1. There are several factors in the patient’shistory that increase her risk of developing breast cancer. Firstly, a familyhistory of breast cancer may increase her risk of developing breast cancer, as15% to 20% of cases are linked to a positive family history (Frazier & Dryzmkowski, 2016). Since her motherand cousin had breast cancer, she may have an increased risk of developing thedisease. Secondly, nulliparous women have an increased risk of developingbreast cancer (Russo, Moral, Balogh, Mailo, & Russo, 2005).
There areseveral proposed mechanisms that suggest pregnant women are at a lower risk of developingbreast cancer. This includes the model that hormonal changes during pregnancy affectthe differentiation of breast tissue, which reduces the risk of developingbreast cancer later in life (Russo & Russo, 1995). 2. Based on her findings, Mrs. Thompson’sbreast lump is not consistent with the general features of a benign breastlump, or the specific features of benign breast conditions. In general, benignbreast lumps tend to feel soft and firm, while malignant breast lumps tend tobe hard (Klein, 2005).
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As a result,Mrs. Thompson’s observation that her breast lump felt hard is more consistent witha malignant breast lump compared to a benign breast lump. The signs andsymptoms associated with Mrs. Thompson’s breast lump also do not correspondwith the specific signs and symptoms of commonly diagnosed benign breastconditions and the at-risk age groups. More specifically, fibrocystic breastconditions commonly affect women between the ages of 30 and 50 years old, andare associated with tenderness and pain which occurs prior to menstruation (Frazier & Dryzmkowski, 2016).
However, Mrs.Thompson is slightly above the commonly affected age group, and moreimportantly, she reports that the lump is painless even though she ispremenopausal. Therefore, there is a low chance that she has a fibrocysticbreast condition. Fibroadenomas of the breast are another benign breastcondition which can be associated with a breast lump.
These benign tumors areassociated with no pain, and most commonly affect women between the ages of 30and 35 years old (Frazier & Dryzmkowski, 2016). Although Mrs.Thompson reports that the lump is painless, her age is significantly higherthan the age range which is commonly affected, and as a result, she is lesslikely to have a fibroadenoma. In conclusion, Mrs.
Thompson’s signs and symptomsare inconsistent with a benign breast condition. 3. The axillary lymph nodes were removed toassist in determine if the cancer has metastasized and to assist in staging ofthe cancer. Breast cancer cells commonlymetastasize to the axillary lymph nodes. As a result, the axillary lymph nodes arecommonly removed and pathologically examined for the presence of cancerouscells. The sentinel lymph nodes are commonly removed, as they are the lymphnodes closest to the tumor’s location and are the first lymph nodes wherecancerous cells are likely to metastasize (American Cancer Society, 2013). Secondly,evaluating the extent of lymph node metastasis assists in the staging of thecancer.
The TNM system of staging assesses a neoplasm based off the size of theprimary tumor (T), the involvement of the lymph nodes (N) and the occurrence ofdistant metastases (M). As a result, findings concerning the lymph nodes arevaluable in evaluating whether the cancerous cells have affected the lymphnodes and are valuable in determining a clinical stage for the neoplasm.Assigning a stage to the neoplasm may assist physicians in determining theappropriate treatment for the patient (Frazier & Dryzmkowski, 2016). 4. Positive estrogen receptors on tumors haveseveral implications for the patient. Firstly, this information suggests thatthe tumor is better differentiated.
Higher estrogen and progesterone receptorsare associated with well and moderately differentiated cancers, which mayimprove the efficacy of treatment and its outcomes (McCarty et al., 1980). Secondly, thissuggests that the tumor can be treated with hormonal therapy. Many cases ofbreast cancer will have tumors that express estrogen and progesteronereceptors, indicating that they may depend on estrogen and progesterone to growand proliferate. As a result, selective estrogen receptor modulators (SERMs)such as tamoxifen can be used to reduce the growth of the tumor. The use oftamoxifen over five years has been shown to reduce the mortality rate by 31% (Yip & Rhodes, 2014). Mrs. Thompson’sbreast cancer seems to be in its early stages, according to the TNM system ofstaging.
The primary tumor is small, regional lymph node involvement appearsminimal, and distant metastases have not been described (Frazier & Dryzmkowski, 2016). As a result, theuse of SERMs may be effective in inhibiting the proliferation of the tumor andtreating her cancer. This may result in a favorable prognosis for hercondition. The second implication is that the patient may need to undergo otherprocedures or use other hormonal therapies to limit the production of femalereproductive hormones. Since Mrs.
Thompson is premenopausal, her monthlymenstrual cycles produce estrogen and progesterone. Therefore, she is acandidate for a prophylactic oophorectomy to limit the production of thesehormones. An equally effective alternative is Luteinizing Hormone ReleasingHormone therapy, which suppresses the release of luteinizing hormone, andtherefore the release of ovarian hormones.
This therapeutic option presents alower risk of morbidity from surgery, and is also reversible (Singh, 2012). 5. In addition to the lumpectomy, there areadditional treatments that are needed. This includes radiation therapy, hormonetherapy and chemotherapy (Frazier & Dryzmkowski, 2016). Radiationtherapy uses ionizing radiation to damage the DNA within the tumor cells. Thiskills the cells and prevents proliferation and growth of the tumor (Braun & Anderson, 2017). As mentionedprior, tumors that are positive for estrogen and progesterone receptors may beresponsive to hormonal therapy (Yip & Rhodes, 2014).
Lastly,chemotherapy can be administered to interfere with the growth of the tumor in asystemic manner. Overall, combination therapy is recommended for Mrs. Thompson,as it uses multiple different mechanisms to ensure that the neoplasm iseradicated to reduce the risk of recurrence (Braun & Anderson, 2017).