CARCINOMA BREAST( EBC , LABC , MBC)

PATIENT NAME

AGE/SEX:

ADDRESS

OCCUPATION:

RELIGION:

RACE:

SOCIO ECONOMIC STATUS:

PREMENOPAUSAL/POST MENOPAUSEAL WOMEN :

CHIEF COMPLAINTS:

• LUMP IN THE RT/LT BREAST…………………..DURATION

• PAIN TH THE RT/LT BREAST…....................DURATION

HOPI:

• H/O LUMP IN THE BREAST……………..DURATION

▪ ONSET – SUDDEN/ INSIDIOUS ONSET
▪ PROGRESSION
• H/O PAIN IN THE BREAST
• H/O NIPPLE DISCHARGE
• H/O RECENT RETRACTION OF NIPPLE
• H/O FEVER
• H/O TRAUMA
• H/O ULCER
• H/O LOSS OF WEIGHT
• H/O LOSS OF APPETITE
• H/O LOW BACK PAIN
• H/O BONY PAIN
• H/O CHEST PAIN
• H/O BREATHLESSNESS
• H/O HEMOPTYSIS
• H/O CHRONIC COUGH
• H/O ABDOMINAL PAIN
• H/O ABDOMINAL DISTENSION
• H/O JAUNDICE
• H/O LOSS OF CONSCIOUS
• H/O HEAD ACHE
• H/O VOMITING
• H/O SEIZURES
PAST HISTORY:

• H/O SIMILAR ILLNESS IN THE PAST

• H/O K/C OF DM/SHT/ASTHMA/ALLERGY/TB/ EPILEPSY, HEART DISEASE, KIDNEY DISEASE
• H/O PREVIOUS IRRADIATION TO CHEST
• H/O CHRONIC DRUG INTAKE
• H/O PREVIOUS SURGERIES IN THE BREAST

PERSONAL HISTORY:

• DIET –

• CHRONIC SMOKER –

• CHRONIC ALCOHOLIC –

• BETEL NUT CHEWER-

• BOWEL AND BLADDER HABITS-

• SLEEP PATTERN –

FAMILY HISTORY:

• TOTAL FAMILY MEMBERS –

• MALES –
• FEMALES –
• ANY HISTORY OF CANCER IN FAMILY MEMBERS –

MENSTRUAL HISTORY:

• AGE AT MENARCHE
• CYCLES – REGULAR/IRREGULAR
• CYCLES………../30
• ASSOCIATED WITH PAIN OR NOT
• AGE AT MENOPAUSE
• LMP –

MARITAL HISTORY:

• AGE AT MARRIAGE –
• AGE AT FIRST CHILD BIRTH –
• AGE AT LAST BIRTH –

OBSTETRIC HISTORY:

• OBSTETRIC CODE –
• AGE AT FIRST CHILD BIRTH –
• NO OF CHILDREN -
• CHILD – MALE/FEMALE,
• BREAST FEEDING-
• AGE AT LAST CHILD BIRTH –
GENERAL EXAMINATION:

• CONSCIOUS
• ORIENTED
• COMFORTABLE
• COPERATIVE
• FEBRILE
• HYDRATION
• PALLOR
• JAUNDICE
• BUILD
• NOURISHMENT
• CLUBBING
• CYNANOSIS
• PEDAL EDEMA
• GENERALISED LYMPH ADENOPATHY
• VITAL SIGNS:
➢ PR-
➢ BP-
➢ RR-
➢ T-

EXAMINATION OF THE BOTH BREAST:

1.INSPECTION:
AFTER GETTING CONSENT FROM THE PATIENT, WITH ADEQUATE EXPOSURE PATIENT IN SITTING POSTURE

INSPECTION OF THE PATIENT IN SITTING POSTURE, ARMS BY THE SIDE OF HER BODY

1. BREAST:
➢ POSITION OF BREAST COMPARED TO OPPOSITE SIDE
➢ SIZE
➢ SHAPE
➢ ANY MASS OR ANY SWELLING, ANY FULLNESS
➢ ULCER
• SKIN OVER THE BREAST:
➢ SCAR
➢ SINUS
➢ DILATED VEINS
➢ DIMPLE
➢ PUCKERING
➢ RETRACTION
➢ PEAU D’ ORANGE
➢ ULCERATION
➢ NODULES
➢ FUNGATION
 • NIPPLE:
➢ SINGLE OR MULTIPLE
➢ POSITION
➢ SIZE
➢ SHAPE
➢ DISCHARGE
• ARELOLA:
➢ SIZE
➢ SURFACE
➢ COLOUR
• ARMS AND THORAX:
➢ EDEMA
➢ NODULES
• AXILLA:
➢ ANY SWELLING
➢ ANY FULLNESS
• SUPRACLAVICULAR FOSSA:
➢ ANY SWELLING
➢ ANY FULLNESS

INSPECTION OF THE PATIENT WITH ARMS RAISED ABOVE HEAD:

• FIXITY
• PEAU D’ORANGE
• RETRACTION OF NIPPLE

INSPECTION ON LEANING FORWARD:

• FIXITY TO CHEST WALL

INSPECTION ON CONTRACTING AND RELAXING PECTORALIS MAJOR:

• SWELLING – PROMINENT OR NOT

2.PALPATION:
• WARMTH
• TENDERNESS
• SINGLE OR MULTIPLE LUMP OF SIZE
• SITE
• SHAPE
• SURFACE
• MARGIN
• CONSISTENCY
• SKIN FIXITY
 • MOBILITY
➢ MOVES ALONG WITH BREAST TISSUE
➢ MOVE INDEPENDENT OF BREAST TISSUE
• FIXITY TO MUSCLES
➢ PECTORALIS MAJOR,
➢ SERRATUS ANTERIOR,
➢ LATTISMUS DORSI
• FIXITY TO CHEST WALL.
• NIPPLE
➢ ANY DISCHARGE
➢ RETRACTION
➢ ANY LUMP
• AXILLARY LYMPHNODES
➢ NUMBER
➢ GROUP –ANTERIOR, CENTRAL, POSTERIOR, LATERAL, APICAL
➢ SIZE
➢ MOBILITY
➢ FIXED
➢ MATTED
➢ CONSISTENCY

3.PERCUSSION:
• OVER THE STERNUM – RESONANT OR DULL.

4. EXAMINATION OF THE OPPOSITE BREAST:

5. CVS –

6. RS –

7. ABDOMEN –

8. SPINE –

9. CRANIUM –

10. PV/PR EXAMINATION:

DIAGNOSIS:

• RIGHT /LEFT
• CARCINOMA INVOLVING THE …………………………….QUARDANT OF BREAST
• WITH AXILLARY LYMPHNODES -
• TNM STAGING -
INVESTIGATIONS:

• BASIC INVESTIGATIONS
• SPECIFIC INVESTIGATIONS

BASIC INVESTIGATIONS:

• HEMOGLOBIN,
• TOTAL COUNT .
• DIFFERENTIAL COUNT
• ERYTHROCYTE SEDIMENTATION RATE
• PLATELET COUNT
• RANDOM BLOOD SUGAR
• SERUM UREA
• SERUM CREATININE
• URINE ROUTINE- ALBUMIN, SUGAR, DEPOISTS
• BLEEDING TIME
• CLOTTING TIME,
• BLOOD GROUPING/TYPING
• HIV-1 AND HIV-2, VDRL, HBSAg, Anti- HCV
• ECG ALL LEADS
• CXR PA VIEW-

SPECIFIC INVESTIGATIONS:

• USG BOTH BREAST AND AXILLA (LESS THAN 1 CM LESION MAY NOT BE IDENTIFIED)

BENIGN LESION:
➢ SOILD OR CYSTIC
➢ SMOOTH
➢ ROUNDED
➢ WELL DEFINED MARGINS
➢ WEAK INTERNAL ECHOES
➢ COMPRESSIBLE
➢ WIDER THAN TALLER
➢ HYPERECHOIC

MALIGNANT LESION:

➢ HYPOECHOIC
➢ IRREGULAR MARGIN
➢ IRREGULAR INTERNAL ECHOES
➢ IRREGULAR POSTERIOR SHADOWING
➢ NON COMPRESSIBILITY
➢ TALLER THAN WIDER
➢ INCREASED VASCULRITY
➢ CALCIFICATION
FINDINGS SUGGESTIVE OF MALINGNANCY IN MAMMOGRAPHY:

➢ LINEAR BRANCHING STIPULATED MICROCALCIFICATION

➢ ARCHITECTURAL DISTORTION
➢ SOFT TISSUE SHADOW WITH IRREGULAR MARGIN
➢ INCREASED DENSITY
➢ SKIN THICKENING
➢ LOSS OF SYMMETRY
➢ SPICULATON

BIRADS:

❖ BIRADS 0 – NEED ADDITIONAL IMAGES

❖ BIRADS 1 – NEGATIVE
❖ BIRADS 2 – BENIGN FINDING
❖ BIRADS 3 – PROBABLY BENIGN FINDING
❖ BIRADS 4 – SUSPICIOUS OF MALINGNANCY
❖ BIRADS 5 – HIGHLY SUGGESTIVE OF MALINGANCY
❖ BIRADS 6 - KNOWN CARCINOMA.

FNAC GRADING OF BREAST:

➢ C0 – NO EPITHELIAL CELLS
➢ C1 – SCANTY EPITHELIAL CELLS
➢ C2 – BENIGN CEELS
➢ C3 – ATYPCAL CELLS
➢ C4 – SUSPICIOUS CEELS
➢ C5 – MALIGNANT CELLS.

SPECIFIC INVESTIGATIONS IN GENERAL:

• MAMMOGRAM.
• USG BREAT AND AXILLA.
• FNAC OF BREAST LUMP.
• CORE NEEDLE BIOPSY.
• USG ABDOMEN AND PELVIS.
• LIVER FUNCTION TEST.
• EXCISION BIOPSY.
• INCISION BIOPSY.
• CT CHEST.
• CT ABDOMEN AND PELVIS.
• BONE SCAN/ SKELETAL SURVEY.
• DUCTOGRAPHY IF NIPPLE DISCHARGE PRESENT.

SPECIFIC INVESTIGATIONS FOR EBC:

• CORE NEDDLE BIOPSY

• ULTRASOUND BREAST AND AXILLA
• MAMMOGRAPHY AFFECTED AND OPPOSITE SIDE BREAST
 • USG ABDOMEN AND PELVIS
• CHEST X RAY
• LIVER FUNCTION TEST

SPECIFIC INVESTIGATION FOR LABC:

• CORE NEDDLE BIOPSY

• ULTRASOUND BREAST AND AXILLA
• MAMMOGRAPHY OPPOSITE SIDE OF BREAST
• CECT CHEST
• CECT ABDOMEN AND PELVIS
• LIVER FUNCTION TEST
• BONE SCAN, IF BONE SCAN NOT AVAILABLE SKELETAL SURGERY.