Examination of the breast of the patient in an upright position
To study the axillary region, the doctor takes the right elbow of the woman with his right hand and holds it, which helps to relax the muscles of the chest. With his left hand, the doctor palpates the lower part of the armpit, then moves towards the collarbone, the middle and upper parts of the armpit. The left axillary region is examined with the right hand while supporting the patient’s left hand with the doctor’s left hand.
If the lymph nodes are palpable, the physician should evaluate the extent of their enlargement and the size, number, and dislocation / fixation to the surrounding tissues. Dense, irregular shape, multiple lymph nodes or one another, which are tied together, as well as lymph nodes with a diameter of more than 1 cm indicate possible metastasis. In many women, especially in the presence of mild inflammatory processes on the hands (cuts, burrs, small scratches or burns), small, soft, movable axillary lymph nodes are palpable as a result of lymphadenitis. The diameter of such lymph nodes is usually less than 1 cm, they are palpable, but not changed clinically.
A thorough examination of the skin and nipples of the mammary glands helps to identify changes indicating the presence of a malignant process. Edema of the skin of the mammary gland (in the form of orange peel) is sometimes small, but much more often, it is longer. This symptom is more noticeable in the lower half of the mammary gland and is better detected when the patient lifts her arms up. Although such edema is usually caused by a blockage of lymphatic vessels by cells derived from deep-seated breast cancer (BC), it can also occur with a massive lesion of the axillary lymph nodes by metastasis.
The contraction of the skin and nipple is better defined when the pectoralis major muscle is reduced. Hyperemia of the skin of the breast – a terrible sign. Although it can be caused by an inflammatory process, such as periductal mastitis or abscess, it is necessary to remember the inflammatory form of breast cancer. It is also important to examine the nipple to identify possible retractions or ulcerations. The ulcerations, which may initially be very small (part of the nipple), suggest an Paget’s disease. This form of breast cancer (BC), which occurs and spreads in large ducts, initially looks like nipple eczema and can capture it entirely.