Paget’s Carcinoma: Examination

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

  • General physical examination – including blood pressure, pulse, body weight, height; further:
    • Inspection (viewing).
      • Skin and mucous membranes
      • Abdominal wall and inguinal region (groin area).
  • Gynecological examination
    • Inspection
      • Vulva (external, primary female sexual organs).
      • Vagina (vagina)
      • Cervix uteri (cervix) or portio (cervix; transition from the cervix (cervix uteri) to 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 (cervix).
      • Uterus (uterus) [Normal: anteflexed/angled anteriorly, normal size, no tenderness].
      • Adnexa (appendages of the uterus, i.e., the ovary (ovary) and uterine tubule (fallopian 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 (water retention); painful nipple (breast); 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 – secretions from one or both nipples (possibly as crusting as an indication of latent (hidden) galactorrhea), open ulceration; Paget’s carcinoma with characteristic, brown-red changes in the nipple and areola, can be misinterpreted as eczema; often occurs unilaterally as a skin rash with pruritus (itching), scaling and crusting]
    • Palpation of the mammae, the two supraclavicular pits (upper clavicle pits) and the axillae (armpits) [breast carcinoma: 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 (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.