Question

Mrs. Smith is a 50 year old Caucasian woman who has 4 children ages 17, 15, 13, and 10. She was 33 with the birth of her first child. Her BMI is 25. She has no personal or family history of breast cancer. She lives with her husband in a suburban community. She is an elementary school teacher who is working part-time as a substitute so she can be home with her children. She has been healthy with no previous medical history. One year ago she noted a small palpable lump in her right breast about the size of an almond. Because she has been healthy she assumed it was nothing and ignored it. Over the last month she has noted that this lump has been increasing in size. Her health insurance would be expiring in the next month so she reluctantly decided to have a mammogram. She called for an appointment and they were unable to see her for another 2 months.

After waiting 2 months, her mammogram confirmed a 5 cm mass. She then had an ultrasound guided biopsy. This biopsy confirmed the presence of cancer cells. An additional biopsy confirmed the presence of cancer cells in 3 of her lymph nodes most proximal to the tumor.

1. What are the primary concerns for the patient right now?
2. What is the rationale for these concerns?
3. What are some of the expected medical surgical interventions?
4. What is the worst possible complication to anticipate?
5. What further assessment will be needed if complications develop?
6. What pharmaceutical drugs are approved treatments for breast cancer patients?
7. Discuss the advantages and disadvantages of the selected drugs, and include safety issues.

Answer 1

The primary concern and rationale for the patient are

• Expenses for treatment needed as her insurance as expired.The income got being a elementary school teacher on part time basis will be even less to run her family and for medical expenses.
• Taking care of her children at this point is so difficult because the elder one is near to early adulthood and others on teens should be directed in the right path and the youngest need support for most of his activity and all the children has to be met with the basic needs

The expected medical surgical interventions are

• Surgery:Lumpectomy with removal of the infected lymphnode.Usually mastectomy is done to prevent spreading of cancer. This is followed by breast reconstructive surgery.
• Radiation therapy to kill  any leftout cancer cells
• Chemotherapy after surgery will reduce the risk of cancer
• The medical intervention is teletherapy and radiation therapy

Possible complication

• Breast tenderness
• Heart failure or leukaemia due to chemotherapy
• Frozen shoulder
• Lympedema
• Capsulaf contractors
• Infection after surgery
• Peripheral neuropathy
• Chemobrain
• Infertility

Further assessment to know about the complications

• Regular screening
• Assessing for any sign of infection ,swelling of arm,lymphedema
• Fever to rule out infection
• Pain at the treated site
• Disturbed gastrointestinal status gives a brief idea on to rule  cancer symptoms

The pharmaceutical drugs used in breast cancer treatment are

• Hormone therapy (estrogen modulator )
• Taxanes
• Anthracyclin
• Platinum agents

	Advantages	Disadvantages
Hormone therapy	reduce risk Prolong life	Hot flashes Vaginal discharges or dryness Fatigue Nausea Joint pain
Taxanes	has broad spectrum clinical activity	Arthralgia Neuropathy Nausea,vomiting, diarrhoea Low blood count Hair loss Sore mouth
Anthracyclin	can be used in adjuvant therapy	Short term hair loss Nausea and vomiting Heart damage Leukemia
Platinum agents	treats specific cancer Targets cancer cell	Nause Vomiting Kidney toxicity Ototoxicity Abnormal blood values