the nipple

Persistent one-sided scaling, crusting, bleeding or erosion of the nipple can be Paget’s disease, which may be associated with cancer beneath the nipple. It should not be repeatedly treated as simple eczema without investigation.

Who is at increased risk?

Risk increases with age, but breast cancer can occur in younger women and men. Factors associated with increased risk include:

  • Female sex and increasing age
  • A personal history of breast cancer or certain high-risk breast lesions
  • Close relatives with breast or ovarian cancer, especially at young ages
  • Inherited variants such as BRCA1, BRCA2, PALB2 and others
  • Previous chest radiotherapy at a young age
  • Longer lifetime exposure to oestrogen
  • Alcohol use, obesity after menopause and low physical activity

Most people diagnosed with breast cancer do not have a strong family history. The absence of known risk factors must never be used to dismiss a suspicious symptom.

How is breast cancer diagnosed?

Triple assessment

Breast symptoms are evaluated using three linked components:

  1. Clinical assessment: history and examination of both breasts and regional lymph nodes
  2. Imaging: diagnostic mammography and/or targeted ultrasound according to age and findings
  3. Pathology: a needle sample, usually an image-guided core biopsy, when a lesion is suspicious

MRI is used selectively, not as a routine substitute for mammography and ultrasound. It may help in particular high-risk patients, difficult imaging situations or when defining the extent of a confirmed cancer.

Core needle biopsy

A core biopsy is performed under local anaesthetic and removes small cylinders of tissue. It confirms whether a lesion is benign, in-situ cancer or invasive cancer and provides tissue for biomarker testing. Needle biopsy does not cause breast cancer to spread.

Understanding the pathology report

In-situ and invasive disease

Ductal carcinoma in situ (DCIS) consists of abnormal cells confined within the milk ducts. It is non-invasive but can progress to invasive cancer in some patients and is usually treated locally.

Invasive breast cancer has moved beyond the duct or lobule into surrounding breast tissue. Invasive carcinoma of no special type is the commonest form; invasive lobular carcinoma is another important type.

Grade

Grade describes how abnormal the cells appear and how actively they are growing. It is different from stage. Higher-grade cancers tend to behave more aggressively, but treatment decisions use many factors together.

Hormone receptors and HER2

Every invasive cancer is generally tested for:

  • Oestrogen receptor (ER)
  • Progesterone receptor (PR)
  • Human epidermal growth factor receptor 2 (HER2)

Hormone-receptor-positive cancers can respond to endocrine treatment. HER2-positive cancers may respond to HER2-targeted medicines. Triple-negative breast cancer lacks ER, PR and HER2 and is treated using other systemic approaches, often including chemotherapy and, in selected cases, immunotherapy.

Breast cancer stages

Staging uses the tumour (T), lymph-node (N) and distant-metastasis (M) system along with grade and biomarkers:

  • Stage 0: non-invasive disease such as DCIS
  • Stages I and II: early invasive cancer confined to the breast or limited regional nodes
  • Stage III: locally advanced disease involving more extensive breast tissue, skin, chest wall or regional nodes
  • Stage IV: cancer that has spread to distant organs

Not every person needs CT, PET or bone scans. Staging scans are selected according to symptoms, examination and cancer stage; unnecessary scans can create false alarms and delay treatment.

How is treatment planned?

A multidisciplinary team reviews the imaging, pathology, stage, biomarkers and patient’s health and preferences. Treatment may begin with surgery or with systemic therapy before surgery. A plan can include several of the following treatments.

Breast-conserving surgery

Breast-conserving surgery—also called lumpectomy or wide local excision—removes the tumour with a margin of healthy tissue while keeping most of the breast. It is usually followed by radiotherapy. For appropriately selected early cancers, breast conservation plus radiotherapy provides survival equivalent to mastectomy.

A second operation may be needed if cancer reaches the specimen margin. Oncoplastic techniques can reshape the breast when a larger volume is removed.

Mastectomy

Mastectomy removes the breast tissue and may be advised for extensive or multicentric cancer, widespread DCIS, an unfavourable tumour-to-breast size ratio, inability to receive radiotherapy, certain inherited risks, recurrence after previous conservation treatment or patient preference.

Skin-sparing or nipple-sparing approaches are suitable for selected patients. Mastectomy does not automatically remove the need for chemotherapy, endocrine therapy or radiotherapy; these depend on the final cancer features and stage.

Breast reconstruction

Reconstruction can be immediate or delayed and may use an implant, the patient’s own tissue, or both. Some patients choose no reconstruction and prefer a flat closure or external prosthesis. The safest timing depends on smoking, diabetes, body shape, cancer treatment and whether radiotherapy is expected.

Lymph-node assessment

The axillary lymph nodes help stage invasive breast cancer. For a clinically node-negative axilla, a sentinel lymph-node biopsy samples the first draining nodes and causes less arm morbidity than removing many nodes. If nodes are involved, options can include further axillary surgery and/or radiotherapy depending on the disease burden and treatment plan.

Possible complications include numbness, shoulder stiffness, fluid collection and lymphoedema. Early shoulder movement and specialist advice help recovery.

Treatment before surgery

Neoadjuvant systemic therapy is treatment given before surgery. It can shrink a tumour, make breast conservation possible, treat cancer cells elsewhere early and reveal how the cancer responds. It is commonly considered for locally advanced cancer, HER2-positive disease, triple-negative cancer and selected node-positive tumours.

Chemotherapy

Chemotherapy may be given before or after surgery depending on tumour size, grade, lymph nodes, receptor subtype, age, health and genomic information. Not every breast cancer needs chemotherapy.

Possible effects include fatigue, nausea, hair loss, infection risk, nerve symptoms, heart effects and effects on fertility. The regimen and supportive treatment are tailored to the patient.

Radiotherapy

Radiotherapy treats a defined area with high-energy radiation. It is usually recommended after breast-conserving surgery and in selected patients after mastectomy, particularly with larger tumours, skin or chest-wall involvement or involved nodes.

Short-course schedules are now used for many patients. Temporary skin reaction and tiredness are common; the radiation team plans treatment carefully to limit exposure to the heart and lungs.

Endocrine or hormone therapy

Endocrine therapy reduces the risk of recurrence in hormone-receptor-positive cancer. Depending on menopausal status and risk, treatment may include tamoxifen, an aromatase inhibitor and/or ovarian suppression. Treatment often continues for several years.

Side effects can include hot flushes, joint symptoms, vaginal changes, effects on bone health and, with some medicines, blood-clot or uterine risks. Do not stop therapy without discussing side effects and alternatives with the oncology team.

HER2-targeted therapy and immunotherapy

HER2-positive cancers can be treated with medicines directed against HER2, commonly alongside chemotherapy. Heart function is monitored with certain HER2 treatments.

Immunotherapy is used for selected triple-negative cancers according to stage, tumour markers and the clinical setting. These medicines can cause immune-related inflammation and require prompt reporting of new symptoms.

Genomic tests

For selected hormone-receptor-positive, HER2-negative early cancers, a multigene tumour test may help estimate recurrence risk and whether chemotherapy is likely to add benefit. These tests do not replace clinical judgement and are not appropriate for every subtype.

Inherited genetic testing

Genetic counselling and testing may be offered for diagnosis at a young age, triple-negative cancer at a relevant age, male breast cancer, bilateral disease, strong breast/ovarian/pancreatic/prostate cancer history or ancestry associated with inherited variants. Results can influence surgery, medicines and screening for relatives.

Fertility, pregnancy and contraception

Chemotherapy and endocrine treatment can affect fertility. People who may want children should discuss egg, embryo or ovarian-tissue preservation before systemic treatment begins. Pregnancy testing and safe non-hormonal contraception may be needed during treatment. Breast cancer diagnosed during pregnancy is treatable, but requires coordinated breast, oncology and obstetric care.

Male breast cancer

Men can develop breast cancer. A firm one-sided lump, nipple inversion, nipple discharge, ulceration or an armpit lump needs prompt assessment. Diagnosis and treatment use the same core principles, with adjustments for male anatomy and tumour biology.

Stage IV breast cancer

Metastatic breast cancer has spread beyond the breast and regional nodes. Treatment is primarily systemic and aims to control disease, relieve symptoms and preserve quality of life. Endocrine therapy, targeted treatment, chemotherapy, immunotherapy, radiotherapy and supportive care are selected according to subtype, previous therapy and sites of disease. Many patients receive several effective treatment lines over time.

Recovery and follow-up

After surgery, follow instructions about wound care, drains, pain relief and shoulder exercises. Contact the team for fever, increasing redness, wound swelling, breathlessness, calf swelling or sudden arm swelling.

Follow-up includes clinical review and mammography of remaining breast tissue according to the treatment plan. Report a new breast or chest-wall lump, persistent bone pain, unexplained weight loss, breathlessness, jaundice or neurological symptoms rather than waiting for a routine appointment.

Lymphoedema risk reduction

Lymphoedema is persistent swelling of the arm, breast or chest wall after lymph-node treatment. Maintain a healthy weight, gradually return to exercise, protect the skin and report heaviness or swelling early. Normal use of the arm is encouraged; overly restrictive rules can impair recovery.

Life after treatment

Fatigue, sleep difficulty, menopause symptoms, altered body image, anxiety, sexual concerns and fear of recurrence are common and deserve care. Rehabilitation, psychological support, physiotherapy and symptom-specific treatment can help. A healthy weight, regular physical activity, avoiding smoking and limiting alcohol support overall health.

Common questions

Does every breast cancer require mastectomy?

No. Many early cancers can be treated with breast-conserving surgery followed by radiotherapy. Cancer extent, breast size, genetics, radiotherapy suitability and personal preference guide the choice.

Does mastectomy guarantee the cancer will not return?

No operation can guarantee zero recurrence. Mastectomy provides excellent local control in appropriate cases, but recurrence risk also depends on tumour biology, lymph nodes and systemic disease.

Does biopsy spread cancer?

No. Image-guided core biopsy is the standard safe method for confirming the diagnosis and obtaining the biomarker information needed for treatment.

Will I definitely need chemotherapy?

No. Chemotherapy benefit depends on stage, grade, lymph nodes, ER/PR/HER2 status, age, health and sometimes a genomic test.

Is breast cancer curable?

Many early and locally advanced breast cancers are treated with curative intent. Outcome varies with stage and tumour biology. Metastatic cancer is generally controlled rather than cured, but modern treatments can provide meaningful disease control and quality of life.

Key message

A new breast lump, nipple change, skin dimpling, bloody discharge or persistent breast inflammation needs prompt assessment. Diagnosis requires imaging and core biopsy, and treatment is personalised using stage, grade and biomarkers. Breast-conserving surgery, mastectomy, radiotherapy and modern systemic therapies are combined according to each patient’s cancer—not according to a single standard operation.

Breast cancer assessment and surgery in Lahore

Prof. Dr. Zahid Mahmood assesses suspicious breast symptoms, coordinates triple assessment and multidisciplinary review, and discusses breast-conserving surgery, mastectomy, lymph-node assessment and reconstruction according to the confirmed diagnosis.

For an appointment, call 0300 413 0159 or visit professorzahid.com.

This article provides general education and does not replace personal medical assessment. A new breast lump, skin or nipple change, bloody discharge, or persistent red swollen breast requires prompt clinical review.

Medical references

  1. Williams NS, O’Connell PR, McCaskie AW, editors. Bailey & Love’s Short Practice of Surgery. 28th ed. CRC Press; 2023. Chapter 58, “The breast,” pp. 928–945.
  2. NICE. Early and locally advanced breast cancer: diagnosis and management (NG101), updated 2025.
  3. NHS. Breast cancer in women: symptoms, tests and treatment.
  4. US National Cancer Institute. Treatment of Breast Cancer by Stage.

Related articles

Other conditions we treat