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Doubts about BREAST CARCINOMA

Discussion in 'Medical Students - MD' started by quackdoc, Apr 14, 2004.

  1. quackdoc

    quackdoc Member
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    I want to clear the following doubts regarding breast carcinoma:
    In the examination of breast what is the optimal time to palpate?After the menstrual cycle is over(when the mass if hormonally sensitive may regress)or before the cycle when the mass is evident?Further when is the optimal time to take a biopsy of the lump in the breast?Does the breast tissue also regress or proliferate with each menstrual cycle as does the uterine epithelium?
    Which subtypes of breast tumours tend to metastasise more often?
    What is the indication for RADICAL MASTECTOMY(specially when nowadays its is not frequently performed)?
    Thanks :)
     
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  3. Kalel

    Kalel Membership Revoked
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    I think that the current "reccomendations" are to do the self exam right after a period because the breast are usually less swollen and tender then. Any time you feel some irregularity though, you can see your doctor about it. I've never heard of anyone trying to time a biopsy, if a mass is suspicious for cancer, it shouldn't be fluctuating in mass all that much that you would need to do something like timing your biopsy. I don't think that radical mastectomies are done anymore. Invasive ductal and lobular carcinomas are probably the tumors that are most likely to metastasize. Anyways, you can read the following websites if you are interested in learning more about breast cancer:
    http://www.vh.org/navigation/vh/topics/adult_patient_breast_cancer.html
    http://www.emedicinehealth.com/articles/13615-1.asp
     
  4. quackdoc

    quackdoc Member
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    Thanks for the reply.
    A far as the breast tissue is concerned,its is known for sure that the breast tissue tends to change with every menstrual cycle.The "fulness" in breasts that women tend to feel every menstrual cycle is a pointer here.In case of endometrium the cyclical changes tend to obscure the in situ carcinomatous changes.This led to think whether there are changes in the breast tissue as well or not.
    Bailey and Love suggests that one should perform a biopsy of any suspicious lesions if possible.That is,corecut or trucut biopsy with a vim silverman needle or any special needle along with FNAC.
    I have come across lumpectomies being done if the
    Age of the woman is more(Old age-50+)
    If there is associated familial history.
    Any suspicious lump.
    Given a choice Id rather do the axillary node dissection also.It is not a radical form of operation in any case.And the axillary nodes if searched assidiously searched for micrometastasis makes perfect sense to me.
    As far as the radical dissection is concerned I believe that it was done for lack of any other alternative during that time.I too havent come across any recommendation as of now.As soon as I come to know I shall post this too.
    The tumour that tends to metastasise early is the Inflammatory type of carcinoma.Differential is Skin eczema or underlying breats abscess.
     
  5. quackdoc

    quackdoc Member
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    Radical mastectomy is performed if the carcinoma has spread beyond the chest wall.That is on clinical examination the breast is fixed to the underlying structures.
    The google search threw up this site:
    http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7247286&dopt=Abstract
    Anyone has got a complete access to this article?
    Another intresting link
    http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14770422&dopt=Abstract
    Another good source
    http://www.silberman-oncology.com/resource/chapters.ihtml?step=3&Cid=12
     

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