Case of Breast Carcinoma

History
45 yrs/lady Resident of Bihar Illiterate Low socioeconomic status House maker

History
Chief complaints

-Lump in right breast x 6 months -ulceration in the swelling x2 months

Insidious onset, initially 2 x 2 cms , rapidly progressed to present size of 10x10 cms Initially painless but since 2 months patient complains of dull aching continuous pain which gets relieved by medication

History
H/o ulceration 2 months back, associated with foul smelling discharge Ulcer progressively increased in size to present size of 7x7 cms No h/o discharge from the nipple No h/o retraction of nipple

History
No h/o loss of weight /appetite No history suggestive of metastasis like hemoptysis, breathlessness, bone pains, jaundice, headaches, sezuires No h/o bowel or bladder disturbances No h/o of intake of oral contraceptive pills No h/o any addictions

History
Menstrual History
Attained menopause 5yrs back Menarche at 12 years P3L3, Breast fed all children First child birth 20 years back

Family history
No h/o of breast cancers, ovarian or colorectal malignancies in family (first degree relatives).

Examination
Middle aged, postmenopausal female Moderately built and nourished Conscious ,co-operative,well oriented to time, space and person Patient occupying decubitus of choice Performance status = 90 (Karnofskys) Normal hydration

Examination
Vitals
Pulse 84/min, right radial, regular BP 124/80 mm Hg Respiratory rate 17/min Afebrile to touch

No pallor/icterus/edema/cyanosis No generalised lymphadenopathy

Right axillary lymphnode - palpable

Examination
Left Breast and axillaNAD Right breast-Nipple-areola complex slightly at higher level than left,seen more prominently when patient lifts both her arms up - prominent veins present over chest wall and breast Ulcero-proliferative growth in the upper outer quadrant, 10 x 10 cms Irregular margins, Everted edges and slough on the floor with pale granulation tissue Foul serosanguinous discharge Bleeds on touch Indurated surrounding skin. Nipple not retracted/no discharge

Examination
Firm, mobile {not fixed to pectoralis major muscle} Irregular margins No other lump palpable in the right breast

Examination of Breast

Examination of Breast

Examination
Axilla
Enlarged central group of lymphnodes 3 in number Maximum size of 2x2cms Mobile B/L Supraclavicular regions are not full

Examination
Respiratory system normal Cardio-vascular system S1S2 heard, no murmurs Central Nervous system normal Per abdominal examination normal Spine and external genitalia normal P/R &P/V examination- NAD

Diagnosis
45 years, post menopausal lady with fungating growth in the right breast s/o locally advanced breast carcinoma T4bN1M0