Breast cancer physical examination: Difference between revisions

Jump to navigation Jump to search
No edit summary
Line 123: Line 123:
===Extremities===
===Extremities===
* Extremities examination of patients with breast cancer is usually normal.
* Extremities examination of patients with breast cancer is usually normal.
* The followings are suggesting metastatic disorder:
* The followings are suggesting metastatic disorder:
 
:*[[Cyanosis]] in lung metastasis
*[[Cyanosis]] in lung metastasis
:*Pitting[[edema]] of the lower extremities suggesting malnutrition and liver involvement
*Pitting/non-pitting [[edema]] of the upper/lower extremities suggesting malnutrition and liver involvement
:*Muscle atrophy due to malnutrition is late stage metastatic cancer
*Muscle atrophy due to malnutrition is late stage metastatic cancer
:*[[Bone]] [[tenderness]]
*[[Bone]] [[tenderness]]
:*[[Pathology (disambiguation)|Pathological]] [[Bone fracture|fractures]]
*[[Pathology (disambiguation)|Pathological]] [[Bone fracture|fractures]]


==References==
==References==

Revision as of 23:06, 1 October 2019

Peau d’ orange appearance in breast cancer. Case courtesy of Rajendran MC. http://generalsurgeryclinics.blogspot.com/2013/06/peau-d-orange-appearance-in-carcinoma.html

Breast Cancer Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Breast cancer from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic study of choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

CT scan

MRI

Echocardiography or Ultrasound

Other Imaging Studies

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Breast cancer physical examination On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Breast cancer physical examination

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Breast cancer physical examination

CDC on Breast cancer physical examination

Breast cancer physical examination in the news

Blogs on Breast cancer physical examination

Directions to Hospitals Treating Breast cancer

Risk calculators and risk factors for Breast cancer physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2] Mirdula Sharma, MBBS [3]

Overview

Patients with breast cancer usually are generally well appearing. Physical examination of patients with breast cancer is usually remarkable for lump in the breast, peau d'orange, and inverted nipple.

Physical Examination

General Appearance

  • Patients with breast cancer are generally well appearing. Patients are generally oriented to time, place, and person.[1][2]
  • Nevertheless, in late stages patients appear ill, pale, and might present with decreased level of consciousness.

Vital Signs

  • Vital signs are generally normal in early stages.
  • In the advanced disease state, almost any abnormality is possible due to brain, bone, liver, and lung metastases.

HEENT

  • HEENT examination of patients with breast cancer is usually normal, particularly in the early stages.
  • In metastatic breast cancer the following abnormalities might be present:
  • Icteric sclera due to liver metastasis
  • Ophthalmoscopic exam may be abnormal with findings of increased ICP due to brain metastasis.
  • Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae due to chemotherapy or widespread disease immunosuppression.

Neck

Lungs

  • Pulmonary examination of patients with breast cancer is usually normal, particularly in early stages.
  • In metastatic breast cancer the following abnormalities might be present suggesting consolidation and pleural effusion due to metastatic disorder::
  • Asymmetric chest expansion OR decreased chest expansion
  • Hyporesonant lung auscultation
  • Fine/coarse crackles upon auscultation of the lung bases either unilaterally or bilaterally
  • Rhonchi
  • Vesicular breath sounds OR distant breath sounds
  • Normal/reduced tactile fremitus

Heart

  • Cardiovascular examination of patients with breast cancer is usually normal/none contributory.

Breast

  • May be attached to the skin or chest wall and cannot be moved.
  • The lump may feel hard, irregular in shape and very different from the rest of the breast tissue
  • The lump maybe tender, but it is usually not painful.
  • Thickening and dimpling of the skin

Abdomen

  • Abdominal examination of patients with breast cancer is usually normal/none contributory, particularly in the early stages.
  • In metastatic breast cancer the following abnormalities might be present:

Skin

With respect to the disease stage and complications, the skin could be either normal, pale, or icteric.

Extremity

Signs of metastasis

Neuromuscular

Signs of metastasis


Back

  • Back examination of patients with breast cancer is usually normal, particularly in the early stages.
  • In metastatic disease, vertebrae is one of the most common sites of metastasis, hence point tenderness over the vertebrae is quite common.

Genitourinary

  • Genitourinary examination of patients with breast cancer is usually normal.

Neuromuscular

  • Neuromuscular examination of patients with breast cancer is usually normal.

OR

  • Patient is usually oriented to persons, place, and time
  • Altered mental status
  • Glasgow coma scale is ___ / 15
  • Clonus may be present
  • Hyperreflexia / hyporeflexia / areflexia
  • Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
  • Muscle rigidity
  • Proximal/distal muscle weakness unilaterally/bilaterally
  • ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
  • Unilateral/bilateral upper/lower extremity weakness
  • Unilateral/bilateral sensory loss in the upper/lower extremity
  • Positive straight leg raise test
  • Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
  • Positive/negative Trendelenburg sign
  • Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
  • Normal finger-to-nose test / Dysmetria
  • Absent/present dysdiadochokinesia (palm tapping test)

Extremities

  • Extremities examination of patients with breast cancer is usually normal.
  • The followings are suggesting metastatic disorder:

References

  1. Breast Cancer. Ganfyd (2015) http://www.ganfyd.org/index.php?title=Breast_cancer#Presenting_Symptoms Accessed on january 16, 2016
  2. Breast cancer. Canadian Cancer Society (2015) http://www.cancer.ca/en/cancer-information/cancer-type/breast/signs-and-symptoms/?region=on#ixzz3xScycfqv Accessed on January 16, 2016

Template:WH Template:WS