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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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  • C79.81 Secondary malignant neoplasm of breast
  • D05.90 Unspecified type of carcinoma in situ of unspecified breast

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Description

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  • Cancer originating in the tissue of the breast4
    • Ductal or lobular
    • Invasive or non-invasive (in situ)

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Essentials of Diagnosis

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  • Mammography
  • MRI
  • Ultrasound
  • Biomarkers
  • Axillary sentinel lymph node biopsy
  • PET/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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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

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Functional Implications

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  • Decreased ROM
  • Impaired posture
  • Pain with mobility
  • Endurance deficits
  • Self-care or ADL 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
  • BRCA-1 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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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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Medication

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  • Tamoxifen
  • Chemotherapy
    • Side effects include
      • Nausea
      • Vomiting
      • Diarrhea
      • Alopecia
      • Mouth sores
      • Conjunctivitis
      • Ulcers
      • Leukopenia
      • Anemia
      • Thrombocytopenia
      • Headaches
      • Dizziness
      • Menstrual irregularities
      • Infertility
      • Peripheral neuropathies
  • Hormonal therapy

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Medical Procedures

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  • Radiation
    • Side effects
      • Pain
      • Lesions
      • Fatigue
      • Secondary neoplasm
      • Integumentary compromise (burns)
      • Radiation fibrosis
  • Mastectomy
    • Bilateral or single
    • Radical
    • Skin sparing
    • Modified radical
  • Axillary lymph node dissection
  • Sentinel lymph node dissection
  • Reconstruction
    • Tissue expander (TE) placement
    • Latissimus dorsi (Lat) flap
    • Transverse rectus abdominus muscle (TRAM) flap
    • Deep inferior epigastric perforator (DIEP) flap

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  • To oncologist, radiologist, or neurologist for medical treatment
  • To plastic surgeon for reconstruction/cosmetic ...

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