Download Case: Breast Cancer

Alegre. Almora. Alonzo. Amaro. Amolenda.
Anacta. Andal. Ang. Ang. Ang. Aningalan
CASE: BREAST CANCER
General Information
• 45-y/o F
• Chief Complaint: Left breast mass.
History
1yr PTC
Other relevant data should be taken
• Noticed a mass
underneath the L
from the history; Family history;
nipple measuring
initially at 1 X 1 cm. menstrual history; pregnancy;
lactation.
• progressive
increase in the size
of the mass
Consult
•
•
•
•
Menarche; menstrual cycles
Sexual History
Previous pregnancies
Family history of breast
cancer
Personal risk factors:
• Gender
– Females have a 100-fold increase in risk as compared to males.
• Age – breast cancer risk increases with age
– 96% of breast cancers occur in women age 40 and older (ACS,
2003-2004).
• Race
– Caucasian women have a greater risk of breast cancer than
other racial groups.
• Prolonged exposure to endogenous estrogen and
progestins
• Exposure to exogenous combined estrogen and progestin
therapy in hormone replacement therapy for
postmenopausal women
Breast Cancer Diagnostic Algorithms for Primary Care Providers
(Third Edition, June 2005)
• Alcohol use
– greater than 27 drinks per week. (Gronbaek,
2004.)
• Obesity
– obese women with BMI >30 had estrogen
concentrations between 60% and 219% higher
then thin women
• Radiation exposure to the upper torso
– e.g. treatment of Hodgkin’s lymphoma.
Breast Cancer Diagnostic Algorithms for Primary Care Providers
(Third Edition, June 2005)
Risk Factors
• Increase number of menstrual cycles
(increased estrogen exposure)
– Early menarche, nulliparity late menopause
• Pregnant or Lactating Women
– During pregnancy, breast grows secondary to
estrogen, progesterone, HPL, prolactin (low levels)
– After pregnancy, progesterone drops, increasing
effects of prolactin
Family History
• One or more first- or second-degree relatives with
breast cancer at an early age (less than 40-50 years of
age).
• Breast cancer and a second primary cancer in a close
relative, especially ovarian cancer.
– Other cancers w/ a genetic risk include:
• thyroid, colorectal, prostate, endometrial, pancreatic,
adrenocortical carcinoma, melanoma, childhood sarcoma,
leukemia/lymphoma, and brain tumors.
• Male breast cancer in a close relative.
• Two or more relatives with breast cancer at any age.
Breast Cancer Diagnostic Algorithms for Primary Care Providers
(Third Edition, June 2005)
Physical Exam
• L breast
– 2 X 2 cm. hard,
non-tender, &
movable mass
with irregular
margins
underneath the
nipple.
• Axilla is negative
for any masses.
• The R breast and
the rest of the
PE are normal.
Personal Risk Factors
• 45y/o F
–
–
–
–
35% benign
25% cyst
9% fibroadenoma
31% other benign lesion
Breast Mass
•
•
•
•
•
Benign
round or oval shape
Smooth border
circumscribed margins
Rubbery; firm like balls of
hand
Mobile
•
•
•
•
•
•
Malignant
Ill-defined margin
microlobulated or
spiculated
Hard like knuckles
Size: the bigger it is the
more chance of malignancy
Fixed
Retractions
Rhabar, et al. Benign versus Malignant
Solid Breast Masses: US Differentiation.
December 1999 Radiology, 213, 889-894.
Working diagnosis
• Malignant breast lesion
– (2 X 2 cm. hard, non-tender, & movable mass with
irregular margins underneath the nipple)
• Clinical stage
– T1N0M0
• T1: Tumor 2.0 cm or less in greatest dimension
• N0: No regional LN metastasis
• M0: No distant metastasis