🍁 Breast CA

Breast cancer long case #

History #

mindmap
	root((Breast Hx))
		HPC
			Lump
				Main lump
				Other lump
			Nipple discharge
			Breast pain
		DD
			TB
			Trauma
		RF
			Hormone
				Endo
					Menarche/Menopause
					1st Preg/Lactation
					Nulliparity
				Exo
					OCP
					HRT
			Lifestyle
		CMLx
			Local
			Systemic
		UptoNow
			Ix
			NAT

HPC #

  1. About the main breast lump
    • How did you 1st notice the lump?
    • Progression of the lump
    • Associated symptoms – pain, alteration of nipple, discharge
  2. Other lumps
    • Is there any lump on opposite breast or axilla?
    • Previous breast lumps
  3. Breast pain
    • Cyclical – in relation to menstrual cycle
    • non-cyclical
  4. Nipple discharge
    • Unilateral/ bilateral
    • Single duct/ multiple duct
    • Spontaneous or expressed
    • Colour

Differential diagnosis #

  • History of trauma
  • Relationship of the size of the lump to the menstrual cycle
  • History of tuberculosis

Risk factors #

  • Past history
    • of breast cancer or previous breast biopsies of,
      • Ductal or lobular atypical hyperplasia
      • LCIS
    • Supra-diaphragmatic radiotherapy
  • Family history of breast, colonic, ovarian, prostate cancer
  • Hormone: Increased oestrogen exposure
    • Endogenous
      • Early menarche
      • Nulliparity
      • Late age at first pregnancy
      • Not breast feeding
      • Late menopause
    • Exogenous
      • HRT
      • Combined OCP
  • Lifestyle related
    • Alcohol/ smoking
    • Obesity
    • Reduced physical activity

Features of dissemination #

  • Bone - pain & fracture
  • Lung - Haemoptysis
  • Brain - Recent onset headache or fits
  • Liver - RHC pain or yellowish discolouration of eyes

Things done upto now? #

  • Investigation + NAT & complications

Fitness #

Other Hx #

  • PMHx
  • PSHx
  • AHx
  • Drug history
  • Social Hx
    • How do u feel about this lump? Explain the patients anxiety

Examination #

mindmap
	root((Breast Ex))
		General
			Systemic CMLx
			Local CMLx
				Lymphoedema
				CT/RT features
		Lump
			Measure Size
			Usual lump Ex
		LN
			Axilla
			Supraclavicular fossa
		Abd
			Hepatomegaly
		Respi
			Pleural effusion
		CNS
			Spinal tender
			Papillodema
  • General examination
    • Pallor, icterus
    • Features of CT/RT
    • Lymphoedema
  • Breast
  • LN Ex
    • axilla
    • supraclavicular fossa
  • Abdominal examination –
    • hepatomegaly , free fluid in the abdomen( request in early tumours but do in advanced tumours/recurrence)
  • Respiratory – evidence of pleural effusions
  • Spinal tenderness
  • Neurological – papilloedema, focal neurological signs

Recurrent Breast Cancer Evaluation #

History #

  • Recurrent Lump
    • Duration
    • Associated Symptoms
  • Previous Lumps
    • Previous Surgery
      • Mastectomy or Wide Local Excision?
      • Sentinel Lymph Node Biopsy / ALND Axillary Lymph Node Dissection?
    • Post-Mastectomy
      • Complications?
      • Recurrence?
      • Follow-up?
    • Previous Treatments - CT (Chemotherapy)/RT (Radiotherapy)/HT (Hormone Therapy) - Neoadjuvant (Given or Not) - Adjuvant CT/RT (Last RT Date)
    • Medications
      • Tamoxifen/Aromatase Inhibitors
      • Adverse Effects
  • Features of Dissemination

Examination #

  • Inspection

    • Features of Irradiation
    • Lymphoedema
    • Winging of Scapula
    • Latissimus Dorsi Muscle Function
    • CT Features

  • Lump

    • Site, Size, Shape, Consistency, Margins
    • Attachments: Skin, Pectoralis Major, Chest Wall

  • Regional

    • Lymph Nodes:
      • Axillary
      • Supraclavicular
      • Infraclavicular
      • Internal Mammary
    • Numbness over Medial Arm

  • Contralateral Breast and Axillae

    • Normal or Not

Youtube Breast CA Discussion #