Concluded Case

CARCINOMA of breast

CARCINOMA of BREAST Chief Complaints HIstory of a small swelling right breast since 20 years - but has increased rapidly in last 3 months History 20 years back patient felt a painless swelling in right breast - but since last 3 months it has grown rapidly to cause an alarm to the patient to consult a doctor .Swelling is painless , and no nipple discharge or associated complaints Vitals All vitals are with in normal limits Physical Examination On Examination a fixed hard lump palpable in upper outer quadrant of right breast . No tenderness . Not fixed to chest wall but fixed to pectoral muscles Skin is free and not adhered to the lump Right axillary lymph nodes are palpable Investigations Mammography - shows a BIRADS 4C lesion in right brest F.N.A.C - an infiltrating duct carcinoma Diagnosis Carcinoma of breast Management Will depend upon the staging Patient is being investigated further with CT chest , USG abdomen and if possible a PET scan Opinions regarding further approach in this case are welcomed

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PET Scan not indicated If no mets on staging BCS/MRM If BCS do a core needle biopsy &ER,PR,Her2,Ki..Mark the tumour with permanent dye& neo adjuvant chemo 3Cycles then BCS followed by completion chemo &RT and hormone block if receptor postive and herceptin if indicated If no BCS go for MRM+/-reconstruction Detailed HP &Breast panel and adjuvant accordingly ie chemo+RT +/- herception or hormone block

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PET Scan not indicated If no mets on staging BCS/MRM If BCS do a core needle biopsy &ER,PR,Her2,Ki..Mark the tumour with permanent dye& neo adjuvant chemo 3Cycles then BCS followed by completion chemo &RT and hormone block if receptor postive and herceptin if indicated If no BCS go for MRM+/-reconstruction Detailed HP &Breast panel and adjuvant accordingly ie chemo+RT +/- herception or hormone block

Valuable opinion
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Radical mastectomy with axillary clearance. PETCT to assess the extent of spread. ER,PR assessment . Chemo- radiotherapy follow up. Tamoxifen follow up.

SUGGESTIVE. OF CARCINOMA BREAST.. ADVISABLE.. RADICAL MASTECTOMY WITH CHEMOTHERAPY RADIOTHERAPY

Infiltrating ductal cell carcinoma breast BIRADS4C Possible adv is radical mastectomy Followed by chemo and radiotherapy

Thanx dr Ashok Leel
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Staging of Tumour to be done.Following investigations are advised Whole body scan LFT and USG of whole abdomen

Hormone status of tumour by truecut biopsy or mastectomy specimen is also very important for further treatment.

Mastectomy specimen or biopsy to know hormonal status with whole body scan will be helpful in future management.

Thanks Dr Dinesh Gupta
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Radical mastectomy followed by chemotherapy and radiotherapy is advisable

Thanks Dr. Dinesh Gupta , Dr. Krishnan Pichumani
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for a critical and combined disease like cancer you have to go for panchkarma treatment. specially starting with karm kaal yog basti. followed by other panchkarma as per petient and disease prakrati

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