Breast Cancer

Referral from Surgery Service

 M.J.
42 y/o
Married
G3P3(3003) Mucinous carcinoma of the breast,
right, stage IV; s/p Modified Radical Mastectomy,
right (2014), s/p radiation (33 days), s/p
chemotherapy (6 cycles); pleural effusion, right,
s/p thoracentesis (2017); Day 18 of cycle
A known case of breast cancer since 2008
• 2008 • (+) brownish discharge for 2 weeks, no
mass palpated, no pain felt
• Consult at DLSU Cavite
• Work-up was done
• Advised for removal of cyst
• Excision biopsy of breast mass at Lucena,
Quezon
• Histopathology revealed: Metastatic
tumor
A known case of breast cancer since 2008
• 2008 • Consult at Medical Center Manila
(MCM) for 2nd opinion
• Advised F.I.S.H. test
• June – MRM of the right breast at MCM
• Result: No residual carcinoma seen, breast;
suture granulomata; negative for tumor:
nipple; basal line of resection; and all 13
axillary lymph nodes
A known case of breast cancer since 2008
• 2008 • Started on Tamoxifen 20mg tab OD for 5
years (2008-2012)
• Feb-July – started 6 cycles of chemotherapy at
• 2014 MCM, unrecalled medications
• Aug – noted recurrence of cyst on right
breast
• Underwent excision of anterior chest wall
mass, right
• Histopath: Mucinous carcinoma (3.3cm),
recurrent; resection planes negative for tumor
A known case of breast cancer since 2008
• 2014-2015 • Nov 2014-Jan 2015 – radiation therapy at
San Juan De Dios (33 days)
• April-Sept – started on oral
chemotherapy
• Capecitabine 4000mg BID
• While on treatment, regular follow –up
with attending physician
• Advised for TAHBSO, but did not
• 2016
comply
History of Present Illness
• 18 days PTA • Difficulty of breathing with 3
months history of non-productive
cough (December), and back pain
• Consulted at Medical Center
Manila
• CXR: pleural effusion, right
• Thoracentesis: 600cc drained
• Discharged stable
• 3 days PTA • Still with the above symptoms
• Consulted again at Medical
Center Manila
• Thoracentesis: 200cc drained
• Advised for UTZ-guided
thoracentesis
• Referred to our institution due to
financial constraints
ADMISSION
• Past Medical History: known hypertensive >5 years,
maintained on Losartan and Carvedilol
• Family Medical History: hypertension on maternal side;
breast cancer on 2nd eldest sibling who underwent
bilateral MRM
• Personal/Social History: former bank employee
Menstrual History
• Menarche: 13
• Interval: 28-30 days
• Duration: 4-5 days
• Amount: 4 pads per day, moderately soaked
• Symptoms: none
Obstetrics History
G3P3(3003)
• G1 – 2004 – live, term via NSD at a Provincial Hospital
assisted by an OB-Gyn, no feto-maternal complications
• G2 – 2005 – live, term via LTCS I secondary to placenta
previa at a Provincial Hospital, no feto-maternal
complications
• G3 – 2006 – live, term via LTCS II at a Provincial
Hospital, no feto-maternal complications
Gynecologic History
• Coitarche: 29 y/o
• Sexual partners: 1
• No post-coital bleeding, dyspareunia, history of STI
• 1998 – PCOS – (+) OCP use for 3 months

• LMP: March 8-12, 2017 (day 18 of cycle)

• PMP: Feb 8-12, 2017
Physical Examination
• Conscious, coherent, not in distress
• VS: BP 100/70 HR 72bpm RR 17cpm T 36.5°C
• Anicteric sclerae, pink palpebral conjunctivae
• Supple neck, (+) supraclavicular lymphadenopathy
bilateral
• Symmetrical chest expansion, (+) crackles right, mid to
lower lung field, clear breath sounds on the left, (+)
linear surgical scar on right breast up to axilla, normal
left breast
Physical Examination
• Adynamic precordium, no murmur
• Flabby abdomen soft, non-tender
• Speculum exam: cervix smooth, clean looking, minimal
whitish discharge, no bleeding noted
• Internal exam: cervix firm, short closed, uterus normal
in size, no adnexal mass or tenderness
• Grossly normal extremities
Ancillaries
CBC Alkaline 96
Hemoglobin 130 phosphatase U/L
Hematocrit 0.40
WBC 6.7 Prothrombin
Segmenters 0.64 Time
Lymphocytes 0.25 Protime 13 sec
Monocytes 0.08
% activity 68.9%
Eosinophils 0.03
INR 1.14
Platelet count 370
Ancillaries
• Ultrasound of the Liver (3/4/17)
• New hypoechoic nodule in the left liver lobe; further
evaluation using CT or MRI is suggested
• Fatty infiltration of the liver
• Stable left liver lobe cyst
• Incidental finding of right pleural effusion
Ancillaries
• Chest X-Ray – PA View (3/6/17)
• Stable pleural effusion, right
• Bilateral pulmonary nodules with no significant interval
change
• Atherosclerotic aorta
• Status post mastectomy changes, right
Plan of Surgery
• For CTT insertion
• For ovarian ablation
Thank You!