Physical Check-up for Recurrence after Mastectomy for Breast Cancer

After a mastectomy for breast cancer, whether partial mastectomy, total mastectomy, with or without axillary dissection, with or without chemotherapy, with or without radiation therapy, or with or without any additional or concomitant treatment, physical check-up with a physician, preferably with a breast surgeon specialist, should be done at a regular interval to check for cancer recurrence. It is the minimum examination, and not the laboratory tests, for a cancer surveillance for possible recurrence.

Physical check-up includes history taking for symptoms of cancer recurrence and physical examination for signs of cancer recurrence. Symptoms are what are reported by the patients and signs are what are found by the physicians.

Physical check-up is the same as the so-called symptom-sign-directed surveillance approach. It can also be called clinical surveillance for breast cancer recurrence. The other approach to cancer surveillance is the so-called screening diagnostic-procedure-directed surveillance approach which is not universally recommended as it is not cost-effective.

In the physical check-up, the physician asks patients for presence of any symptoms (how they feel / what they have noticed in their body) that may be suggestive of breast cancer recurrence in the local (chest and breast), regional (axilla and neck) and distant (bone, lung, brain and liver) areas.

The questions usually asked are:

• • Have you felt an unusual lump in the breast, armpit and neck areas or in any other parts of your body?

• Do you have a persistent cough, say for more than one month?

• Do you have a persistent bone pain, say for more than one month?

• Do you have a persistent headache, say for more than one month?

• Do you have a persistent right upper abdominal discomfort or pain, say for more than one month?

In the physical check-up, the physician also does a physical examination (clinical examination) to check for any signs of breast cancer recurrence, in the local (chest and breast), regional (axilla and neck) and distant (bone, lung, brain and liver) areas.

Physical examination includes inspection (looking) and palpation (feeling for a lump and anything unusual).

The areas in the body that a physician usually does a physical examination on to check for local, regional and distant recurrence consist of the following:

• Chest area – operated areas, residual breasts after subtotal mastectomy, chest wall after total mastectomy, and intact breast (no previous operation) – to check for local recurrence and new cancer on the intact breast

• Axillary areas to check for possible lymph node metastasis

• Neck or especially the supraclavicular areas, to check for possible lymph node metastasis

• Right subcostal area to check for possible liver metastasis

Above constitute the areas of focused physical examination for possible local and regional and distant breast cancer recurrence.

The physician usually makes a drawing illustrating what areas of physical examination were done.

The physician then jots down the findings.

If nothing unusual was found, which implies no recurrence in the palpated areas, the physician places a null sign as a symbol to indicate "negative." A null sign is preferred over a "(-)" notation because the "(-)" can easily be changed unofficially or unprofessionally to "(+)." Furthermore, a null sign looks more emphatic than "(-)".

If there are positive findings, then the physician illustrates or draws the findings accordingly with some descriptive notes.

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