Breast Cancer Stages And Symptoms: Detection, Diagnosis And Treatment

Breast Cancer Stages And Symptoms: Detection, Diagnosis And Treatment

In this article, we focus on breast cancer stages and symptoms, risk factors, detection and diagnosis, and possible treatment options...

Breast cancer is cancer that forms in the cells of the breasts. The cancer usually forms in either the lobules or the ducts of the breast. Lobules are the glands that produce milk, and ducts are the pathways that bring the milk from the glands to the nipple. Cancer can also occur in the fatty tissue or the fibrous connective tissue within the breast.

The cancerous cells may then spread throughout the breast, to lymph nodes (glands) in your armpit and to other parts of the body.

Breast cancer is the most common cancer among Singaporean women with one in 14 suffering from the condition before the age of 75. It is also the most lethal cancer among women, with 991 deaths from the condition in 2018 alone n Singapore. All women are at risk of breast cancer, and the chances of developing it increase with age.

Risk factors for breast cancer include:

  • Being female. Women are much more likely than men are to develop breast cancer
  • Increasing age. Your risk for breast cancer increases if you are 50 years of age or older
  • Having a family history of breast cancer
  • A history of malignant or benign (non-cancerous) breast disease
  • A history of ovarian cancers
  • Early onset of menstruation
  • Late menopause
  • Having your first child after the age of 30
  • Having fewer children or never having children
  • Being on hormone replacement therapy
  • Weight gain, especially after menopause
  • Drinking alcohol

Breast Cancer Stages And Symptoms

Breast cancer stages and symptoms

Symptoms of breast cancer include:

  • Painless lump in the breast
  • Persistent itch and rash around the nipple
  • Bleeding or unusual discharge from the nipple
  • Skin over the breast is swollen and thickened
  • Skin over the breast is dimpled or puckered
  • Nipple becomes pulled in or retracted
  • Change in the size, shape or appearance of a breast
  • Breast pain
  • A lump or swelling under your arm

Do note that, these symptoms do not necessarily mean that you have breast cancer. However, if you spot any of these symptoms, do consult a doctor as soon as possible for further examination and testing.

Breast cancer stages

There are five stages of breast cancer: 0, 1, 2, 3 and 4. At the earlier stages (0 and 1), treatment can result in survival rates of over 90 percent.

Stage 0 breast cancer

Stage 0 means that the cancer has been diagnosed early. It started in the breast ducts or milk glands and has stayed there. The words "in situ" are commonly used, which mean “in the original place.”

Stage 1 breast cancer

From Stage 1, breast cancer is called invasive, meaning it has broken free to attack healthy tissue.

  • Stage 1A: It means that the cancer has spread into the fatty breast tissue. The lymph nodes are not affected.
  • Stage 1B: Some cancer cells, but just tiny amounts, have been found in a few lymph nodes.

Stage 2 breast cancer

By Stage 2, the cancer has grown, spread, or both.

  • Stage 2A: Means that the tumour in the breast is still small, if there's one at all. There may be no cancer in the lymph nodes, or it may have spread to as many as three.
  • Stage 2B: At this stage, the breast tumour is bigger - it may be the size of a walnut or as big as a lime. It may or may not be in any of the lymph nodes.

Stage 3 breast cancer

At Stage 3, the cancer has not spread to the bones or organs, but it is considered advanced, and it is harder to fight.

  • Stage 3A: The cancer has spread to 4–9 axillary lymph nodes or has enlarged the internal mammary lymph nodes, and the primary tumour can be any size. In some cases there is a large tumour in the breast, but other times there’s no tumour.
  • Stage 3B: A tumour has invaded the chest wall or skin and may or may not have invaded up to 9 lymph nodes.
  • Stage 3C: Cancer is found in 10 or more axillary lymph nodes, lymph nodes near the collarbone, or internal mammary nodes.

Stage 4 breast cancer

By Stage 4, breast cancer cells have spread far away from the breast, to nearby and distant lymph nodes as well as to distant organs. The most common sites are the bones, lungs, liver, and brain. This stage is described as “metastatic,” meaning it has spread beyond the region of the body where it was first found.

Detection of breast cancer

There are three types of screenings involved in detecting breast cancer: self-examination, clinical examination, and mammography.

It is recommended that women above 20 carry out breast self-examination once a month, a week after menses. If the patient no longer has menses, she should perform breast self-examination on the same day of each month, for example the first of every month.

Breast Cancer Stages And Symptoms

Here is what you need to look out for during self-examination:

  • A lump, swelling, or thickening in the breast or underarm area
  • Changes in the size or shape of one breast
  • Puckering or dimpling of the skin of the breast or nipple
  • Persistent rash or change in the skin around the nipple
  • Recent changes in the nipple, eg. inversion, retraction
  • Any bleeding or unusual discharge from the nipple
  • Skin redness or soreness of the breast
  • Accentuated veins on the surface of the breast
  • Unusual swelling of one upper arm
  • Any enlarged lymph nodes in the armpit and collarbone areas

Apart from breast self examination, it is advised for women above 40 to go for a clinical breast examination once a year.

It is also recommended that women aged 40 to 49 go for a mammogram once a year, while those aged 50 and above go for it once every two years.

A mammogram is a screening procedure that uses a special machine to take X-ray pictures of the breast. The X-ray pictures make it possible to detect cancerous tumours that cannot be felt by hand, or lumps in the breast that are not yet cancerous but may grow into cancerous tumours. 

Click here on where you can get a mammogram done in Singapore. Do note that, for those above 50, mammogram is Medisave-claimable.

Breast Cancer Stages And Symptoms

In case of a suspicious lump, apart from a mammogram, a needle biopsy is necessary. Even if the mammogram returns negative, a biopsy may be needed.

A biopsy involves removal of tissue from the breast lump using either a core or skinny needle and syringe. The tissue is processed and sent to the pathologist, who will be able to tell if the tissue is cancerous.

If cancer is diagnosed, other tests such as chest X-ray, ultrasound of the liver and bone scan may be required to determine if the cancer has spread to other parts of the body.

Treatment of Breast Cancer

Treatment for breast cancer usually depends on the stage of the cancer, the size of the tumour and the extent of spread. One or a combination of therapies may be recommended by the doctor.


This is the most common treatment for breast cancer and involves two types:

Lumpectomy: The breast lump and some normal tissue around it are removed, with the breast being preserved. Some lymph nodes may be removed as well. This is usually done for early breast cancer.

Quadrantectomy: This involves removal of ¼ of the breast that contains the lump and surrounding tissue.

Mastectomy: Removal of the entire breast, often including the lymph nodes in the armpit and sometimes the chest wall muscles. It is required when the cancer is found in numerous parts of the breast or the cancerous area is large.


Drugs, usually in a combination, are given orally or by injection, to kill cancer cells.

The drugs enter the bloodstream and travel through the body. There may be mild nausea or vomiting, hair loss, lethargy or tiredness, and loss of appetite.

Chemotherapy is given in cycles - a treatment period followed by a recovery period, then treatment again and so on.

Hormonal Therapy

Normal female hormones like oestrogen may promote growth of normal healthy breast tissue, but may also accelerate the growth and recurrence of certain breast cancers. Hormone therapy can prevent your body’s natural hormones from activating growth or spread of cancer cells.

Hormonal therapy could involve drugs to change the way hormones work or surgery to remove the ovaries that produce female hormones which can affect cancer cells. 

The most common drug used for hormone therapy for breast cancer is the oral tablet, tamoxifen, which stops the action of oestrogen.

Side effects can occur. These depend on the type of drug used and vary among individuals. They include hot flushes/sweats, vaginal irritation, irregular menstrual periods, depression, mood swings and a slightly increased chance of developing cancer of the uterus and deep vein thrombosis. Regular gynaecological checkups are recommended.

Radiation Therapy or Radiotherapy

High-energy X-rays are directed at the breast, to damage cancer cells and stop them from growing. Radiotherapy to the chest usually takes place over 5 weeks.

Radiotherapy can be vital after a breast-conserving surgery like lumpectomy, since much of the breast tissue is left intact. Most women who have a mastectomy do not need radiotherapy.


Physical rehabilitation includes:

  • Shoulder exercises after the surgery
  • Arm care, to avoid the beginning of lymphoedema (swelling of the arm(s) due to fluid retention)
  • Balanced nutrition and lifestyle changes to improve recovery

Mental rehabilitation involves:

  • Close support from your spouse, family and friends, as well as support groups
  • Reassurance through a better understanding of the chances of survival
  • Regular reviews with the doctor

Prevention of breast cancer

As mentioned above, the best way to protect yourself from breast cancer is through regular self-examination, clinical breast examination and mammograms. Doing a monthly breast self-examination also keeps you aware of any changes to your breasts.

breast cancer stages and symptoms

It is advised for women above 40 to go for a clinical breast examination once a year.

It is also recommended that women aged 40 to 49 go for a mammogram once a year, while those aged 50 and above go for it once every two years.

In addition to this, maintain a healthy and active lifestyle:

  • Maintain a healthy weight
  • Stay physically active
  • Eat a diet rich in fruits, vegetables and whole grains, and low in fats
  • Avoid alcohol or reduce its consumption

(Source: MayoClinic, Healthline, GlenEagles, Healthhub, BCF, SingHealth, WebMD)

Also READ: Breast self-examination: An illustrated guide for mums

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