Breast examination

Breast examinationCreated OnApril 2, 2020Last Updated OnApril 16, 2020byadmin You are here: Main Clinical Examination Breast examination < All Topics Table of Contents Both breast should exposed and normal breast is examined first Inspection of patient in sitting position Site: Anterior visible lumps in relation to 4 quadrants Size & shape of both breasts Any puckering or dimpling of the skin Skin over the breast: colour and texture, peau d’ orange (blockage of subcuticular lymphatics with oedema of the skin), nodules, ulceration Nipple: Presence, position ( both nipple in same level or not?), discharge, size and shape Areola Arms for oedema, nodules: multiple cancerous nodules and thickened skin in nearby area. Axilla: enlarged lymph nodes Inspection wit Arms raised above head: Peau d’ orange Retraction of nipple Inspection on Leaning forward: Fixity to chest wall (breast falls equally on both sides if not fixed) Contracting and relaxing pectoralis major: Swelling becomes prominent or not Palpation- 45 degree head up position is preferred. Palpate normal breast first Temperature and tenderness Mass: describe the features of the lump like other lumps anywhere in the body Carcinoma Fibroadenoma Fibroadenosis Palpation Easily felt / may be fixed to skin or chest. Mostly not mobile, non-tender Easily felt/ not fixed to skin/chest. Freely mobile, non-tender Just a feeling of lumpiness, no definitive swelling Not freely mobile May be tender Margins Ill defined Well defined Slippery edges Ill defined Consistency Hard Firm encapsulated Firm, softy, diffuse rubbery feeling Surface Uneven Smooth May be nodular Sign of Fixity to skin/ skin involvement Skin cannot pinched over the tumour Peau d’ Orange: lymphatics of skin obstructed Skin ulcer, skin nodules **Dimpling(tethered)-infiltrate to cooper’s ligament( not consider in staging, in other words it is not a T4b in TNM staging) Intrinsic mobility-carcinoma moves along with breast tissue Fixity to muscles- Pectoralis Major : total restriction of mobility along the muscle fibres when upon contraction of the muscle by asking the patient to push the hand against the hip Serratus Anterior : Restriction of movement when patient is asked to push over the wall Fixed to chest wall- Tumour fixed all the time (even the muscle not contracted) Nipple: Squished around the areola to demonstrate nipple discharge Axillary lymph nodes Level 1: lateral to lateral border of pectoralis minor Anterior (pectoral ) – behind the anterior axillary fold Posterior (subscapular) – posterior axillary fold Lateral (brachial) – felt over the head of humerus Level 2: behind the pectoralis minor Central Level 3: medial to medial border of pectoralis minor Apical (infraclavicular) Cervical Lymph nodes : especially supraclavicular Examination of other systems: Respiratory system: sign of pleural effusion Abdomen: liver secondaries ( liver enlargement of palpable mass) Spine : bone tenderness Taken from Doctrina Perpetua...

Continue reading

Please Login/Register to read full article.