Mrs. B comes to the clinic today because she felt a lump in her breast. She is extremely anxious and wants to know if she is going to die. (Learning Objectives: 10, 11, 14, and 18)
1. If you were the nurse who greets Mrs. B, how might you respond to her concerns and anxiety?
2. What are some questions that may be helpful in identifying any risk factors she may have for any type of cancer? Give the rationale for asking each question.
3. Following a mammogram, a needle biopsy is ordered. What is the purpose of a biopsy?
4. The biopsy results were positive for cancer. Why would a sentinel node biopsy be advisable for Mrs. B?
Since there was no evidence of metastasis, a lumpectomy was performed and all surrounding lymph nodes were clear. Mrs. B will be monitored on a regular basis.
5. If chemotherapy had been ordered, what would have been the rationale for combination drug therapy?
1. Being empathetic is essential. Actively listen to her concerns. Explain that tumors can be benign or malignant, and only malignant tumors can be dangerous. Treatment options are available and can be treated completely in the early stages. Answer her queries appropriately and do not give false reassurances.
2. Risk factors for cancer
i) Does anyone in your family have any cancer? (Cancer can be hereditary and the risk increases with family history of cancer among maternal or paternal first degree relatives)
ii) What is your age? (Risk of cancer increases with aging)
iii) Do you consume alcohol or smoke excessively? (Can lead to damage of liver and other cells in the body, smoking causes lung damage increasing the risk of cancer)
iv) What is your diet pattern? (Poor diet with less nutrients and antioxidents increases the risk of cancer)
v) What is your body weight? (Obesity increases the risk of cancer)
vi) Do you have any chronic inflammatory conditions? (Eg. Inflammatory bowel disease can increase the risk of colon cancer)
vii) Are you on hormonal supplements? (Post menoupausal hormone supplements increases cancer risk)
viii) Are you at risk of exposure to radiation? (Radiation exposure increases the risk of cancer )
3. Biopsy is the examination of the tissue obtained. It helps to identify the type of tumor - benign or malignant
4. Sentinel node biopsy is used to identify whether cancer has spread beyond the primary tumor into the lymphatic system. So it would be advised for Mrs. B to identify the metastasis and staging of cancer
5. Although lumpectomy was done and there was no metastasis, adjuvant chemotherapy will help reduce the chance of recurrance of cancer.