3. Chief complaints
• c/o lump in right breast since 4 months
• c/o pain in right breast since 10 days
4. History of presenting illness
• Patient was apparently normal 4 months back
when she noticed a lump in her right breast while
bathing that was insidious in onset and gradually
progressive from the size of a pea (approx 1x1
cm) to the current size of about 8x8cm.
• The patient also c/o pain in the right breast since
10 days, sudden in onset, gradually progressive,
non radiating, dragging type, on and off which
persisted throughout the day which aggravated
while she was working and relieved on rest.
5. • No h/o swelling in other breast, axilla or
anywhere else in the body
• No h/o nipple retraction, discharge, cracks or
ulceration
• No h/o chest pain, cough, hemoptysis
• No h/o pain abdomen, jaundice
• No h/o backache, limb pain
• No h/o fever, headache, loss of consciousness
• No h/o swelling of arm
• No h/o prior radiation exposure
6. Past history
• No previous h/o any similar complaints
• Not a k/c/o HTN, Type2 DM, TB, Asthma
• No previous h/o hospitalisation or surgery
• No h/o any medications in the past
7. Family history
• No h/o any breast, ovarian or colorectal
cancer in any family members
• h/o throat cancer in the patient’s elder sister 5
years ago
• h/o HTN, Type 2 DM in patient’s parents
8. Obstetric and Menstrual history
• Age of Menarche: 13 years
• Cycles were regular 30 day cycles, lasting 4-5 days,
changed 3-4 pads/day, no clots or dysmenorhhea
• Married life: 27 years
• Obstetric score: P2L2A1
• 1st child: Male, born 27 years ago, FTVD, breast feed for
1 year
• 2nd child: Female, born 25 years ago, FTVD, breast fed
for 1 year
• Attained menopause 2 years ago
• Tubectomised 25 years ago
9. Personal history
• Diet: Mixed
• Appetite: Normal
• Sleep: Adequate
• Bowel and bladder movements: Regular
• Habits: None
10. General physical examination
• A middle aged woman moderately built and nourished,
conscious, cooperative, well oriented to time, place
and person.
• Vitals:
i. Blood pressure: 130/90 mm Hg measured in right
arm, supine
ii. Pulse Rate:86 bpm, normal in rate, rhythm, volume,
character, no delays
iii. Respiratory Rate: 18cpm
iv. Temperature: 98.2F
• No pallor, icterus, clubbing, cyanosis, generalised
lymphadenopathy or edema.
11. Examination of the breasts
• Consent of the patient was taken before
examination.
• The patient was examined in an adequately lit
room with exposure up to the waist. She was
examined in sitting, semi recumbent and
recumbent position.
12. Inspection
1. Breasts
i. Position- Right breast is at a lower level than left
breast
ii. Shape and size: Right breast appears larger than
left breast
iii. No puckering or dimpling seen
iv. Swelling- A diffuse lump is seen on the right
breast, predominantly the upper outer
quadrant, approximately 10x10 cm with a
smooth surface, skin over the lump appearing
normal.
13. v. Dilated veins present
2. Nipple
i. Both nipples present and symmetrical
ii. Normal in size, shape, surface position
iii. No flattening or retraction
iv. No discharge
14. 3. Areola
• Appears normal
• Colour brown
• Size- 3cm diameter
• No cracks, fissures, ulceration
4. Arm and thorax- clinically, no abnormality
seen. On raising the arm above the head, no
change in shape of the breast or lump
15. Palpation
• Left breast normal
• No local rise in temperature
• Tenderness present
• A single lump of size 8x8 cm felt near the areola
which is globular in shape, nodular surface,
having well defined margin and firm consistency
• Lump is not fixed to overlying skin
• Mobility of the lump is both vertically and
horizontally.
• Not attached to chest wall.
• Nipple- no underlying lump felt, no discharge
16. Examination of lymph nodes
i. Axillary lymph nodes
• Pectoral lymph nodes
• Brachial group
• Subscapular group
• Central group
• Apical group
ii. Supraclavicular lymph nodes- not palpable
Not palpable
17. Systemic examination
• CVS- S1, S2 heard, no murmurs
• RS-Bilateral NVBS heard
• PA- soft, non tender, no organomegaly
• CNS- higher mental functions normal
• Musculoskeletal system: Normal
• Rectal and vaginal examination- not done
18. Investigations
• Radiology- USG of breast and axilla,
Mammography
• FNAC
• PET scan
• USG Abdomen- for any liver mets
• Chest X-ray- for lung metastasis
• Spine X ray
• X ray of long bones
In locally
advanced
carcinoma
19. Diagnosis
• This is a case of right sided breast carcinoma
of stage cT3N0M0.
