A Lump, a Bump to Life

01 March 2014

Case study:

46 year old Miss Cupido is a single mom from x town. She has enjoyed the most part of her life with no ailments and has was blessed with two children at the age of 30. No one in her immediate family has ever had any unprecedented deaths from illness but one or two distant aunts has succumbed to some malignancy. She is a non-smoker who takes pride on relative healthy living within her occupation as a company clerk.

She has reported the size of her left breast increasing making them equal in size where as previously not so. It did not bother her for almost a year and a half when she noticed a small bump with overriding orange peel skin.

In light of the breast cancer awareness month that has passed we continue to bring awareness right through. breast cancer is one of the most common malignancies occurring in women world wide. It is important to spread this awareness with great frequency and emphasis.

Breast cancer in the most basic definition of any type of cancer is the abnormal proliferation of breast tissue (group of cells) which leads to the increase in size and number of abnormal cells or breast tissue.

Incidence/Risk factors:

Breast cancer is one of the most common cancers in women up there with cervical cancer as already alluded to above. According to the Journal of Clinical Oncology, S.A, 1 in 81 of African women comparable with international figures and 1 in 13 whites also comparable to international figures.

Risk factors are vast but for the purpose of this article the common ones will be highlighted. Most women with breast cancer do not have identifiable risk factors.

Risk factors include (among others):

  • family history of breast cancer, genetics (BRCA1, BRCA2)
  • delayed childbearing
  • family history of proliferative breast conditions
  • use of hormonal medication have been controversially mentioned

Clinical presentation:

How does breast cancer present? How do I know, or when should I suspect breast cancer? These are anxious questions that women usually ask. Most of the presentation of breast cancer is mostly as a physical sign commonly a lump or a bump on the breast.

Early signs:
  • single non-tender firm hard mass
  • ill-defined margins
  • palpable mass
Later signs:
  • skin/nipple retraction
  • Axillary lymph nodes
  • Breast enlargement
  • erythema ,edema, ulceration(orange peel appearance) ""peau de orange"", pain, fixation of the mass to the chest wall.

Diagnosis: Breast cancer is mostly diagnosed on clinical grounds meaning by listening to the patients history, inspection: looking and inspecting the breast, palpation and percussion: feeling the mass with hands n ascertaining pain fixation which has staging and management implications.

However, the definitive diagnosis can be made by imaging studies like mammogram which may show spiculated lession or ultrasound to exclude other differentials then followed by tissue diagnosis through biopsy.

Summary of diagnosis:

  • History
  • examination
  • imaging
  • biopsy

Staging: staging system used for breast cancer is based on clinical findings. The size of the tumour (T) presence of lymph nodes(N) presence of metastasis (M) which indicates spread and severe disease.

The staging is I - IV increasing in severity with subdivisions under each stage which has implications on management from curable to palliative

For the purposes of this article details on staging will not be mentioned.

The purpose of this article is awareness, hence this part on management and treatment will just highlight a few facts but emphasise on prevention. In usual cases when the diagnoses of cancer is made it devastates the patient and family, however like most medical condition early detection plays important role in the prognosis.

The examination of the breast is most important, self-examination is vital.

Examination of the breast:
It is done with the patient sitting hands on the side. The breast is divided into four quadrants and each palpated with a flat palm of the hand. Then the patient is asked to lift the hands over her head and exam repeated. The patient then presses hands on hips to flex pectoralis major masses the lymph nodes are also palpated for. The patient then lies down and abducts arm to inspect for further changes.

Breast self exam: If this is not done correctly can raise false alarms. It should be done at least 7-8 days after the menstrual period. First, stand in front of the mirror and inspect for any changes, press firmly on hips to flex the chest muscles. Then the patient lies supine and palpate the 4 quadrants.

Interventional treatments:

lumpectomy - breast conservation therapy where only the lump is removed.

Mastectomy - radical mastectomy on the whole breast and some neighbouring tissue (entire breast, skin, nipple and areolar complex, pectoralis fascia and axillary lymph nodes)

Chemotherapy - medical treatment adjuvant therapy - chemotherapy to prevent recurrence Neo-adjuvant therapy - chemotherapy before resection.

Prognosis: The prognosis of most cancers depend mostly on the stage at which intervention is initiated. The earlier the better. So stage I, II, III maybe curable cancers whereas stage IV may need palliation.

This article was grossly simplified to make awareness simpler for further details questions may be posted in the comment area below.

The information was compiled from various medical resources.

Journal of Clinical Oncology
Talley and O'Connor
Current Diagnosis and Treatment Surgery, 3rd edition LANGE

Dr Tsiko Makwarela

Related Topics:

  • Cancer
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