1. Question:\u00a0What would you do if you were the GP or polyclinic doctor seeing her for the first time?\u00a0<\/strong><\/p>\n Here are some options to consider, \u00a0which would you choose?<\/p>\n After taking a directed history, a breast examination was done.<\/p>\n Summary of findings:<\/p>\n History – Self-palpated breast lump 2 months ago, not noticed to be enlarging. No noted loss of weight. \u00a0No family history of malignancy.<\/p>\n Physical examination – 4cm firm, irregular non-tender right upper outer quadrant mass.<\/p>\n Action taken: Refer to specialist breast clinic in a restructured hospital for further investigation.\u00a0<\/strong><\/p>\n\t Mdm Suppiah is seen at the Breast Clinic in the National University Hospital one week later.<\/strong><\/p>\n\t\t\tHere are the Clinical Findings<\/a>\n\t\t\t\t\t\t\tExpand<\/i><\/a>\n\t\t 2. Question: What is your clinical diagnosis?\u00a0<\/strong><\/p>\n\t\t\tClinical diagnosis<\/a>\n\t\t\t\t\t\t\tExpand<\/i><\/a>\n\t\t The diagnosis is breast cancer until \u00a0proven otherwise.<\/p>\n The findings of a new lump that is hard and irregular in a patient of this age is very suspicious. The presence of palpable axillary lymph nodes is worrying for axillary nodal metastases.<\/p>\n\t 3. Question: What would you do to confirm the diagnosis?\u00a0<\/strong><\/p>\n\t\t\tHere’s how the diagnosis was confirmed<\/a>\n\t\t\t\t\t\t\tExpand<\/i><\/a>\n\t\t What Mdm Suppiah needs is rapid tissue diagnosis (biopsy) so that definitive management can be planned.<\/p>\n Remember the Triple Test: Clinical examination, Imaging and Pathology.<\/p>\n 1. Imaging:<\/strong> A mammogram is ordered on the same day.<\/p>\n 2. A core biopsy<\/strong> is ordered:<\/p>\n The pathologist’s diagnosis was:<\/p>\n The\u00a0TRIPLE TEST is now done (clinical examination, imaging, biopsy), and the diagnosis is now made. The next step is to plan definitive management.\u00a0<\/strong><\/p>\n\t 4. Question: The diagnosis is made. What is the needs to be done next?<\/strong><\/p>\n\t\t\tClick here to see what was done next<\/a>\n\t\t\t\t\t\t\tExpand<\/i><\/a>\n\t\t After the diagnosis is made, the next step is to STAGE the tumour.<\/p>\n 1. Staging: This usually involves imaging.<\/p>\n CT thorax, abdomen and pelvis was done to look for metastases (eg lung, liver, etc)<\/p>\n A bone scan was performed to look for bony metastases.<\/p>\n Results: All were negative.\u00a0<\/strong><\/p>\n 2. The case was then discussed at the Breast multidiscplinary meeting – oncologists, radiation oncologists, surgeons, nurse managers, pathologists, radiologists attend.<\/p>\n Decision: Offer neoadjuvant chemotherapy (due to large size) and then surgery; \u00a0OR surgery.\u00a0<\/strong><\/p>\n The patent opted for surgery. \u00a0Mastectomy was performed, with axillary lymph node clearance.\u00a0<\/strong><\/p>\n 1. Handling the Breast specimen.<\/strong> After surgery, the excised breast specimen (mastectomy) arrives in the Pathology Lab. <\/p>\n The pathologist examines it and samples selected areas – this is known as Grossing<\/strong>\u00a0or\u00a0Trimming. <\/strong>Here is the pathologist in action.<\/p>\n If you can’t play the video, watch it here on YouTube: https:\/\/youtu.be\/0UbVpZSAEG4<\/a><\/p>\n\t\n
![\"\"](\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2017\/05\/Clinic-examination.jpg\")
<\/a><\/p>\n\t![\"\"](\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2017\/05\/Mammo-Pic.jpg\")
<\/a><\/p>\n![\"\"](\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2017\/05\/Core-bx-2lol5n8.jpg\")
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<\/a><\/p>\n\n\t\tII. In the Pathology Lab \n\t<\/h3>\n\t