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62: BREAST CANCER

Eric Shamus, PhD, DPT, PT, CSCS; Adrian Taylor, DPT; Elizabeth E. Demarse, DPT, MTC; Stephanie N. Wright, MOT, OTR/L

ICD-9-CM CODES

  • 198.81 Secondary malignant neoplasm of breast

  • 233 Carcinoma in situ of breast and genitourinary system

  • 233.0 Carcinoma in situ of breast

ICD-10-CM CODES

  • C79.81 Secondary malignant neoplasm of breast

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

PREFERRED PRACTICE PATTERNS

  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation1

  • 6B: Impaired Aerobic Capacity/Endurance Associated with Deconditioning2

  • 6H: Impaired Circulation and Anthropometric Dimensions ­Associated with Lymphatic System Disorders3

PATIENT PRESENTATION

A 60-year-old woman is noted to have a 2-cm mass in the left breast. The patient’s physician recommends that a core needle biopsy be performed. Tissue analysis by the pathologist under the microscope reveals intraductal carcinoma. The patient is advised by the surgeon to have surgery to remove the primary breast mass in addition to some lymph nodes. The patient undergoes wide excision of the breast mass and lymph node removal.4 Patient comes to physical therapy for scar and lymphedema management.

KEY FEATURES

Description

  • Cancer originating in the tissue of the Breast

    • Ductal or lobular

    • Invasive or noninvasive (in situ)

Essentials of Diagnosis

  • Mammography

  • MRI

  • Ultrasound

  • Biomarkers

  • Axillary sentinel lymph node biopsy

  • PET/CT to determine spread

  • Biopsy of tumor

    • Needle or core/open

FIGURE 62-1

Magnification view of microcalcifications seen on a screening mammogram of a patient. Note the pleomorphism of the microcalcifications. The size varies from very fine to coarse, and shapes are bizarre. This appearance is typical of comedocarcinoma. (From Chen MYM, Pope TL, Ott DJ. Basic Radiology. 2nd ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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General Considerations

  • Not always associated with pain

  • Lumps in breast or axilla

  • Change in breast/nipple shape or color

  • Nipple discharge

Demographics

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

  • Women 100 times more likely to be diagnosed than men

  • Increased risk with age

FIGURE 62-2

Sonographic appearance of palpable breast masses. (From Hoffman BL, Schorge j, Schaffer j, Halvorson l, Bradshaw k, Cunningham F. Williams Gynecology. 2nd ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

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CLINICAL FINDINGS

SIGNS AND SYMPTOMS

  • 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 ...

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