Presentasi Kasus

Identitas Pasien
Nama: Ny. S Umur: 35 th Pekerjaan: Ibu rumah tangga Suku: Sunda Tanggal Kunjungan:8/5/2011

Keluhan Utama: Benjolan di payudara sebelah kiri sejak 1 bulan SMRS

Riwayat Penyakit Sekarang

Sejak 1 bulan SMRS pasien mengeluh ada benjolan di payudara sebesar biji salak ( 2cm) Benjolan keras, mudah digerakan, tidak terasa sakit, tidak bertambah besar Tidak ditemukan benjolan di tempat lain Tidak keluar cairan dari putting Tidak ada luka di payudara Tidak ada penurunan berat badan, demam (-), lemas (-)

Riwayat Penyakit Dahulu

Hipertensi (-) DM (-) Asma (-) Alergi (-)

Riwayat Penyakit Keluarga

Hipertensi (-) DM (-) Asma (-) Alergi (-) Riwayat penyakit serupa (-) Riwayat keganasan (-)

Riwayat Social
Pasien menikah usia 13 tahun Memiliki 3 orang anak, dengan jarak masingmasing 5 tahun
Tiap anak ASI eksklusif selama 2 tahun

Menarche: usia 14 tahun, siklus normal 1x tiap bulan selama 7 hari KB: suntik 3 bulan baru mulai 9 bulan terakhir.

Pemeriksaan Fisik
Keadaan Umum: CM, TSR Tanda-tanda vital
TD: 140/90 mmHg Nadi: 100 RR: 22 Suhu: afeb

Status Generalis

Status Lokalis
Benjolan pada payudara kiri di sebelah lateral, Warna ~ kulit sekitar, suhu ~ sekitar Benjolan ukuran 2cm x 2cm x 2cm, permukaan rata, padat, mobile, nyeri (-)

Working diagnosis
Tumor mamae suspek FAM

Rencana diagnosis
USG Pro eksisi biopsi

LITERATURE REVIEW

Epidemiology
22% cases of primary cancer In Indonesia, Breast cancer is the second largest cancer after cervical cancer More than 70% cases found in advance stage

Anatomy

Risk factor
Major factors Gender Age Previous breast cancer Family history and genetic predisposition (BRCA 1 or 2 mutations) Intermediate factors Alcohol and diet Endocrine factors: Early menarche Late menopause Oral contraceptive and hormone replacement therapy Nulliparity Irradiation Benign proliferative breast disease (e.g. multiple papillomatosis) Benign breast disease (e.g. hyperplasia with moderate or severe atypia) Minor or controversial factors Body size Stress Benign breast disease (e.g. hyperplasia with moderate or mild atypia)

Pathogenesis
Modification of DNA of breast epithelial caused by gene alteration & enviromental agents Growth factor increase the rate of premalignant to malignant cells Specific oncogenes are modified Transition of carcinoma in situ into invasive carcinoma

Clinical manifestation
A new lump ,a painless, hard mass that has irregular edges Swelling of all or part of a breast Skin irritation or dimpling Breast or nipple pain Nipple retraction (turning inward) Redness, scaliness, or thickening of the nipple or breast skin Nipple discharge The skin may have ridges or pitting so that it looks like the skin of an orange.

Physical examination
Both breast should be examined The tumor mass - Location - Size - Consistency - Surface - Form & tumor edge - Number of tumor - Fixated / not to surrounding area Skin changes - redness, dimpling, edema, satellite nodule - Peau dorange, ulcer Nipple - Retraction - Erosion - Crustae - Discharge

Physical examination
Lymph node - axilla: number of involved lymph node, size, consistency, fixation - Infraclavicula - Supraclavicula Site of metastasis Lung Bone Liver Brain

Diagnosis
Mammogram It detects lump that cannot be felt in palpation USG Target a specific area of concern found on the mammogram. Ultrasound helps distinguish between cysts & solid tumor Biopsy Fine needle aspiration Core biopsy Open biopsy

Classification
Noninvasive Epithelial Cancers Lobular carcinoma in situ (LCIS) Ductal carcinoma in situ (DCIS) or intraductal carcinoma Papillary, cribriform, solid, and comedo types Invasive Epithelial Cancers (Percentage of Total) Invasive lobular carcinoma (10%15%) Invasive ductal carcinoma Invasive ductal carcinoma, NOS (50%70%) Tubular carcinoma (2%-3%) Mucinous or colloid carcinoma (2%3%) Medullary carcinoma (5%) Invasive cribriform carcinoma (1%3%) Invasive papillary carcinoma (1%-2%) Adenoid cystic carcinoma (1%) Metaplastic carcinoma (1%)

Mixed Connective and Epithelial Tumors Phyllodes tumors, benign and malignant Carcinosarcoma Angiosarcoma NOS (which is an abbreviation for not otherwise specified).

STAGE

0 I IIA

Tis T1 * T0 T1 * T2

N0 N0 N1 N1 N0 N1 N0 N2 N2 N2 N1 N2 N0 N1 N2 N3 Any N

M0 M0 M0 M0 M0 M0 M0 M0 M0 M0 M0 M0 M0 M0 M0 M0 M1

IIB

T2 T3

IIIA

T0 T1 T2 T3 T3

IIIB

T4 T4 T4

IIIC IV

Any T Any T

Management
Treatment of stage I, stage II, stage IIIA and operable stage IIIC breast cancer may include the following: Breast-conserving surgery to remove only the cancer and some surrounding breast tissue, followed by lymph node dissection and radiation therapy. Modified radical mastectomy with or without breast reconstruction surgery. Sentinel lymph node biopsy followed by surgery. Adjuvant therapy (treatment given after surgery to increase the chances of a cure) may include the following: Radiation therapy to the lymph nodes near the breast and to the chest wall after a modified radical mastectomy. Systemic chemotherapy with or without hormone therapy. Hormone therapy

Management
Treatment of stage IIIB and inoperable stage IIIC breast cancer may include the following: Systemic chemotherapy Systemic chemotherapy followed by surgery (breastconserving surgery or total mastectomy), with lymph node dissection followed by radiation therapy. Additional systemic therapy (chemotherapy, hormone therapy, or both) may be given.

Stage IV and metastatic breast cancer Treatment of stage IV or metastatic breast cancer may include the following: Hormone therapy and/or systemic chemotherapy with or without trastuzumab (Herceptin). Radiation therapy and/or surgery for relief of pain and other symptoms. Bisphosphonate drugs to reduce bone disease and pain when cancer has spread to the bone.

Screening
Self breast exams - Started since fertile: next week after first day of menstruation Physical examination by doctor Mammogram - Women 35-50 years old every two years - Women 50 years old every year