Breast Cancer (Mammary Carcinoma): Examination

General

From the aspect of breast carcinoma, there are three examination aspects:

  • Women with an increased risk of breast cancer due to family history: they must be submitted to a so-called multimodal intensified early detection at an early stage. The following examinations are necessary because of the difficulty in assessing breast tissue, which is denser in youth:
    • Palpation (palpation)
    • Sonography (ultrasound)
    • Mammography (X-ray examination of the breast)
    • Magnetic resonance imaging (MRI) – see under prevention.
  • Women with symptoms: Redness, pain, questionable palpation findings (palpation findings), nipple secretion (secretions from the nipple): examinations at:
    • Palpation findings
      • Sonography
      • Mammography
      • Possibly punch biopsy (tissue sampling)
    • Redness
      • Inflammatory parameters (CRP (C-reactive protein), leukocytes, ESR (erythrocyte sedimentation rate)),
    • Secretion
      • Galactography – imaging of the mammary ducts of the mammae using contrast medium.
  • Women with a finding of, for example, screening or routine mammography or sonography: examinations:

A comprehensive clinical examination is the basis for the selection of further diagnostic steps:

  • General physical examination – including blood pressure, pulse, body weight, height; furthermore:
    • Inspection (viewing).
      • Skin and mucous membranes
      • Abdominal wall and inguinal region
  • Gynecological examination
    • Inspection
      • Vulva (external, primary female sexual organs).
      • Speculum setting:
        • Vagina (vagina)
        • Cervix uteri (cervix) or portio (cervix; transition from the cervix uteri into the vagina (vagina), if necessary, taking a Pap smear (for early detection of cervical cancer).
    • Palpation (bimanual; palpation with both hands) of the internal genital organs.
      • Cervix uteri
      • Uterus (uterus) [Normal: anteflective, normal size, no tenderness].
      • Adnexa (appendages of the uterus, i.e., the ovary and uterine tube). [Normal: free]
      • Parametria (pelvic connective tissue in front of the cervix to the urinary bladder and on both sides to the lateral pelvic wall) [Normal: free].
      • Pelvic walls [Normal: free]
      • Douglas space (pocket-like bulge of the peritoneum (abdominal wall) between the rectum (rectum) at the back and the uterus (uterus) at the front) [Normal: clear].
    • Inspection of mammae (breasts), right and left; nipple (breast), right and left; and skin [Local edema (local water retention); painful nipple; skin retraction (skin retraction visible spontaneously or occurring when arms are raised: Spontaneous retraction) or undisplacement over a induration; retraction of the nipple in advanced carcinoma; coarse pores of the skin (orange peel; peau d’orange; orange peel phenomenon) – as a result of lymphedema; newly appearing difference in size of the mammae, galactorrhea (possibly As crusting as an indication of latent galactorrhea: secretions, often hemorrhagic (bloody), from a nipple), open ulcerations (ulcerations); Paget’s carcinoma with characteristic, brown-red changes of the nipple and areola, can be misinterpreted as eczema; often occurs unilaterally as a rash with pruritus (itching), desquamation and crusting]
    • Palpation of the mammae (palpation of the breasts), the two supraclavicular pits (clavicle pits) and the axillae (armpit) [indolent (“painless”), coarse node, especially in the upper, right quadrant near the armpit (here occur circa 50% of all carcinomas), plateau phenomenon – retraction over palpable tumor when pushing the skin together with the fingers (sign of connection of the tumor with the skin); possibly. Enlarged lymph nodes in the axillae and supraclavicular pits]
  • Health check (as an additional follow-up measure).

Square brackets [ ] indicate possible pathological (pathological) physical findings.