Breast cancer history taking/examination

 History taking
o SOCRATES
 Site, onset – when did you notice it, character – what did it feel like, associated symptoms –
weight loss, nipple discharge, change in sensitivity or consistency of the area, time – how
long did you notice it for, exacerbating – does it change with your period at all, any other
changes in it that you notice beside the change in size, ever happened before
 PMHx – menarche, children menopause, HRT
 Past SurgHx – any radiation in that area before
 Medication history – use of oral contraceptive pill
 Family – Family history of breast cancer, genetic testing done before
 Social – alcohol, smoking, illicit substances
 Screening and vaccination and genetic testing – attendance of screening
o Length of time mass noticed
o Pain
o Change in size, termperature and texture
o Relationship to menstrual cycle
o Nipple discharge
o Do you conduct regular self examinations
o Previous cyst aspiratuions
o Risk factor
 History of breast or ovarian cancer + what age
 Personal history of breast cancer, obesity, early menarche and late menopause, late first
pregnancy, mantle radiation, heavy alcohol use, HRT
 BRCA1/2
 Attendance of regular screening
 Examination
o Sit up with chest fully exposed
 Inspection
 Nipple retraction, pagests disease
 New asymmetry
 Visible veins (if unilateral)
 Skin dimpling and peau dorange
 Areola plaque
 Raise hands above her head and then lower slowly
 Tethering of nipple or skin
 Shift in position of the nipples
 Visible masses in the axilla
 Hands on hip
 Palpation
 Supraclavicular and axillary regions for lymphadenopathy
 Hand behind head
 Pulps of middle 3 fingers parallel to the contour of the breast
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 Feel behind the nipple for lumps and note if any fluid can be expressed
o Bright blood (carcinoma), yellow serous fluid(ealy pregnancy), green fluid
(mammary duct ectasia)
 Evaluation of breast lump
 Position
 Size, shape and consistency
 Tenderness
 Fixation
 Single or multiple lesions
 PS for tender love and care – position, size, shape, fixation, lesion number,
consistency

Colon cancer history taking and examination

- Recent change in bowel habits – blood, melaena, diarrhea, constipation

- Symptoms of anaemia – fatigued easily, history of anaemia, change in menstruation
- Abdominal pain
- Symptoms of the bowel or bladder
- Staging done, colonoscopy, size, number, type
- Family history - thousands of polyps – FAP -> if tumor ask about tumor to the brain, jaw or bone (Turcot and
Gardiner)
- Any genetic testing and screening