Breast cancer physical examination: Difference between revisions

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===General Appearance===
===General Appearance===
*[[Patient|Patients]] with breast cancer are generally well appearing. [[Patient|Patients]] are generally oriented to time, place, and person.<ref name="PE">Breast Cancer. Ganfyd (2015) http://www.ganfyd.org/index.php?title=Breast_cancer#Presenting_Symptoms Accessed on january 16, 2016</ref><ref name="ss">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</ref>
*[[Patient|Patients]] with breast cancer are generally well appearing. [[Patient|Patients]] are generally oriented to time, place, and person.<ref name="PE">Breast Cancer. Ganfyd (2015) http://www.ganfyd.org/index.php?title=Breast_cancer#Presenting_Symptoms Accessed on january 16, 2016</ref><ref name="ss">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</ref>
===Vital Signs===
*Vital signs are generally normal in early stages.
*In advanced disease state, almost any abnormality is possible due to brain, bone, liver, and lung metastases.
===Neck===
===Neck===
Enlarged [[Supraclavicular lymph nodes|supraclavicular]] [[Lymph node|lymph nodes]]
Enlarged [[Supraclavicular lymph nodes|supraclavicular]] [[Lymph node|lymph nodes]]
===Breast===
===Breast===
*[[Lump]]
*[[Lump]]


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:*The [[lump]] may feel hard, irregular in shape and very different from the rest of the [[breast]] [[Tissue (biology)|tissue]]
:*The [[lump]] may feel hard, irregular in shape and very different from the rest of the [[breast]] [[Tissue (biology)|tissue]]
:*The [[lump]] may be [[Tenderness (medicine)|tender]], but it is usually not [[Pain|painful]].
:*The [[lump]] may be [[Tenderness (medicine)|tender]], but it is usually not [[Pain|painful]].
*Dimpling of the skin
*Dimpling of the skin
*[[Peau d'orange]]
*[[Peau d'orange]]
:*Thickening and dimpling of the skin
:*Thickening and dimpling of the skin
*Change in size of affected [[breast]]
*Change in size of affected [[breast]]
*Inverted [[nipple]]
*Inverted [[nipple]]
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*Crusting, [[Ulcer|ulcers]] or scaling on the [[nipple]] - in [[Paget's disease of the breast|Paget's disease of breast]]
*Crusting, [[Ulcer|ulcers]] or scaling on the [[nipple]] - in [[Paget's disease of the breast|Paget's disease of breast]]
*[[Discharge]] from [[nipple]] - mostly bloody
*[[Discharge]] from [[nipple]] - mostly bloody
===Respiratory===
===Respiratory===
[[Medical sign|Signs]] of [[metastasis]]
[[Medical sign|Signs]] of [[metastasis]]
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*[[Pleural effusion]]
*[[Pleural effusion]]
*[[Consolidation (medicine)|Consolidation]]
*[[Consolidation (medicine)|Consolidation]]
===Abdomen===
===Abdomen===
[[Medical sign|Signs]] of [[metastasis]] to [[liver]]
[[Medical sign|Signs]] of [[metastasis]] to [[liver]]
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*[[Hepatomegaly]]
*[[Hepatomegaly]]
*[[Ascites]]
*[[Ascites]]
===Extremity===
===Extremity===
Signs of metastasis
Signs of metastasis
*[[Bone]] [[tenderness]]
*[[Bone]] [[tenderness]]
*[[Pathology (disambiguation)|Pathological]] [[Bone fracture|fractures]]
*[[Pathology (disambiguation)|Pathological]] [[Bone fracture|fractures]]
===Neuromuscular===
===Neuromuscular===
Signs of [[metastasis]]
Signs of [[metastasis]]
*[[Headache]]
*[[Headache]]
*[[Seizure]]
*[[Seizure]]
*[[Personality change due to another medical condition|Personality change]]
*[[Personality change due to another medical condition|Personality change]]
*[[Papilledema|Papilloedema]]
*[[Papilledema|Papilloedema]]




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===Appearance of the Patient===
===Appearance of the Patient===
*Patients with [disease name] usually appear [general appearance].


===Vital Signs===
*Patients with [disease name] usually appear [general appearance].


*High-grade / low-grade fever
*
*[[Hypothermia]] / hyperthermia may be present
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Tachypnea / bradypnea
*Kussmal respirations may be present in _____ (advanced disease state)
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]


===Skin===
===Skin===

Revision as of 22:21, 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

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

Vital Signs

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

Neck

Enlarged supraclavicular lymph nodes

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 may be tender, but it is usually not painful.
  • Thickening and dimpling of the skin

Respiratory

Signs of metastasis

Abdomen

Signs of metastasis to liver

Extremity

Signs of metastasis

Neuromuscular

Signs of metastasis



Overview

Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

Physical Examination

Physical examination of patients with [disease name] is usually normal.

OR

Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

Appearance of the Patient

  • Patients with [disease name] usually appear [general appearance].

Skin

  • Skin examination of patients with [disease name] is usually normal.

OR

HEENT

  • HEENT examination of patients with [disease name] is usually normal.

OR

  • Abnormalities of the head/hair may include ___
  • Evidence of trauma
  • Icteric sclera
  • Nystagmus
  • Extra-ocular movements may be abnormal
  • Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
  • Ophthalmoscopic exam may be abnormal with findings of ___
  • Hearing acuity may be reduced
  • Weber test may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
  • Rinne test may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
  • Exudate from the ear canal
  • Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
  • Inflamed nares / congested nares
  • Purulent exudate from the nares
  • Facial tenderness
  • Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae

Neck

  • Neck examination of patients with [disease name] is usually normal.

OR

Lungs

  • Pulmonary examination of patients with [disease name] is usually normal.

OR

  • Asymmetric chest expansion OR decreased chest expansion
  • Lungs are hyporesonant OR hyperresonant
  • Fine/coarse crackles upon auscultation of the lung bases/apices unilaterally/bilaterally
  • Rhonchi
  • Vesicular breath sounds OR distant breath sounds
  • Expiratory wheezing OR inspiratory wheezing with normal OR delayed expiratory phase
  • Wheezing may be present
  • Egophony present/absent
  • Bronchophony present/absent
  • Normal/reduced tactile fremitus

Heart

  • Cardiovascular examination of patients with [disease name] is usually normal.

OR

  • Chest tenderness upon palpation
  • PMI within 2 cm of the sternum (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
  • Heave / thrill
  • Friction rub
  • S1
  • S2
  • S3
  • S4
  • Gallops
  • A high/low grade early/late systolic murmur / diastolic murmur best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the stethoscope

Abdomen

  • Abdominal examination of patients with [disease name] is usually normal.

OR

Back

  • Back examination of patients with [disease name] is usually normal.

OR

  • Point tenderness over __ vertebrae (e.g. L3-L4)
  • Sacral edema
  • Costovertebral angle tenderness bilaterally/unilaterally
  • Buffalo hump

Genitourinary

  • Genitourinary examination of patients with [disease name] is usually normal.

OR

  • A pelvic/adnexal mass may be palpated
  • Inflamed mucosa
  • Clear/(color), foul-smelling/odorless penile/vaginal discharge

Neuromuscular

  • Neuromuscular examination of patients with [disease name] 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 [disease name] is usually normal.

OR

  • Clubbing
  • Cyanosis
  • Pitting/non-pitting edema of the upper/lower extremities
  • Muscle atrophy
  • Fasciculations in the upper/lower extremity

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

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