CASE PRESENTATION

BREAST CARCINOMA

By
R.P.BALACHANDAR
K.M.DURGGA
A 70 year old female Mrs.Parapara mary who is a house wife,
residing in Ilayangudi, came to surgery OPD with chief complaint
of

• Lump in the Right breast for past 6 months

 HISTORY OF PRESENTING ILLNESS
• The Patient was apparently normal before 6 months, after that
she noticed a lump in the right breast while bathing which is
insidious in onset, initially smaller in size and gradually
progressed to attain the present size, not associated with pain.
• No H/O breast pain
• No recent H/O retraction of nipple
• No H/O nipple discharge
• No H/O fever
• No H/O trauma
• No H/O swelling elsewhere in the body
• No H/O loss of weight
• No H/O loss of appetite
• No H/O bone pain
• No H/O Jaundice
• No H/O Breathlessness
• No H/O cough with hemoptysis
 PAST HISTORY
• No H/O similar illness in the past
• Known case of Systemic hypertension for past 15 years under
medication
• Not a known case of Diabetes mellitus, tuberculosis, bronchial
asthma, ischemic heart disease.
• H/O previous orthopaedic surgery on both legs for fracture of
femur
• No H/O Oral contraceptive pills or Hormone Replacement
Therapy intake
 PERSONAL HISTORY
• Consumes mixed diet
• Not a smoker, alcoholic or tobacco chewer
• Normal sleep pattern
• Normal bowel and bladder habits
 MENSTRUAL HISTORY
• Attained menarche at the age of 13 years
• Regular cycle – 4/28, not associated with pain or clots
• Attained menopause at the age of 44 years
 MARITAL HISTORY
• Married at the age of 19 years
• Non-consanguinous marriage
• P5L4D1
• Breastfeeding Given for 1 year for all children
 FAMILY HISTORY
• No H/O similar illness in the family
• No H/O any malignancies in her family
 SUMMARY
A 70 year old postmenopausal female, came to the surgery OPD
with chief complaint of lump in the right breast for past 6 months
which is insidious in onset and gradually in progression, not
associated with pain, hence this could be a case of right breast
lump for evaluation.
I would like to proceed with examination for further.
 GENERAL EXAMINATION
After getting consent from the patient, she was examined in sitting
position in adequate day light.
• Patient is conscious, oriented, moderately built and nourished.
• No pallor
• No icterus
• No cyanosis
• No clubbing
• No generalised lymphadenopathy
• No pedal edema
 VITALS

• Pulse rate : 86/min, regular in rhythm, normal volume, no special

characters, condition of vessel wall normal, no radio-radial delay, no
radio-femoral delay, all peripheral pulses felt
• Blood pressure : 130/90 mmHg in left upper arm in sitting position

• Respiratory rate : 16 cycles/min, thoraco-abdominal type of respiration

• Temperature : Afebrile
 LOCAL EXAMINATION OF RIGHT BREAST
• The patient was adequately exposed from neck upto the waist and
examined by maintaining proper privacy.

INSPECTION
Patient was inspected in
1. Sitting position with arms by side
2. Raising arm above the head
3. Bending forward position
4. Hands over the hip
 1.SITTING POSTURE WITH ARMS BY SIDE:
BREAST
• Symmetrical with respect to nipple level.
• Size of the both breast are equal.
SKIN OVER BREAST
• Skin over the breast is normal.
• No puckering/dimpling is seen
• No Peau’d orange appearance is seen
• No ulceration
• No dilated veins
• No nodules
 NIPPLE
• No retraction of nipple
• No fissure or ulcers
• No dicharge
• No change in colour
• No deviation or displacement
AREOLA
• Normal in size
• Normal in shape
• Normal in colour
• No ulceration
• No nodules
 ARMS AND THORAX
• No visible swelling present
AXILLA
• No visible fullness present
SUPRACLAVICULAR FOSSA
• No fullness present
2.WITH ARMS RAISED ABOVE HEAD:
• No Peau’d orange appearance
• No retraction of nipple
3.ON LEANING FORWARD:
• Breast falls equally on both sides

4.WITH HANDS OVER HIP

• On contraction, Swelling is not prominent
 PALPATION
Palpation done concentrically
• No warmth and no tenderness
• Inspectory findings are confirmed.
• A lump of
- size 4 x 3 cm
- irregular surface
- hard in consistency
- Ill defined margins
- in upper outer quadrant, at 9-11’o clock position
• Skin over the lump is pinchable
• Lump moves along with the breast tissue
• Mobility of the lump is not restricted on contracting the
pectoralis major and serratus anterior muscle
• Swelling is not fixed to chest wall
EXAMINATION OF AXILLA
• Single mobile lateral axillary lymph node of size 1 x 2 cm which is
firm in consistency is palpable
• No swelling in supraclavicular fossa.

• Examination of left breast, axilla and supraclavicular fossa are

normal
 PERCUSSION
• Resonant over parasternal area
• Per vaginal and per rectal examination to be done
SYSTEMIC EXAMINATON
• Cardiovascular system – S1 S2 heard, no murmur
• Respiratory system – Normal vesicular breath sounds heard
• Central nervous system – No focal neurological deficits
• Abdomen – Soft, non – tender, no free fluid, no organomegaly.
• Skeletal system – No tenderness in spine and cranium
 PROVISIONAL DIAGNOSIS
A 70 year old post menopausal lady with lump in the right breast is
suggestive of EARLY CARCINOMA OF RIGHT BREAST, with TNM
staging of T2N1Mx of stage II b with unknown ER,PR status.
 INVESTIGATIONS
• ROUTINE INVESTIGATIONS:
- Complete blood count
- Total count
- Differential count
- Random blood sugar
- Serum urea
- Urine albumin & sugar
- ECG, Echocardiogram
- X-ray chest, CT chest
• Mammogram of opposite breast
• USG Breast
• Fine needle aspiration cytology
• Trucut biopsy
• Excision biopsy
• USG Abdomen
• Liver function test
 TREATMENT:
• MODIFIED RADICAL MASTECTOMY
• HORMONAL THERAPY (BASED ON ER,PR STATUS)
• CHEMOTHERAPY
THANK YOU