Breast Carcinoma.pptx a case scenario for exam
- 1. A Case of Lump in the Breast Shambhavi Kulkarni 4th year KIMS Bangalore
- 2. Preliminary Details • Name: Mrs RG • Age: 47years • Address: Devanahalli, Bengaluru • Education: SSLC • Occupation: Farmer • DOA: 1st May 2023 • DOE: 3rd May 2023
- 3. Chief complaints • c/o lump in right breast since 4 months • c/o pain in right breast since 10 days
- 4. History of presenting illness • Patient was apparently normal 4 months back when she noticed a lump in her right breast while bathing that was insidious in onset and gradually progressive from the size of a pea (approx 1x1 cm) to the current size of about 8x8cm. • The patient also c/o pain in the right breast since 10 days, sudden in onset, gradually progressive, non radiating, dragging type, on and off which persisted throughout the day which aggravated while she was working and relieved on rest.
- 5. • No h/o swelling in other breast, axilla or anywhere else in the body • No h/o nipple retraction, discharge, cracks or ulceration • No h/o chest pain, cough, hemoptysis • No h/o pain abdomen, jaundice • No h/o backache, limb pain • No h/o fever, headache, loss of consciousness • No h/o swelling of arm • No h/o prior radiation exposure
- 6. Past history • No previous h/o any similar complaints • Not a k/c/o HTN, Type2 DM, TB, Asthma • No previous h/o hospitalisation or surgery • No h/o any medications in the past
- 7. Family history • No h/o any breast, ovarian or colorectal cancer in any family members • h/o throat cancer in the patient’s elder sister 5 years ago • h/o HTN, Type 2 DM in patient’s parents
- 8. Obstetric and Menstrual history • Age of Menarche: 13 years • Cycles were regular 30 day cycles, lasting 4-5 days, changed 3- 4 pads/day, no clots or dysmenorhhea • Married life: 27 years • Obstetric score: P2L2A1 • 1st child: Male, born 27 years ago, FTVD, breast feed for 1 year • 2nd child: Female, born 25 years ago, FTVD, breast fed for 1 year • Attained menopause 2 years ago • Tubectomised 25 years ago
- 9. Personal history • Diet: Mixed • Appetite: Normal • Sleep: Adequate • Bowel and bladder movements: Regular • Habits: None
- 10. General physical examination • A middle aged woman moderately built and nourished, conscious, cooperative, well oriented to time, place and person. • Vitals: i. Blood pressure: 130/90 mm Hg measured in right arm, supine ii. Pulse Rate:86 bpm, normal in rate, rhythm, volume, character, no delays iii. Respiratory Rate: 18cpm iv. Temperature: 98.2F • No pallor, icterus, clubbing, cyanosis, generalised lymphadenopathy or edema.
- 11. Examination of the breasts • Consent of the patient was taken before examination. • The patient was examined in an adequately lit room with exposure up to the waist. She was examined in sitting, semi recumbent and recumbent position.
- 12. Inspection 1. Breasts i. Position- Right breast is at a lower level than left breast ii. Shape and size: Right breast appears larger than left breast iii. No puckering or dimpling seen iv. Swelling- A diffuse lump is seen on the right breast, predominantly the upper outer quadrant, approximately 10x10 cm with a smooth surface, skin over the lump appearing normal.
- 13. v. Dilated veins present 2. Nipple i. Both nipples present and symmetrical ii. Normal in size, shape, surface position iii. No flattening or retraction iv. No discharge
- 14. 3. Areola • Appears normal • Colour brown • Size- 3cm diameter • No cracks, fissures, ulceration 4. Arm and thorax- clinically, no abnormality seen. On raising the arm above the head, no change in shape of the breast or lump
- 15. Palpation • Left breast normal • No local rise in temperature • Tenderness present • A single lump of size 8x8 cm felt near the areola which is globular in shape, nodular surface, having well defined margin and firm consistency • Lump is not fixed to overlying skin • Mobility of the lump is both vertically and horizontally. • Not attached to chest wall. • Nipple- no underlying lump felt, no discharge
- 16. Examination of lymph nodes i. Axillary lymph nodes • Pectoral lymph nodes • Brachial group • Subscapular group • Central group • Apical group ii. Supraclavicular lymph nodes- not palpable Not palpable
- 17. Systemic examination • CVS- S1, S2 heard, no murmurs • RS-Bilateral NVBS heard • PA- soft, non tender, no organomegaly • CNS- higher mental functions normal • Musculoskeletal system: Normal • Rectal and vaginal examination- not done
- 18. Investigations • Radiology- USG of breast and axilla, Mammography • FNAC • PET scan • USG Abdomen- for any liver mets • Chest X-ray- for lung metastasis • Spine X ray • X ray of long bones In locally advanced carcinoma
- 19. Diagnosis • This is a case of right sided breast carcinoma of stage cT3N0M0.
- 20. THANK YOU