Cancer Breast Examination

Cancer Breast

General : Age
Weght
Height
Siting on the bed /Chair

eye
nose
neck
extremities - ( browny ) oedema ( lymphadema )

Local : Exposed to the wrist
Inspection - လက္ေဘးခ်ၿပီး ထိုင္ပါ ။
both breasts are same size/ not

NIPPLE - both beast are _ same level / not
_ same size / not
_ shape is normal / retracted / prominent
_ Others _ crack
_ulcer
_discharge
လက္အေ ပၚေျမွာက္ေပးပါ ။
Both nipples are _ same level / raised on R / L

လက္ေဘး ျပန္္ ခ် ေပး ပါ ။

AREOLA - level _ same / not
- size _ equal / not
- surface _ crack / ulcer / discharge

LUMP - visible on R / L side breast
site - upper outer quadrant ( mostly )
size - ___ x ___ x ___ cm in greatest dimention
shape - globular
surface - smooth
margin - well defined margin

SKIN OVER BREAST - colour - normal / red
dilated veins
dimplilng
Peau d' orange
singn of inflammation
Others - scar ( ရွိ ရ င္ ဆက္ ေျပာ ---)
ulcer ( site ,size , shape , margin , edge, floor, discharge )
discharge

ကိုယ္ ကို ေရွ့ ကိုင္း ေပး ပါ ။
R / L side breast is left behind ( Ca ျဖစ္ တဲ့ဘက္ က က်န္ခဲ့မယ္ )
More proinent of dimpling

Palpation : ( စာထဲ မွာက Normal breast ကို အရင္စမ္း ဆိုေပမယ့္စာေမးပြဲ မွာ Abnormal breast ဘက္ပဲအရင္စမ္းပါ။ )
( Palm of fingerနဲ ့ 4 quardran ကို စမ္း ပါ ။ )( လက္ ဖ၀ါး တျပင္လံုး နဲ ့ စစမ္းၿပီးမွ လက္ေခ်ာင္း ျပင္နဲ ့စမး ရ မယ္ )

Temparture
Tenderness
LUMP - site - upper outer quadrant
size - __ x __ x __ cm
shape - globular ( fidroadenoma ဆိုရင္) / irregular ( Ca ဆိုရင္ )
surface - smooth ( bedign ) / irregular ( Ca )
consistancy - cystic ( Fluctuation test ဆက္စမ္းေပး-----)
firm ( fibroadenoma )
hard ( Ca )
margin - well defined / irregular

Tests ----------

Skin fixity by Pinch test - အေရျပားကို ဆြဲံၾကည့္ပါ။ တေနရာမက ဆြဲ ၾကည့္ဖိုလိုအပ္တယ္ ။
there is fixity or tethered
Fixityto breast tisue - breast tissue ကိုလက္နဲ ့axillary fold ကို ကိုင္ထိန္းထား ၿပီး Lump ကို ဘယ္ညာ တြန္းေရြွ့ ၾကည့္ပါ။
fixity to breast tissue present or not
Fixity to underlying fascia and muscle -(1) ခါးေထာက္ခိုင္းပါ - ၿပီးရင္ -Lumpကိုalong and perpandicular to P.major တြန္းေရႊ ့ၾကည့္ပါ ။
-(2)ခါးကို အားပါပါေထာက္ ခိုင္း ပါ။ ကို ကိုင္ၾကည့္ၿပီး တင္းေနတာေသခ်ာပါေစ ။
ၿပီးရင္ -Lump ကို along and perpandicular to P.major muscle အတိုင္း ထပ္ၿပီး တြန္းေရႊ ့ၾကည့္ပါ ။
fixity to underlying fascia and muscle present or not

( Lower outer quadrant LUMP ဆို ရင္ Serratous Anterior muscle fixity စမ္းဖို ့-လက္ဆန္ ့တန္းၿပီး နံရံ ကိုတြန္းသလိုလုပ္ခိုင္း -ၿပီးမွ fixity စမ္းပါ ။
fixity to chest wall သိဖို ့- ပက္လက္အိပ္ ခိုင္း ၿပီး ကို ရင္ဘတ္ေပၚ မွာ တြန္းေရႊ ့ ၾကည့္ပါ ။ )

---------------------------
Axillary Lymph node and Supraclavicular lymph node ေတြစမ္းေပးပါ ။ - site
numbers
size
consistancy - firm
surface
#mobility

Other breast and axillary ေတြဆက္ စမ္း ေပး ပါ ။
တျခား ဘာစမ္းခ်င္ေသးသလဲ ဆုိ၇င္ - Chest
Abdomen ( liver , spleen, ascites , krukenberg 's tumour )
Vaginal examination
Per-Rectal examination


Diagnosis : Left sided Ca breast Manchester staging 2 ,T N1 M0

Difeential Diagnosis : fibroadenoma
fibroadenosis
fibrosystic disease
mammary duct ectasia
traumatic fat nacrosis

Staging :

(1) Manchester staging

Stage 1 - tumour confined tho the breast
no skin ,muscle ,lymph node involvement
Stage 2 - 1 + ipsilateral mobile axillary lymph node involvement
Stage 3 - 2 + ipsilateral fixed axillary lymph node involvement
ipsilateral supraclavicular lympnode involvement or
attach to pectoralis majour muscle or
estensive skin invlovement
Stage 4 - chest wall fixation
contralateral breast / axillary lymphnode / clavicular lymph node involvement
lympoedema
distant metastasis

(2) TNM staging

T is - cancer insitu
T 1 - less than 2 cm
T 2 - 2 to 5 cm
T 3 - more than 5 cm
T 4 - skin involvement

N 0 - no lymp node involvement
N 1 - mobile ipsilateral axillary lymph node
N 2 - fixed ipsilateral axillary lymph node
N 3 - supra clavicular Lymph node

M 0 - no metastasis
M 1 - metasis

Invetigation : for diagnosis - FNAC
needle biopsy
USG
MRI

for staging - chest x ray
USG abdomen

Treatment : Stage 1 and 2 - early breast cancer - locoregional treatment
Stage 3 and 4 - adbanced breast cancer - systemic theraphy - chemptheraphy
homornal theraphy
- radiotheraphy
- toilet mastectomy
- treatment of metastasis