Download 62 yr old Female was found to have a right breast

62 yr old Female was found to have a right breast abnormality on a screening
mammogram. This mammogram was repeated which revealed an abnormality
measuring 1.5 cm suspicious of malignancy in the upper outer quadrant of the
right breast. She underwent a needle localization biopsy of this abnormality
revealing infiltrating ductal carcinoma and DCIS.
PMHx: History of benign disease in left breast.
PSHx: Excision of breast lumps in left breast. Benign.
Meds: Vit E and calcium
Allergies: Amoxocillin
Social:
She is a widow.
Attained menarche at 14 yrs of age and menopause at age 55. She is grii, pii.
(No hx of tobacco or alcohol consumption.)
(On Birth Control Pill x 2 yrs. No hx of Estrogen Replacement Therapy.)
Family Hx: No family history of any type of cancer.
Review of Systems: Negative.
PEx: Was within normal limits except for mild echymosis and vague palpable
abnormality at the biopsy site.
Assessment:
Infiltrating ductal carcinoma of right breast along with Ductal Carcinoma In Situ
History of fibrocystic disease of left breast.
Recommendation: She was advised lumpectomy and sentinel node biopsy
pending further recommendations after sentinel node biopsy and ER, PgR data.
Pathology: Infiltrating ductal carcinoma long with DCIS. T 1 C, N 1 , M x .
Margins of resection clear.
Estrogen Receptor status: 90% positive
Progesterone Receptor: Negative
Her-2Neu: Positive
Final Recommendation: Adjuvant chemotherapy followed by Adjuvant
Radiotherapy and Tamoxifen.
Follow-up: Eight years later, the patient presents with metastases to liver, bones
and brain. Patient and family decided to go into hospice.
1
Describe the epidemiology of Breast Cancer.
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2
What are the known risk factors for developing breast cancer?
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3
What is BRCA 1 and BRCA 2? What is its clinical significance?
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4
What are the usual presenting signs and symptoms of breast cancer?
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5
What is the differential diagnosis of a breast mass?
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6
What are estrogen and progesterone receptors and their clinical
significance?
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7
What are important Prognostic factors in early breast cancer?
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8
What are predictive factors in Breast Cancer?
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9
What is adjuvant chemotherapy and the principles involved?
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10
What are the side effects of systemic chemo chemotherapy?
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