Download MBBS (Bachelor of Medicine and Bachelor of Surgery) Surgery Final Year Case Presentation Early Stage of Breast Carcinoma Clinical Examination Discussion and Treatment
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
Examination of Spine and Cranium: Normal
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
.
This post was last modified on 08 August 2021