Pathophysiology Concept map (stage four metastatic breast cancer) Key: Risk factors pathophysiology Diagnostics Clinical manifestation Treatment Aetiology Pre-menopausal women Hormonal changes Oral contraceptive pills for last three years Mutation in the DNA Colonial expansion Progression of the tumour Breast biopsy Hormonal therapy Activation of the oncogenes promoting growth Damage & failure in DNA repair Modification of the genes reguating the apoptosis Unregulated proliferation of the cell Decreased apoptosis of the cells Genetically mutated ductal epithelial cells Inactivatin of the tumour supressor genes Cytotoxic chemotherapy Hormonal therapy +Trastuzumab Breast ultrasound MRI Painless lump on the upper quadrant of the left breast Nipple dischargeModerate non pitting edema in the left arm. Lower back pain and weight loss Lymph node radiation Opioid & anti-inflammatory medicines Lymph node radiation therapy Lumpectomy IV therapyfor dehydration & IV antibiotics for infection Age: 50 years Gender: Female