Question

A female patient calls to request an appointment, stating that she has been experiencing an uncomfortable feeling in her breasts. She found a lump this morning in her right breast. How do you handle this call?

Answer 1

Answer •

The patient should be told to not panic and an appointment with a doctor should be booked. •

When the patient visits, then the doctors should take a brief history about the problem , with topics involving:-

i) nature of onset of lump ie(sudden or gradual

ii) mode of onset ie after some trauma or injury

iii) any pain associated with lump

iv) duration of lump

v) nature of growth of lump

vi) any previous history of lump or chronic disease

Then the patient should be informed that a brief medical examination of lump will be done, then with her concent , expose the area above abdomen & the examination should be done Examination should be done in following order

i) See the site of lump

ii) Size of lump

iii) any discoloration of skin above it because orange discoloration of skin above lump is indicator of breast cancer iv) position of both nipple as rectaction of nipples can also indicate towards cancer

v) sensation of skin above lump as loss of sensation alsohave significance in detection of cancer

vi) Reducibility test as it can signify to presence of any abscess

vii) Illumination test ie it is done to see if lump is due to any accumulation of bodily fluid ie blood or puss

viii) Examination of cervical, brachial and axillary lymph nodescare done to detct any swelling

Then after the examination of patient if further doubt of breast carcinoma is detected then

i) Contrast Mammography.— In this technique contrast medium is injected in one of the major mammary duct and then soft tissue X-ray is taken.

ii) ULTRASOUND.— This examination of the breast is useful only in differentiation of solid from cystic swellings greater than 2.5 cm in diameter by ultrasonic waves

. iii)BIOPSY.— It is done when presented with a palpable mass in the breast to remove the lump for accurate diagnosis. Whatever the degree of suspicion of cancer, most surgeons still prefer to be quite certain before committing a woman to mastectomy or radiotherapy.

iv) CHEST X-RAY.— This is the simplest method of looking for potential site of visceral metastasis.

Then after these diagnosis the patient is infored about her condition and its severity and present her with treatment options. Then doctor can begin her treatment as required.