2.BREAST CA

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EARLY STAGE

OF BREAST
CARCINOMA
C.GNANA PRAKASH
A 55 yr old female Mrs.Usha
Rani, house wife from
Perambur belonging to low
socioeconomic status
presents with the chief
complaints of lump in the
Right breast for the past 6
months.
HISTORY OF PRESENTING ILLNESS

Patient was apparently normal 6 months


back,after which she noticed a lump in the
outer aspect of her right breast
-insidious in onset ,
-progressive,
-initially small in size gradually
increased in size and attained the current
size
-not associated with pain
 No h/o nipple discharge/ retraction of nipple
 No h/o ulceration over breast
 No h/o fever/trauma
 No h/o loss of weight
 No h/o loss of appetite
 No h/o bone pain
 No h/o difficulty in breathing
 No h/o cough with hemoptysis
 No h/o jaundice/abdominal pain/distension
 No h/o headache/blurring of vision/seizures
 No h/o swellings elsewhere in the body
PAST HISTORY

 Pt is a K/C/O Dibetes mellitus for 3 years. (On regular


medication Tab. Metformin 1BD)
 No H/O HT/ Bronchial asthma/ Pulmonary
tuberculosis/ Seizures
 No h/o previous hospitalization
 No h/o previous surgeries.
 No h/o previous irradiation.
 No h/o intake of OCPs
PERSONAL HISTORY

 Consumes non vegetarian diet


 Normal bowel and bladder habits
 No h/o additive habits
 No h/o drug/food allergy
MENSTRUAL HISTORY

Age at menarche : 13 years


Attained Menopause 5 years ago ( At the age of
50)
No h/o bleeding PV
OBSTETRIC HISTORY

Obstetric score: P3 L3
Age at marriage : 17
Age at first child birth : 18
2nd child : 20
3rd child : 22
breastfeeding done for all children till 10 months
FAMILY HISTORY

No h/o
breast/
gynaecological/
gastrointestinal malignancy in first degree
relatives.
GENERAL EXAMINATION

On Examination,
patient is conscious
oriented
moderately built and nourished
No pallor
No icterus
No cyanosis
No clubbing
No pedal edema
No significant generalized lymphadenopathy
VITAL SIGNS
 PR-76/min,regular in rhythm,normal volume,no
specific character,no radiofemoral, radioradial
delay,felt in all peripheral pulses,nature of vessel
wall normal
 RR-18/min, thoracoabdominal type
 BP-130/70 mm Hg in right upper limb,sitting
posture
 Afebrile.
LOCAL EXAMINATION

EXAMINATION OF RIGHT BREAST


After getting consent from the patient and in the presence of
a female attender, the patient is stripped upto waist.
Examined in sitting posture with arms by the side, arms
raised, arms at hip, leaning forward, and supine posture
under bright light
INSPECTION
[Arms by the side]-
Right breast is larger than the left breast
fullness is noted in the upper outer quadrant of breast,
skin over the lump is normal,
No peau d’orange appearnance
no ulcers, sinuses, nodules, fungation and dilated veins
No dimple/puckering seen
Nipple :
size 1*1 cm, centrally placed
same level as the contralateral nipple
no retraction of nipples
no discharge from nipples
no ulcers, cracks, fissures
Areola ;
size 4*4cm, brown in colour
circular, no cracks ,fissures and ulcerations
Arms and thorax : no edema, no visible nodes/fullness
Axilla : no visible nodes
Supraclavicular fossa : no fullness

ON RAISING ARMS ABOVE HEAD


Both breast move equally
undersurface of the breast appears normal
No prominence of lump
no peau d’ orange /dimpling/puckering
no retraction of nipple
ON LEANING FORWARDS
Breast fall equally on both sides.

ON CONTRACTING PECTORALIS MAJOR BY KEEPING


HANDS AT HIP
The lump does not become prominent
PALPATION
 Not warm, not tender.
 Single Lump of size 4*3 cm, hard in consistency, ovoid in
shape, well defined margins, irregular surface, felt in the
the upper outer quadrant.
 Skin over the lump is pinchable.
 The Lump moves along with breast tissue on contracting
and relaxing the pectoralis major there is no restriction of
mobility along the line of muscle fibres
 No fixity to chest wall/ serratus anterior
Nipple : no palpable mass deep to the nipple
no discharge from the nipple
no retraction of nipple
 Examination of rt axilla: No lymph nodes palpable
 Rt Supraclavicular fossa: No nodes palpable
Examination of contralateral breast :normal

Examination of contralateral axilla :normal.

Examination of contralateral supraclavicular fossa :


normal
Percussion

 Resonant note felt over parasternal areas


 Per rectal examination- to be done
 Per Vaginal examination- to be done
EXAMINATION OF OTHER
SYSTEMS
Examination of abdomen : soft, not tender, no organomegaly
no palpable mass, no free fluid
hernia orifices- free
external genitalia- normal

Examination of RS : Normal vesicular breath sounds heard


No added sounds

Examination of CVS: S1, S2 heard


no murmurs

Examination of CNS: No focal neurological deficit

Examination of thyroid gland: Noraml, No swelling


DIAGNOSIS

CARCINOMA of Right BREAST – T2 N0 M0


(STAGE IIA).
MANAGEMENT

INVESTIGATIONS
 Routine:
Blood: Complete hemogram- TC, DC, Hb%, ESR, BT, CT

Blood urea, sugar ,creatinine

Urine: sugar, albumin


X
ray chest , ECG
 Specific : Mammogram of Right breast
FNAC of Right breast lump
core needle biopsy
Sentinel node biopsy
 Staging investigation: X-Ray Chest
USG abdomen
liver function test
bone scan
x-ray skull and pelvis
mammogram of contralateral

breast
TREATMENT
1.WIDE LOCAL EXCISION (Breast conservative surgery)
+adjuvant radiotherapy of Right Breast

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