Detailed patient history is vital when dealing with a patient who presents with breast lumps and has a history that indicates the likelihood of breast cancer. When interviewing such a patient, it is vital to ask the patient-specific questions concerning her medical history and the development of the lump to try to identify its cause. More importantly, it is vital to ask various aspects of her family history, which helps determine her breast cancer risk. A family history of breast cancer is associated with an increased risk of breast cancer. Additionally, previous breast biopsy indicating atypical lobular or ductal hyperplasia increases breast cancer risk in a patient (American College of Obstetricians and Gynecologists, 2017).
Some of the clinical findings that patients who are indicative of breast cancer may present with include skin changes, such as swelling, reddening, and visible differences on one or both breasts, change in breast shape or an increase in size, nipple discharge, change in nipple appearance, general pain and lumps often felt inside the breast. Considering the patient's age and medical history, a diagnostic mammogram and a breast ultrasound should be ordered. A mammogram will capture various areas inside the breast, while a breast ultrasound will capture areas that are difficult to see with mammography (American College of Obstetricians and Gynecologists, 2017). These diagnostic tests will help determine whether the lumps on the patient's breast are benign or cancerous, thereby guiding treatment (Brown et al., 2017).
Delegate your assignment to our experts and they will do the rest.
Given the patient's health and family history, the primary diagnosis is breast cancer if she has a family history of breast cancer and has previously had a biopsy, which revealed atypical hyperplasia. The fibrocystic condition also causes lumps in the breast. These are often non-cancerous and occur in most women at particular stages of their lives. However, the condition is characterized by breast lumps, swelling, tenderness, and pain, absent in the case study patient. They are often associated with menstrual periods and their maybe cloudy nipple discharge. Fat necrosis is also another possible condition that is often associated with breast lumps. It is common in middle-aged women, and symptoms include painless lumps, red skin, and dimpled skin. While the patient reports lumps, she does not have the other symptoms hence excluding fat necrosis. Breast fibroadenoma is painless lumps common in women aged between 14 and 35 years, although they can occur at any age. The masses, in this case, are non-tender, painless, and mobile. These shrink after menopause, hence are less likely in post-menopausal women (Ajmal & Fossen, 2020). These features exclude fibroadenoma as a primary diagnosis.
It is vital to incorporate shared decision-making during patient management, where the patient participates in treatment and expresses treatment preferences. The patient is likely to have early-stage breast cancer (EBC); hence appropriate therapy should include adjuvant chemotherapy. In this case, chemotherapy and radiation, which is expected to produce better results, will be used (Fisusi & Akala, 2019). After radiation to shrink the size of the tumor, the patient will be prescribed with Cytoxan, Adriamycin, and fluorouracil (CAF). Frequent tests will be conducted to establish how the body is handling the chemotherapy. Blood tests, for instance, will help determine the number of blood cells. Patient education will be delivered through face-to-face conversations, information handouts, and online videos. The patient will be educated on various side effects that are associated with chemotherapy. The patient will be educated on detecting any unusual or new symptoms and the need to report such symptoms. Once treatment has been completed, the patient will be monitored. A physical examination and a review of symptoms will be conducted every three to six months for the first three years, once every six months up to five years after treatment and annually afterward. The patient will continue to have mammograms on her left breast, which will be done annually. In case the patient develops any unusual symptoms, she will be referred to a breast specialist who will conduct more focused assessments and diagnoses.
References
Ajmal, M., & Fossen, K. V. (2020). Breast Fibroadenoma. StatPearls . https://www.statpearls.com/articlelibrary/viewarticle/18600/#:~:text=A%20fibroadenoma%20is%20a%20painless
American College of Obstetricians and Gynecologists. (2017). Breast Cancer Risk Assessment and Screening in Average-Risk Women . Acog.Org. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2017/07/breast-cancer-risk-assessment-and-screening-in-average-risk-women
Brown, A. L., Phillips, J., Slanetz, P. J., Fein-Zachary, V., Venkataraman, S., Dialani, V., & Mehta, T. S. (2017). Clinical Value of Mammography in the Evaluation of Palpable Breast Lumps in Women 30 Years Old and Older. American Journal of Roentgenology , 209 (4), 935–942. https://doi.org/10.2214/ajr.16.17088
Fisusi, F. A., & Akala, E. O. (2019). Drug Combinations in Breast Cancer Therapy. Pharmaceutical Nanotechnology , 07 (3), 3–23. https://doi.org/10.2174/2211738507666190122111224
