92035720 Case Personal CA MAMMAE

7/27/2019 92035720 Case Personal CA MAMMAE

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Compiled by :

Aria Adhitya S

1102003035

Mentor:

Dr. H. Herry Setya Yudha Utama, Sp.B, MHKes, FInaCs

SURGERY DEPARTMENT

RSUD ARJAWINANGUN

PERIOD 30 January 7 April 2012

PERSONALCASE CARCINOMA MAMMAE


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BAB ICa Mamae case

STATUS OF PATIENTS :

A. PATIENT IDENTITY

Name : Mrs. S L

Age : 42 years

Sex : Female

Job : Housewife

Religion : Moslem

Address : Arjawinangun

B. ANAMNESA

Main complaint :Lump in left breast

Additional complaints : -

History of present illness :Mrs N, 42 years old, comes to Arjawinangun Hospital complains theres a lamp in

left breast that she had since 4 years ago. At first, it is a mobile sized, but in several mounth

it becomes bigger than before. On palpable, it feels pain. Theres no discharge comes from

nipple, It is immobile / fixed, There is no lumps on the right breast. Mrs S L said that this

lump doesnt affect patients breath. Patient said that her mother had the same illness.

Past medical history :Theres no same medical history in the past


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Family history of disease:Her mother had the same illness.

C. PHYSICAL EXAMINATION

Status PresentGeneral condition : Moderate ill appearance

Consciousness : compost mentis

vital sign :Blood pressure : 120/80 mmHg

Pulse : 80x/mnt

respiratory rate : 24x/mnt

temperature : 36.6 C

Generalis Status

Skin : Skin color is black, no jaundice, enough turgor

Head : Symmetrical, normochepal, equitable distribution of hair

Eyes : conjunctiva anemis (- / -), sclera jaundice (- / -), light reflex (+ / +) normal

Nose : Deviation of the septum (-), discharge (-)

Ears : symmetrical, cerumen right-left (+)

Mouth and throat :

Lips : not dry, and no cyanosis

Tonsils : T1/T1

Pharing : not hiperemis

Neck : Not deviasi, No enlargement of lymph glands

Thoracic :

Inspection : hemithorak symmetrical right and left in a state of static and dynamic

Palpation : tactile fremitus symmetrical right and left

Percussion : sonor to the hemithorax


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- Leukosites :8500 sel/cmm

- Platelet :256.000 sel/cmm

Blood glucose level :96 mg/dl

Rontgen :Results : No vesible heart enlargement

No vesible metastasis intra pulmonal

E. WORKING DIAGNOSIS

Carcinoma mammae sinistra

F. MANAGEMENT

- IVFD NaCl 20 drops/minutes- Cefotaxim 2x 1amp- Tramadol 2x1 amp- Ranitidin 2x1 amp- Modified Radical Mastectomy by lifting the breast tissue around the sinistra

G. PROGNOSIS

Quo ad vitam : dubia ad bonam

Quo ad functionam : dubia ad bonam


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CARCINOMA MAMMAE

A.DefinisiBreast canceris cancer that originates from the breast tissue. It can affect women of all ages

but most commonly affects those above 40. It is potentially fatal but achieving a complete

cure is also possible. There are 5 stages of breast cancer (stage 0, 1, 2, 3 and 4). Treatment

at stage 0 & 1 can result in cure rates of above 90%.

Fig 1. Most breast cancers begin in the cells that line the ducts ( ductalcancers). Some begin in

the cells that line the lobules (lobularcancers), while a small number start in other

tissues.
http://www.singhealth.com.sg/PatientCare/ConditionsAndTreatments/Pages/Breast-Cancer.aspxhttp://www.singhealth.com.sg/PatientCare/ConditionsAndTreatments/Pages/Breast-Cancer.aspx


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B.Pathophysioilogy


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C.Stages of Breast Cancer

S t a g e s o f B r e a s t C a n c e r

Stage Definition

Stage0

Cancer cells remain inside the breast duct, withoutinvasion into normal adjacent breast tissue.

StageI

Cancer is 2 centimeters or less and is confined to thebreast (lymph nodes are clear).

StageIIA

No tumor can be found in the breast, but cancer cellsare found in the axillary lymph nodes (the lymph nodesunder the arm)OR

the tumor measures 2 centimeters or smaller and hasspread to the axillary lymph nodesORthe tumor is larger than 2 but no larger than 5centimeters and has not spread to the axillary lymphnodes.

StageIIB

The tumor is larger than 2 but no larger than 5centimeters and has spread to the axillary lymph nodesORthe tumor is larger than 5 centimeters but has notspread to the axillary lymph nodes.

StageIIIA

No tumor is found in the breast. Cancer is found inaxillary lymph nodes that are sticking together or toother structures, or cancer may be found in lymphnodes near the breastboneORthe tumor is any size. Cancer has spread to theaxillary lymph nodes, which are sticking together orto other structures, or cancer may be found in lymphnodes near the breastbone.

StageIIIB

The tumor may be any size and has spread to the chestwall and/or skin of the breast

ANDmay have spread to axillary lymph nodes that areclumped together or sticking to other structures, orcancer may have spread to lymph nodes near thebreastbone.

Inflammatory breast cancer is considered at leaststage IIIB.
http://www.breastcancer.org/symptoms/types/inflammatory/http://www.breastcancer.org/symptoms/types/inflammatory/


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of each breast is normal. If you're not sure how hard to press, talk with your doctor or

nurse. Use each pressure level to feel the breast tissue before moving on to the next

spot

Move around the breast in an up and down pattern starting at an imaginary line drawnstraight down your side from the underarm and moving across the breast to the

middle of the chest bone (sternum or breastbone). Be sure to check the entire breast

area going down until you feel only ribs and up to the neck or collar bone (clavicle).

Mammogram. If you're over 40 or at a high risk for the disease, you should also have anannual mammogram.

Magnetic resonance imaging (MRI)For certain women at high risk for breast cancer, screening MRI is recommended along

with a yearly mammogram. It is not generally recommended as a screening tool by itself,

because although it is a sensitive test, it may still miss some cancers that mammograms

would detect.

Physical Exam by a doctor. The earlier breast cancer is found and diagnosed, the betteryour chances of beating it.

The actual process of diagnosis can take weeks and involve many different kinds of tests.

Waiting for results can feel like a lifetime. The uncertainty stinks. But once you understand

your own unique big picture, you can make better decisions. You and your doctors can

formulate a treatment plan tailored just for you.

G. Treatment

Generaltypesoftreatment

Local versus systemic therapy

Local therapy is intended to treat a tumor at the site without affecting the rest of the

body. Surgery and radiation therapy are examples of local therapies

Adjuvant and neoadjuvant therapy

Patients who have no detectable cancer after surgery are often given adjuvant

(additional) systemic therapy. Doctors believe that in some cases cancer cells may
http://www.breastcancer.org/symptoms/testing/types/mammograms/http://www.breastcancer.org/symptoms/testing/types/mammograms/http://www.breastcancer.org/symptoms/testing/types/mammograms/http://www.breastcancer.org/symptoms/testing/types/mammograms/


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break away from the primary breast tumor and begin to spread through the body by way

of the bloodstream even in the early stages of the disease. These cells can't be felt on a

physical exam or seen on x- rays or other imaging tests, and they cause no symptoms.

But they can establish new tumors in other organs or in bones. The goal of adjuvant

therapy is to kill these hidden cells. Some patients are given systemic therapy, usually

chemotherapy, before surgery to shrink a tumor in the hope it will allow a less extensive

operation to be done. This is called neoadjuvant therapy.

Surgery for breast cancerBreast conserving surgery

Lumpectomy removes only the breast lump and a surrounding margin of normal tissue.Radiation therapy is usually given after a lumpectomy. If adjuvant chemotherapy is to

be given as well, the radiation is usually delayed until the chemotherapy is completed.

Partial (segmental) mastectomy orquadrantectomy removes more breast tissue than a

lumpectomy. For a quadrantectomy, one-quarter of the breast is removed. Radiation

therapy is usually given after surgery. Again, this may be delayed if chemotherapy is to

be given as well.

For most women with stage I or II breast cancer, breast conservation therapy

(lumpectomy/partial mastectomy plus radiation therapy) is as effective as mastectomy.

Survival rates of women treated with these 2 approaches are the same. However, breast

conservation therapy is not an option for all women with breast cancer (see "Choosing

between lumpectomy and mastectomy" below

Radiation therapy can sometimes be omitted as a part of breast-conserving therapy.

Women who may consider lumpectomy without radiation therapy typically have all of -

the following characteristics

- they are age 70 years or older- they have a tumor 2 cm or less that has been completely removed- the tumor is hormone receptor-positive, and the women is getting hormone

therapy (such as tamoxifen)

- they have no lymph node involvement


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Mastectomy

Mastectomy involves removing all of the breast tissue, sometimes along with other

nearby tissues.

In a simple or total mastectomy the surgeon removes the entire breast, including the

nipple, but does not remove underarm lymph nodes or muscle tissue from beneath the

breast. Sometimes this is done for both breasts (a double mastectomy), especially when

it is done as preventive surgery in women at very high risk for breast cancer. Most

women, if they are hospitalized, can go home the next day

A modified radical mastectomy involves removing the entire breast and some of the

axillary (underarm) lymph nodes. This is the most common surgery for women with

breast cancer who are having the whole breast removed.

For some women who have smaller tumors, one option may be a newer procedure

known as a skin-sparing mastectomy, where most of the skin over the breast (other than

the nipple and areola) is left intact. This procedure is described in more detail in

"What's new in breast cancer research and treatment?"

A radical mastectomy is an extensive operation where the surgeon removes the entire

breast, axillary lymph nodes, and the pectoral (chest wall) muscles under the breast.

This surgery was once very common. But because of the disfigurement and side effects

it causes, and because a modified radical mastectomy has been proven to be as effective

as a radical mastectomy, it is rarely done today

Lumpectomy

A lumpectomy is surgery to remove a small area of breast tissue that is cancerous.This

surgery is carried out only in early breast cancer, if the area of tissue to be removed is

relatively small. Women who choose a lumpectomy will require radiation therapy to

destroy any cancer cells that may remain in the area


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REFERENCES

1. Abeloff MD, Wolff AC, Wood WC, et al. Cancer of the Breast. In: Abeloff MD, ArmitageJO, Lichter AS, et al, eds. Clinical Oncology. 3rd Ed. Philadelphia, Pa: Elsevier; 2004: 2369-

2470.

2. American Cancer Society. Cancer Facts and Figures 2008. Atlanta, Ga: American Cancer

Society; 2008

3. American Joint Committee on Cancer. AJCC Cancer Staging Manual, 6th ed. New York:Springer; 2002: 221-240.

4. Avis N, Crawford S, Manuel J, et al. Quality of life among younger women with breastcancer. J Clin Oncol. 2005;23:3322-3330.

5. Darbre PD, Aljarrah A, Miller WR, et al. Concentrations of parabens in human breasttumours. J Appl Toxicol. 2004;24:5-13.

6. National Cancer Institute. Surveillance Epidemiology and End Results (SEER) CancerStatistics Review, 1975-2005. 2008. Available at:

http://seer.cancer.gov/csr/1975_2005/sections.html. Accessed July 17, 2008.

92035720 Case Personal CA MAMMAE

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