A 45-Year-Old Woman Visited Her Physician Because of a Low

A 45-year-old woman visited her physician because of a low back pain of 3 months' duration. She was otherwise very fit. On examination of her back, nothing abnormal was discovered. The physician then listened to her chest, examined her thyroid gland, and finally examined both breasts. A large, hard mass was found in the left breast.
-The following facts supported the diagnosis of carcinoma of the left breast with secondaries in the vertebral column except which?

A) The lump in the breast was painless and the patient had noticed it while showering 6 months previously.
B) Several large, hard, pectoral lymph nodes were found in the left axilla.
C) A lateral radiograph of the lumbar vertebral column showed extensive metastases in the bodies of the second and third lumbar vertebrae.
D) The lump was situated in the upper outer quadrant of the left breast and was fixed to surrounding tissues.
E) Although the cancer had spread by the lymph vessels, no evidence of spread via the bloodstream was present.