Case sheet proforma for History taking and Examination of Breast Lump.

Name: 

Age/Sex: 

Occupation: 

Socioeconomic Status:

Presenting Complaints

• Lump in the right/left breast for last………….. months/years.

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• UNDERSTANDING SKIN INVOLVEMENT IN CA BREAST: T4B

• WHAT IS THE REASON FOR PUCKERING OR SKIN RETRACTION IN BREAST CANCER?

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History of Presenting Illness

• H/O Lump

• Site

• Duration

• Onset

• Progress of the swelling:

• Associated

• H/O Pain

• Site

• Duration

• Onset

• Character: Usually dull-aching

• Radiation

• Relieving factors 

• Aggravating factors

• H/O Ulcer

• Site

• Duration

• Onset

• Progress of the ulcer

• Associated

10/24/2020 03:49:00 PM

What is Aberration of Normal Development and Involution (ANDI) ?

Aberrations in the Normal Development and Involution of the breast (ANDI) is an all encompassing term that is used to describe a wide spectrum of the benign breast diseases. As the name suggests, it is based on the theory that most of the encountered benign breast disorders are essentially minor aberrations in the normal development process, hormonal response and involution of the breast.

How does the incidences across years of life varies for Fibroadenoma, Simple Cyst, Nodularity and Breast Ca ?

From which structure does a Fibroadenoma arise?

Arises from a single lobule and is composed of epithelial and fibrous components. Check out the anatomical origin of various breast pathologies in the figure below.

What is the relative risk of breast cancer in case of Proliferative breast disease with atypia?

Moderate Risk. (Relative risk >2)

6/17/2016 05:23:00 PM

What is Skin Involvement or T4b ?

Edema (including peau d’ orange) or ulceration of the skin of the breast or satellite skin nodules confined to the breast.

What is not Skin Involvement or T4b ?

Dimpling of the skin and nipple retraction is not considered skin involvement.

Skin involvement in breast showing a skin nodule 

surrounded by edema (peau d orange)

How does peau d’ orange appearance develop?

Localised edema (peau d’orange) develops when drainage of lymph fluid from the skin is disrupted by infiltration of lymphatics by metastatic cells.

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Read more about Ca Breast:

WHAT IS THE REASON FOR PUCKERING OR SKIN RETRACTION IN BREAST CANCER?
http://www.worldsurgeryforum.net/2016/05/what-is-reason-for-puckering-or-skin.html

SKIN PUCKERING AND PEAU D ORANGE APPEARANCE IN BREAST CANCER
http://www.worldsurgeryforum.net/2016/05/skin-puckering-and-peau-d-orange.html

WHAT IS THE ACCURACY OF CLINICAL DETERMINATION OF AXILLARY LYMPH NODE METASTASIS IN CA BREAST?
http://www.worldsurgeryforum.net/2016/06/what-is-accuracy-of-clinical.html

MECHANISM OF METASTASIS FROM CA BREAST TO BATSON'S PLEXUS AND LIVER
http://www.worldsurgeryforum.net/2016/06/mechanism-of-metastasis-from-ca-breast.html

6/12/2016 02:39:00 PM

How does metastatic lesion from Ca Breast reach vertebrae?

• The malignant cells from the breast reaches vertebrae via the intercostal veins.
• The intercostal vein will join the vertebral plexus of the veins. This is also called Batson’s plexus of veins. 
• The peculiarity of this plexus is that there are no valves and therefore the malignant cells can freely reach all the vertebrae from the base of the skull to the sacrum.
• 
  

How does a metastatic lesion from Ca Breast reach the liver ?

• The liver is involved in 2 ways. 
• The most important route is bloodstream spread. 
• The liver also can be involved by lymphatic route. 
• The lymphatics from the lower inner quadrant of the breast traverse the plexus in the rectus sheath and reach the subperitoneal plexus. From their along the falciform ligament it will reach the liver. 

6/10/2016 07:16:00 PM

The clinical stage of breast cancer is determined primarily through physical examination of the skin, breast tissue, and regional lymph nodes (axillary, supraclavicular, and internal mammary). The clinical determination of axillary lymph node metastases has an accuracy of:

1. Only 80%
2. Only 50%
3. Only 33%.
4. Only 10%

Answer in the comment section below. Detailed explanation will be posted.

6/08/2016 12:19:00 PM

Worldsurgeryforum.net

What is the most important prognostic correlate of disease-free and overall survival in Ca Breast?

A) Distant Metastasis
B) Size of the tumour
C) Skin involvement or Chest fixation
D) Axillary lymph node status   

Answer in the comment section below. Detailed explanation will be posted.

6/01/2016 01:58:00 PM

Invasive breast cancer and LCIS

Which of the following is true?

 A) Invasive cancer may develop in same breast which harbored the initial focus of LCIS

 B) Invasive cancer may develop in either breast, regardless of which breast harbored the initial focus of LCIS

 C) Invasive cancer does not develop in the breast which harbored the initial focus of LCIS

 D) Association between the laterality of Invasive cancer and LCIS is scientifically not significant      

Answer in the comment section below.

Detailed explanation here: http://www.worldsurgeryforum.net/2016/05/surgical-vignettes-lobular-carcinoma-in.html

6/01/2016 11:58:00 AM

A) Puckering/ Skin Retraction B) Peau d' Orange appearance

A) Shows skin retraction/ puckering
More than 80% of breast cancers show productive fibrosis that involves the epithelial and stromal tissues. With growth of the cancer and invasion of the surrounding breast tissues, the accompanying desmoplastic response entraps and shortens Cooper’s suspensory ligaments to produce a characteristic skin retraction. 

B) Shows peaud’orange appearance
Localised edema (peau d’orange) develops when drainage of lymph fluid from the skin is disrupted    

5/26/2016 09:56:00 PM

A)Puckering in Breast Cancer B)Peau d' orange appearance

  What is the reason for puckering or skin retraction in Breast Cancer?

 1) Desmoplastic Response of tumor leading to shortening of cooper's ligaments
 2) Drainage of lymph fluid from the skin is disrupted
 3) Direct migration of tumor cells
 4) Satellite growth leading to retraction

Please leave your answer in the comment section below.

Click here for a detailed explanation.

Click here for more Freshly Brewed MCQs.    

5/26/2016 12:19:00 AM

• Inherited in an autosomal dominant fashion
• BRCA1 is located on chromosome arm 17q
• BRCA1 functions as tumor suppressor gene
• Female mutation carriers have been reported to have up to a 85% lifetime risk (for some families) for developing breast cancer and up to a 40% lifetime risk for developing ovarian cancer.
• BRCA1-associated breast cancers are invasive ductal carcinomas, are poorly differentiated, are majorly hormone receptor negative and have a triple receptor negative profile (immunohistochemical profile: ER-negative, PR-negative and HER-2-negative)

5/16/2016 07:33:00 PM

The use of MRI for breast cancer screening is recommended by the American Cancer Society for women with a 20% to 25% or greater lifetime risk using risk assessment tools:

1. BRCA mutation carriers
2. Individuals who have a family member with a BRCA mutation who have not been tested
3. Individuals who received radiation to the chest between the ages of 10 to 30 years
4. Individuals with a history of Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome or those who have a first-degree relative with one of these syndromes

References

 Schwartz's 10th ed (http://amzn.to/1q10JSc)

5/16/2016 03:17:00 PM

Atypical Ductal and Lobular Hyperplasia of breast

What is the cancer risk for Atypical ductal hyperplasia?
What is the cancer risk for Atypical lobular hyperplasia?
What is the management if Atypical hyperplasia is found after surgery?
What is the management if Atypical hyperplasia is found after core needle biopsy?

5/14/2016 11:41:00 PM

Breast Implants

Below are a few specific points to remember related to breast cancer in patients with cosmetic breast implants:

1. Breast Implants and Risk of Breast Cancer: Women who have undergone cosmetic breast implantation do not have an increased risk of breast cancer. [1]
2. Breast Implants and Breast Cancer Survival: A meta-analysis showed reduced survival after breast cancer among women who had implants compared with those who did not (overall hazard ratio for breast cancer specific mortality 1.38, 95% confidence interval 1.08 to 1.75) [2]. This can be due to the delayed detection of breast cancer in these patients because implants can interfere with mammography
3. Mammography and Silicon Implants: The presence of silicone gel-filled breast implants may interfere with standard mammography since silicone is radiopaque, and the physical presence of the implant compresses fat and glandular tissues, creating more homogeneous dense tissue that frequently lacks the contrast needed to detect subtle early features associated with breast cancer [3]
4. Breast Implants and Stage at Diagnosis:  A 2013 systematic review of 12 studies found that women with breast cancer who had breast implants are diagnosed with later-stage cancers than women with breast cancer who did not have implants [4]
5. Breast cancer screening schedule and Breast Implants: Though breast augmentation decreases the sensitivity of screening mammography among asymptomatic women but does not increase the false-positive rate [5]. Thus it is advised that women with breast implants should undergo screening at the same schedule as women without breast implants.

References

[1] Noels EC, Lapid O, Lindeman JH, Bastiaannet E. Breast implants and the risk of breast cancer: a meta-analysis of cohort studies. Aesthet Surg J. 2015 Jan;35(1):55-62. doi: 10.1093/asj/sju006. PMID:25568234
[2] Lavigne Eric, Holowaty Eric J, Pan Sai Yi, Villeneuve Paul J, Johnson Kenneth C, Fergusson Dean A et al. Breast cancer detection and survival among women with cosmetic breast implants: systematic review and meta-analysis of observational studies BMJ 2013; 346 :f2399
[3] Institute of Medicine (US) Committee on the Safety of Silicone Breast Implants; Bondurant S, Ernster V, Herdman R, editors. Safety of Silicone Breast Implants. Washington (DC): National Academies Press (US); 1999. 12, Silicone Implants and Breast Imaging.Available from: http://www.ncbi.nlm.nih.gov/books/NBK44781/
[4] Lavigne E., Holowaty EJ, Pan SY, Villeneuve PJ, Johnson KC, Fergusson DA, Morrison H, & Brisson J. Breast cancer detection and survival among women with cosmetic breast implants: Systematic review and meta-analysis of observational studies
[5] Handel N. The effect of silicone implants on the diagnosis, prognosis, and treatment of breast cancer. Plast Reconstr Surg. 2007 Dec;120(7 Suppl 1):81S-93S. Review. PubMed PMID: 18090817
.

5/13/2016 07:46:00 PM

Ref: Schwartzs 10th ed (http://amzn.to/1q10JSc)

Image Source: Wikipedia

   

• Calcifications associated with LCIS typically occur in adjacent tissues. This neighbourhood calcification is a feature that is unique to LCIS and contributes to its diagnosis.
• The average age at diagnosis is 45 years, which is approximately 15 to 25 years younger than the age at diagnosis for invasive breast cancer
• Invasive breast cancer develops in 25% to 35% of women with LCIS. 
• Invasive cancer may develop in either breast, regardless of which breast harbored the initial focus of LCIS, and is detected synchronously with LCIS in 5% of cases. 
• In women with a history of LCIS, up to 65% of subsequent invasive cancers are ductal, not lobular, in origin. 
• For these reasons, LCIS is regarded as a marker of increased risk for invasive breast cancer rather than as an anatomic precursor

5/06/2016 10:42:00 PM