INVASIVE

DUCTAL
CARCINOMA
GROUP S(4A)
GROUP MEMBERS

THAKUR SUSHIL
URVISH PANCHAL
SRINIVAS VASHISTHA
PATEL VIDHI VANDITKUMAR
KODURI VIJAY KUMAR REDDY

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 Table of Contents

01 02 03
HISTORY TAKING PHYSICAL ASSESSMENT
EXAMINATION

04 05
OPERATIVE FINDINGS CASE DISCUSSION
HISTORY TAKING
GENERAL DATA
NAME: S.B.

AGE: 32 YEARS

SEX: FEMALE

DATE OF BIRTH: 03/29/1990

PLACE OF BIRTH: DAGUPAN CITY, PANGASINAN

PRESENT ADDRESS: MANGALDAN, PANGASINAN

NATIONALITY: FILIPINO

RELIGION: ROMAN CATHOLIC

DATE OF ADMISSION: JUNE 27, 2022

TIME OF ADMISSION: 8:30 AM

CHIEF COMPLAINT:
RIGHT BREAST MASS
AND TENDERNESS
HISTORY OF PRESENT ILLNESS:

6 months PTA (12/13/2021):

● Patient experienced pain in her left breast after her one year old baby
bumped his head into her breast. She then experienced pain of 7/10
on her left breast.
● There were no associated breast redness and tenderness.
● No consult was done. No medications taken.

5 months 9 DAYS pta(12/18/2021):

● Symptom progressed now with pain of 10/10 radiating to the left
neck region with breast swelling, redness and tenderness which
prompted consult to R1MC OPD
● No associated fever and discharge.
● Ultrasound was done which revealed an ill-defined cystic lesion at 11
to 12 o’clock measuring approx 4.20x4.19(walnut size) cm on left and
several anechoic cystic structure at 12 o’clock and 6 o’clock with sizes
2.74x 2.20 & 0.75x0.37cm, on right.
● She was then scheduled for a biopsy.
HISTORY OF PRESENT ILLNESS:

5 months 6 days pta (12/21/2021):

● Symptoms were persistent.
● She went back to R1MC OPD and had core needle biopsy
which revealed:
- a chronic mastitis in left breast
- invasive carcinoma, no special type, one fragment on right breast
● She was then prescribed unrecalled antibiotics which she
took for 7 days which provided relief of the left breast
lump and tenderness.
● Due to the finding of the biopsy in her Right Breast, she
was advised for Modified Radical Mastectomy. However,
due to financial constraints the patient did not opt for
operation and lost to follow up.
HISTORY OF PRESENT ILLNESS:

FEW WEEKS PTA:

● Patient went in for a follow-up checkup and scheduled her
operation in R1MC after few days
● No other associated symptoms
● There were no medications taken

Few hours pta

● Symptoms Persisted.
● No associated Fever, Anorexia, Weight loss, Breast Redness and
Tenderness, nipple Discharge, constipation and edema.
● Consulted in R1MC for scheduled MRM and subsequently
admitted.
 PAST MEDICAL HISTORY

● No heredofamilial diseases
● Underwent C-section (oct 28, 2020)
● No previous accident/ trauma
● No known allergies to food and medications
● Completely immunized
Family History

● History of breast cancer on the

maternal side
● Father has gout arthritis
● No other heredofamilial Disease
 PERSONAL/SOCIAL/ENVIRONMENTAL
History

● Housewife
● Non-cigarette smoker
● Non-alcoholic beverage drinker
● (-) Illicit Drugs
● Consumes mostly rice, vegetables, fruits, coffee
 OB/ MENSTRUAL HISTORY

● G1P1 (1001)
● LMP : June 14 2022
● Menarche: 13 years old
● Interval: Regular
● Duration: 5-7 days
● Amount: 4-5 pads
● Symptoms: (+) Dysmenorrhea, (+) Headache
● (-) Use of Contraceptive Pills
 Review of Systems
GENERAL (-) weight gain/loss, (-) fatigue

SKIN (-) rashes, (-)dryness, (-) pruritus

HEENT (-) headache, (-) dizziness, (-)eye pain/ redness, (-) blurred vision,
(-) double vision, (-) ear pain/discharge, (-)hearing problem, (-)
epistaxis, (-) bleeding gums, (-) sore throat

RESPIRATORY (-) cough, (-) dyspnea, (-) hemoptysis, (-) wheezing

CARDIOVASCULAR (-) chest pain, (-) palpitation, (-) cyanosis

GASTROINTESTINAL (-) loss of appetite, (-) nausea and vomiting, (-) regurgitation, (-)
dysphagia, (-) hematemesis, (-) light-colored stools
 Review of Systems
GENITOURINARY (-) dysuria, (-) gross hematuria, (-) urinary
urgency, (-) frequency

MUSCULOSKELETAL (-) muscle pain (-) muscle weakness, (-) joint

pain/ swelling, (-) stiffness

NERVOUS (-) paralysis, (-) seizure, (-) loss of

consciousness, (-) numbness

HEMATOLOGY (-) easy bruising, (-) bleeding tendency

ENDOCRINE (-) heat/cold intolerance, (-) polydipsia,

(-)polyphagia
GENERAL SURVEY

Vitals
BP : 120/80
HR : 82
Patient is conscious, coherent,
RR : 21
cooperative, oriented to time and place,
TEMP : 37℃
not in cardiopulmonary distress
WEIGHT : 50 kg
HEIGHT: 4’8”
BMI: 24.7
 Physical Examination

SKIN (-)jaundice, Warm to touch. Good skin turgor. No pallor, cyanosis, lesions or excoriation.

HEENT Normocephalic, black hair evenly distributed.

● Anicteric sclera. Pink palpebral conjunctiva. Eyes symmetrical, pupils are 2-3 mm
in diameter, and equally
round & reactive to light and accommodation.
● Ears are symmetrical. No swelling, redness or discharges.
● No nasal discharge, (-) deformity, nontender
● Moist and pink gingiva and mucosa. No lesion.

CHEST AND LUNGS (-) Symmetrical Chest Wall Expansion. Resonant. Clear Breath Sound.

BREAST Asymmetric breast, irregular shape, (+)multiple palpable breast mass UIQ & LIQ, (+)
tenderness, no Peau d'orange appearance , no lymphadenopathy was noted
 Physical Examination

HEART Adynamic Precordium, Normal rate, regular rhythm, no murmur

ABDOMEN Flat regular contour. No bulges, stretch marks, scars or lesions.

Normoactive bowel sounds. Tympanitic. Soft (-) organomegaly (-)
mass (-) tenderness (-) muscle guarding

GENITALIA Grossly female, no swelling, no discharge

RECTUM No perirectal lesions or fissures. External sphincter tone intact.

Rectal vault with no mass. No rectal bleeding was noted

EXTREMITIES No visible joint swelling, no deformities, no limitation of ROM,

no edema. Peripheral pulses are equal. Capillary refill is less than
2 sec.

NEUROLOGICAL EXAMINATION GCS 15, no sensory deficits,

Muscle strength : 5/5 in all extremities
ASSESSMENT
 SALIENT FEATURES
SUBJECTIVE OBJECTIVE
● 32/F
Breast (Right)
● Breast lump ● Solid hypoechoic mass (3.53 x 1.74) on the
right breast periareolar region
● Breast pain
Ultrasound : 2021

● Solid hypoechoic mass spiculated mass,

right breast
● Multiple breast simple cysts, right
● Fat Necrosis, left breast
● Unenlarged axillary lymph nodes, bilateral
● BI-RADS 5 (spiculated mass, right)
● BI-RADS 2 (Fat Necrosis, left)
● Left breast mass, Core Needle Biopsy :
Chronic Mastitis
● Right breast mass, Core Needle Biopsy :
Invasive carcinoma
INITIAL IMPRESSION:

T/c INVASIVE DUCTAL CARCINOMA

OF RIGHT BREAST
Basis:
● 32/F
● Solid hypoechoic mass (3.53 x 1.74) on the right breast
periareolar region
● Ultrasound : BI-RADS 5 (spiculated mass, right) Highly
suggestive of Malignancy
● Core Needle Biopsy : Invasive Carcinoma, Right
DIFFERENTIAL DIAGNOSIS
Fibroadenoma Age less than 40 (-) Cyclic pain
(+) Well circumscribed mass
(+) Movable mass
(+) Slow growing

Phyllodes Tumor Age (-) Fast growing mass

(+) Breast lump
(+) Mobile breast mass

Fibrocystic change (+) Multiple breast lump (+) Severe pain

(+) Mobile mass (-) cyclic pain
(+) Pain (-) may resolve with age
Operative Findings
● Preoperative
● Intraoperative
● Postoperative
 Immuno hematology (06/27/22) 11:05 AM

PREOPERATIVE LABORATORY
FINDINGS
Clinical Chemistry (06-27-22,11:33)
Test Result Reference
Range
Test Result Reference Range

MCV 90.6 80.0-100.0

Sodium 134.70 135 – 148

MCH 29.0 27.0-34.0

Potassium 3.61 3.5 - 5.3

MCHC 32.0 31.0-37.0

Chloride 108.10 98 – 107
Platelet Count 326 150-450
Ionized Calcium 1.11 1.13 - 1.32
 PREOPERATIVE LABORATORY
FINDINGS
Test Result Reference range

CBC Differential Count

WBC 8.37 4.0-10.0

Neutrophils 60.7 55.0-65.0

Lymphocytes 30.8 25.0-35.0

Monocytes 5.3 3.0-6.0

Eosinophil 2.4 2.0-4.0

Basophil 0.8 0.0-1.0

Erythrocytes 4.48 4.00-5.40

Hemoglobin 130 120-160

Immuno hematology
(06/27/22) 11:05 AM Hematocrit 40.6 37.0-47.0
Preoperative Chest X-ray(AP Supine and Lateral
Views)
Lungs are well aerated without acute focal opacity or consolidation

Heart is not enlarged ,pulmonary vascularity is within normal limits

Aorta is not unusual

Both hemidiaphragms and costophrenic sulci are unremarkable

The visualized bones are intact

Impression:

Unremarkable chest findings

Pre Operative Sonography
Pre operative findings
Intraoperative Findings
Procedure Done

MODIFIED RADICAL
MASTECTOMY RIGHT
POST OPERATIVE DIAGNOSIS

INVASIVE DUCTAL CARCINOMA;

RIGHT; STAGE IIA; T2N0M0
CASE DISCUSSION
 DEFINITION

➢ Invasive ductal carcinoma (IDC) of the breast begins in

the lining of a breast duct (milk duct) and spreads outside
the duct to other tissues in the breast.
➢ It can also spread through the blood and lymph system to
other parts of the body.
➢ IDC is the most common type of invasive breast cancer.
ETIOLOGY

● Invasive ductal carcinoma is cancer (carcinoma)

that happens when abnormal cells growing in
the lining of the milk ducts change and invade
breast tissue beyond the walls of the duct. Once
that happens, the cancer cells can spread.
 EPIDEMIOLOGY

➢ Breast cancer is the most common cause of cancer death in women worldwide.
➢ Rates vary about five-fold around the world, but they are increasing in regions
that until recently had low rates of the disease.
➢ Many of the established risk factors are linked to estrogens.
➢ Risk is increased by early menarche, late menopause, and obesity in
postmenopausal women, and prospective studies have shown that high
concentrations of endogenous oestradiol are associated with an increase in
risk.
➢ Childbearing reduces risk, with greater protection for early first birth and a
larger number of births.
 EPIDEMIOLOGY

➢ Breastfeeding probably has a protective effect.

➢ Both oral contraceptives and hormonal therapy for
menopause cause a small increase in breast-cancer risk,
which appears to diminish once use stops.
➢ Alcohol increases risk, whereas physical activity is
probably protective.
➢ Mutations in certain genes greatly increase breast cancer
risk, but these account for a minority of cases.
 CLINICAL MANIFESTATIONS

➢ Dimpling or retraction of the skin of the breast or the

nipple.
➢ Nipple discharge, other than breast milk.
➢ Scaly or flaky skin on the nipple or an ulceration (sore) on
the skin of the breast or nipple.
➢ These can be signs of Paget's disease, a different kind of
breast cancer that can occur along with IDC.
 LABORATORY

➢ ER AND PR
➢ HER2
➢ GRADE:

There are 3 grades:

Grade 1 (well differentiated),

Grade 2 (moderately differentiated), and

Grade 3 (poorly differentiated).

 IMAGING

➢ Magnetic resonance imaging (MRI): This imaging test uses

radio waves and magnets to produce detailed pictures of
your breast tissue.
➢ Ultrasound: Using high-frequency sound waves, an
ultrasound provides clear images of your internal organs
and other tissues.
➢ Biopsy: Takes a small sample of your breast tissue with a
needle. The sample is then sent to a pathology lab for
further testing.
 TREATMENT

➢ 1.Breast cancer surgery: A surgeon removes the tumor and

confirms whether or not the cancer has spread to the lymph
nodes. Some people may only have the tumor removed
(lumpectomy), while others may have some or all of their breast
tissue removed (mastectomy).
➢ 2.Chemotherapy: For people with invasive ductal carcinoma,
chemotherapy may be given before surgery to shrink the tumor
or after surgery to reduce the chance of cancer returning.
Chemotherapy may also be recommended as the main treatment
for people with metastatic breast cancer.
 TREATMENT

➢ 3.Radiation therapy: In most breast cancer cases, radiation

therapy is used after surgery to kill any remaining cancer cells.
Occasionally, it may be used to shrink a tumor before surgery.
Radiation therapy may also be recommended when a tumor can’t
be surgically removed due to the size or location.
➢ 4.Targeted therapy:This treatment uses drugs to target certain
characteristics of cancer cells. For example, if there’s a protein in
your body that causes abnormal cells to multiply, your provider
might give you drugs that target that specific protein.
➢ 5.Anti-hormone therapy:Sometimes called endocrine therapy,
this treatment lowers the amount of estrogen in your body. This
blocks estrogen from causing breast cancer cells to grow.
➢ 6.Immunotherapy:Used in combination with chemotherapy, this
treatment uses the power of your immune system to fight cancer
cells.
 Thankyou

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