Question

A 51-year-old woman complained to her family practitioner that she had felt very fatigued for several weeks. She had lost 7–10 pounds in weight over the previous month. On physical examination the physician discovered a firm nodular swelling, about 3–4 cm in diameter, in the left breast that was anchored in tissue several centimeters beneath the skin.

Questions:

1. To which additional areas of this woman’s body should the physician direct special attention during the physical examination and why?

2. Which muscle should be caused to contract in order to demonstrate the fixation of the swelling?

3. Following surgical removal of the swelling and exploration of the axilla, the patient is found to have a winged scapula. How has this occurred?

4. Following surgery, she noted a swollen left arm. Why?

Answer 1

1) The cervical nodes spine for tenderness of bone (possible bone metastasis), signs of hepatomegaly in abdomen and lungs for any exudates. Also important to check contralateral breast for additional lumps.

2)The patient should be asked to lift the arms- which will show tethering of the lump in the form of dimpling.

3) It has occured due to damage to the long thorasic nerve of the shoulder.

4)Lymphadema - collection of fluid (mainly lymph) in the arm is a common side effect of breast cancer surgery