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MBChB Year 4
SCENARIO
Module 4: Breast Lumps
Current Assessment SCENARIO 1 It’s Anna’s 37th birthday. She is sitting in the surgical
outpatients with her husband, John. Three weeks ago she thought she could feel
a lump in her right breast and went straight to her GP who referred for an
urgent appointment. Last week she was seen by the consultant who detected a 3
cm lump in the left upper outer quadrant and a firm mobile 1.5 cm node in the
axilla. He performed a fine needle aspiration
(FNA). Anna has been convinced she had cancer from the moment she discovered
the lump and is anxious and tearful. John wants to know why Anna and other
women like her aren’t screened for breast cancer, in the same way as cervical
smears are done to detect early cancer of the cervix. He refuses to talk with
Anna about her fear of cancer. His father died last year of a lung cancer
which had spread to the liver before it was diagnosed. Anna and John are seen by the registrar who explains that the
cells from the FNA were not normal. The lumps are not definitely cancerous,
but they could be and Anna will need to be admitted to have the lump in the
breast removed and also the gland taken from under the arm so that both can
be looked at under the microscope. SCENARIO 2 Anna has had surgery successfully and is recovering in hospital.
The lumps removed were cancerous, but the laboratory reports that they have
been entirely excised. Also, several scans have shown no spread of cancer throughout
the body. However, her consultant explains that even so, the next step is for
her to have chemotherapy, as there is still a chance that some tumour cells
may still have “seeded out” around the body. Anna doesn’t really want
‘chemo’, as she remembers how sick her aunt was when she had treatment like
this for ovarian cancer. She and her husband also wonder why she can’t have
radiation treatment instead – or even nothing at all, and wait and see how
things go? They are even further confused, as the consultant is asking
whether she would enter a clinical trial of two different types of
chemotherapy systems. He says that breast specialists are still trying to
find the best treatment regimes, and the trial will help them decide this.
However, Anna wants to discuss the situation with her two young daughters –
she has heard there is a test for genetic susceptibility to breast cancer,
and she wants to know if her girls should have this test, and if so when. |
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