Pain,progressive,size,erythema,discharge,orangelike,bilateralorunilateral,

lymphadenopathy,fever,weightloss
2.Familyhistory,stress,radiation
3.weightloss,pain,lymphadenopathyandctSCAN
Otherinformation
defineyourbreastproblem,howlong,uniorboth,isthereanyrelationshipabout
menstrualcycleormedicationsuchasoralcontraceptives
Alarmsymptoms:seriousdiagnoses:breastcancer
Ulcerating
Breastmass
Axiallrymass
Bloodnippledischarge
Famiyhistory
Systemicsymptoms:respiratory,headacheandbonepain.Itmeansmetastatic

Differentialdiagnosis
Fibrocyticdisase:Themostcommoncauseofbreastlumpinessandpain
Fibroadenoma
Breastcancer
Mastitis/breastabcess
Papilloma:Themostcommoncauseofabloodynippledischarge

StretchingofCooperLigament:yclicalbreastpaininwomenwithlarge,pendulous
breasts

FibrocysticBreastChanges
EssentialsofDiagnosis
Painful,oftenmultiple,usuallybilateralmobilemassesinthebreast.
Rapidfluctuationinthesizeofthemassesiscommon.
Frequently,painoccursorincreases,asdoessizeduringthepremenstrualphaseofthe
cycle.
Mostcommonageis3050years;occurrenceisrareinpostmenopausalwomen.
Pathogenesis
Anothername:fibrocysticdisease,chroniccysticmastitis,ormammarydysplasia,are
themostcommoncauseofcyclicbreastpainormastalgiainreproductiveagewomen.
Hormonalstimulationmayresultindilatedfluidfilledlobularaciniinterpretedas
microcystsonhistologicsectionsandisusuallyaccompaniedbyrelativestromal
abundance.Thisiscommonlyreferredtoasfibrocysticchange.Dependingonthe
particularpatternofepithelialstructuresandassociatedstroma,abreastmayappear
mammographicallydense,feelnodulartopalpation,orboth.Fibrocysticchangeis
generallyclassifiedasproliferativeornonproliferativeaccordingtotheepithelial
featuresoftheprocess.
ClinicalFindings
Fibrocysticchangesarecommonandaffectmorethan50%ofwomenof
reproductiveage.
asymptomatic:breastlumpsthatarediscoveredbypalpation.
Periodic:Cyclicalbreastpainortendernessisoftenthepresentingsymptom
Thepain:iscausedbytheproliferationofnormalglandularbreasttissuewith
estrogenstimulatingtheductalelementsandprogesteronestimulatingthe
stroma.
Discharge:nonbloody,greenorbrowndischargefromthenipple.
discomfortoccursorisincreasedduringthepremenstrualphaseofthecycle.
Caffeine;seemstopotentiatethesesymptoms.
Pathology:includingfibrosis,ductalhyperplasia,andadenosis.
Treatment
brawithadequatesupportcanbeveryhelpful.
avoidcoffe
AcetaminopenandNSAID
Danazolandtamoxifencanbeavoidsymptoms
Prognosis
menopause:symptomsloss
presenceofmultiplenonproliferativelesionsorproliferativelesions(florid
hyperplasia,sclerosingadenosis,andintraductalpapillomas),particularlythosewith

atypia(atypicallobularorductalhyperplasia),isassociatedwithanincreasedriskof
subsequentbreastcancer.

FibroadenomaoftheBreast
Theetiologyoffibroadenomasisnotknown,butahormonalrelationshipislikely
sincetheycanincreaseinsizeduringpregnancyorwithestrogentherapyandusually
regressaftermenopause.Multipletumorsin1orbothbreastsarefoundin1015%of
patients
ClinicalFinding
- round,firm,discrete,relativelymovable,nontendermass15cmindiameter.
- Fibroadenomastypicallypresentaswelldefinedsolidmasseswithbenign
imagingfeaturesonultrasoundandcanbemanagedwithcoreneedlebiopsy
orshortterm(36months)followupwitharepeatultrasoundandbreast
examination.
Treatment
Treatmentisbylocalexcisionofthemasswithamarginofsurroundingnormalbreast
tissue.
BreastCarcinoma
isamalignantproliferationofepithelialcellsliningtheductsorlobulesofthebreast.

Earlyfindings:Single,nontender,firmtohardmasswithilldefinedmargins;
mammographicabnormalitiesandnopalpablemass.
Laterfindings:Skinornippleretraction;axillarylymphadenopathy;breast
enlargement,redness,edema,brawnyinduration,peaud'orange,pain,fixationof
masstoskinorchestwall.
Latefindings:Ulceration;supraclavicularlymphadenopathy;edemaofarm;bone,
lung,liver,brain,orotherdistantmetastases.
Riskfactor
FamilyHistory
GeneticMutations:BRCA1andBRCA2
NaturalHormonalFactors
a.ageatmenarche:Onestudyhasreportedthatforevery2yeardelayinmenarche
therewasa10%reductioninbreastcancerrisk
b.AgeatFirstPregnancy
Womenwhogivebirthforthefirsttimeatage35havea1.6foldhigherriskof
breastcancerthaniftheywere26to27attimeoffirstbirth.Further,womenwhoare
overage30atthetimeoffirstbirthareathigherriskthannulliparouswomen
c.AgeatMenopause
Latemenopauseisassociatedwithahigherriskofbreastcancer.
- PregnancyTheincidenceofpregnancyassociatedbreastcancerislikely
relatedtothedelayofchildbirthuntilafterage30.

HormoneReplacementTherapy
Whilelongtermhormonereplacementtherapyisassociatedwithahigherrisk
ofbreastcancer,shorttermusedoesnotseemtosignificantlyincreasethe
riskofbreastcancer.

Signandsymptoms
Symptoms:
Seriousdiagnoses
Sign:
- nippleretraction,andslightedema,redness,orretractionoftheskincanbe
identified.
- Asymmetryofthebreastsandretractionordimplingoftheskincanoftenbe
accentuatedbyhavingthepatientraiseherarmsoverheadorpressherhands
onherhipsinordertocontractthepectoralismuscles.
-

nontender,firmorhardlumpwithpoorlydelineatedmarginsgenerallycaused
bylocalinfiltration.
- Axillaryandsupraclavicularareasshouldbethoroughlypalpatedforenlarged
nodeswiththepatientsitting
- Advancedcarcinoma:edema,redness,nodularity,orulcerationoftheskin;
thepresenceofalargeprimarytumor(>5cm);fixationtothechestwall;
enlargement,shrinkage,orretractionofthebreast;markedaxillary
lymphadenopathy;edemaoftheipsilateralarm;supraclavicular
lymphadenopathy;anddistantmetastases.
Treatment:
tamoxifenwhencomparedtonoadjuvantendocrinetherapywasassociatedwitha
41%reductionintheannualriskofrelapseanda34%reductionintheannualdeath
rateforwomenwithERpositivebreastcancer.

Acompletebloodcellcount(CBC),chemistrypanelincludingliverfunctiontests
(LFTs),andahumandxgonadotropin(hCG)inpremenopausalpatientsshould
beobtainedaspartoftheinitialevaluation.Anelevationinalkalinephosphataseor
liverfunctionmaybeanindicationofdistantmetastaticdiseaseandwarrantsfurther
investigation.Hypercalcemiamaybeseeninadvancedcasesofmetastaticcancer.

Fineneedleaspiration:limitedbyitsinabilitytodistinguishinvasivefrom
noninvasivebreastcancersandtherelativelyhighrateofnondiagnosticstudies,
especiallyfornonpalpableabnormalitiesandwithlessexperiencedpractitioners.
24selama30hari
tdtn;2tdt:15
Pump
inflame,panas,riwayatmenyusuicardinalsign
infeksi,8
1. mastitis(paindemam,panas,red,diffuse,unilateral)
2. kebanyakansaureusbayi:galactoselese:susuyangkeras
retraksinipple:nge.palingsringgalctotele:ampullalebihlamaclotsusu.
Daridalamkeluar.
Abcess:indurasi,fluctuatingandtegang.Jarangkeluar
2haritidaksembuhdiinsisis.Antibiomajikatidakdinisisipadhalsudah
diberidenganantibiotic.
Gold
Periductalmastitis:
Carabedanyadenganslitlikeretraction:circumbulat
Ituterapiradiasi
Stage3:localized
Chestwallinvolvement
Inflamebreastcancer
Tidakbisadisurgery
Chemodanadjuvant:
Benign:FAMdan
BRACA1:breastdanovary
BRACA2:ovary,breastcancer
HERB2
Peutdorange:stage3
History
TNM:
Masectomy:
1. T2marginandnodule:
2. PATEkemudiadiradiotherapy

Cekhormone:untukindikasihormonaltherapy
Adjuvant:surgery,chemodantamoxifent
Premenopause:tamoxident
Postandpre:aromataseinhibitor
Neoadjuvant:chemoandsurgery
Allpatient
Followup
36bulanselama2bulan
screeningmammae:23tahunskaliumur2040
screening>40tahun:
setelahusia20tahunphysicalexamination:1harisetelahmens35hari