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ICD-9-CM Codes

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  • 198.81 Secondary malignant neoplasm of breast

  • 233 Carcinoma in situ of breast and genitourinary system

  • 233.0 Carcinoma in situ of breast

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ICD-10-CM Codes

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  • C79.81 Secondary malignant neoplasm of breast

  • D05.90 Unspecified type of carcinoma in situ of unspecified breast

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Preferred Practice Patterns

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Key Features

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Description

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  • Cancer originating in the tissue of the breast4

    • - Ductal or lobular5

    • - Invasive or noninvasive (in situ)

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Essentials of Diagnosis

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  • Mammography

  • Magnetic resonance imaging (MRI)

  • Ultrasound

  • Biomarkers

  • Axillary sentinel lymph node biopsy

  • Positron emission tomography (PET)/computed tomography (CT) to determine spread

  • Biopsy of tumor

    • - Needle or core/open

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General Considerations

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  • Not always associated with pain

  • Lumps in breast or axilla

  • Change in breast/nipple shape or color

  • Nipple discharge

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Demographics

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  • Accounts for one-third of all cancers diagnosed in American women

  • Women are 100 times more likely to be diagnosed than men

  • Increased risk with age

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Clinical Findings

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Signs and Symptoms

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  • Lumps, hard knots, or thickening in any part of the breast

  • Swelling, warmth, redness, darkening

  • Change in size or shape of breast

  • Dimpling or puckering of the skin

  • Itchy, scaly, sore, or rash on the nipple

  • New pain in one spot that does not go away

  • Pulling in of nipple or other area of breast

  • Chest, breast, axillary, or shoulder pain of unknown etiology

  • Nipple discharge

  • Fatigue6,7

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Functional Implications

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  • Decreased ROM

  • Impaired posture

  • Pain with mobility

  • Endurance deficits

  • Self-care or activities of daily living (ADLs) deficits

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Possible Contributing Causes

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  • Female sex

  • Hormone replacement therapy

  • Weight gain and obesity

  • Older age

  • Personal or family history, heredity

  • Race/ethnicity

  • Excessive alcohol consumption

  • BRCA1 gene

  • Childbirth

  • Radiation

  • Age of menarche

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Differential Diagnosis

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  • Mammary dysplasia (fibrocystic breast disease)

  • Fibroadenomas

  • Lipomas

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Means of Confirmation or Diagnosis

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Laboratory Test

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Imaging

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  • Digital mammography

  • MRI

  • PET

  • Ultrasound

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Diagnostic Procedures

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  • Biopsy

    • - Needle

    • - Lymph node

    • - Open

  • Staging

    • - Stages 0 through IV

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Treatment

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Medication

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  • Tamoxifen

  • Thyrotropin8

  • Chemotherapy

    • - Side effects

      • Nausea

      • Vomiting

      • Diarrhea

      • Alopecia

      • Mouth sores

      • Conjunctivitis

      • Ulcers

      • Leukopenia

      • Anemia

      • Thrombocytopenia

      • Headaches

      • Dizziness

      • Menstrual irregularities

      • Infertility

      • Peripheral neuropathies

  • Hormonal therapy

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