Kas 7-8E: The patient with breast cancer II.
34 years old woman is referred by a surgeon to an oncological department for adjuvant
treatment and follow-up.
Family history: mother and grandmother underwent a therapy of breast cancer, now are only
followed-up
Past medical history: has never been seriously ill, no-smoker, alcohol occasionally,
hormonal contraception, Allergies: allergy to Cotrimoxazolum
History of the present complaint: mammographic and US screening because of hormonal
contraception. On last mammography suspicious lesion in the right breast was diagnosed,
after biopsy with unclear pathology partial mastectomy was performed. Intraductal carcinoma
was histologically verified. Axillary sampling was also performed.
Physical examination: patient in good general condition, there is no obvious pathology.
Locally: a scar after wide excision with postsurgical infiltration about 15mm in upper outer
quadrant of the right breast. Well healed. No palpable masses in the breast, no axillary
lymphadenopathy. Minimal post-surgical swelling in supraclavicular region and right hand,
but no palpable nodes. Right hand with limited mobility, especially limited elevation.
Other examinations: FBC: Hb 10,1 g/dl, erytrocytes 2,98 x 1012/l, HTK 29,8 %, leu 5,8 x
1012/l, trombo 250 x 1012/l.
Biochemistry: normal, CXRay: normal. Histology: … intraductal carcinoma 10 mm in diam.,
tumour is not reaching margins, grading of the tumour is not established. Axillary dissection:
13 lymphnodes identified, all free of tumour.
Tasks and question:
1. Determine the stage of disease (advanced, early)
2. Do you need any further information to start the treatment? If yes, what examinations
are necessary?
3. What is the most often metastatic site of breast cancer?
4. What is the patient’s prognosis?
5. Is swelling of the right hand connected with the diseases or surgery ?
6. Folow-up: is billateral or only on right side mammography and US necessary after the
surgery?
7. Patology: Types of breast carcinoma in situ
8. Patophysiology of lymfatic system