Case Study
Breast
Cancer
Scenario
M.D.
is
a
50-year-old
woman
whose
routine
mammogram
showed
a
2.3-x4.5-cm
lobulated
mass
at
the
3
o'clock
position
in
her
left
breast.
M.D.
underwent
a
stereotactic
needle
biopsy
and
was
diagnosed
with
infiltrating
ductal
carcinoma,
estrogen
receptor
positive.
The
staging
workup
was
negative
for
distant
metastasis.
Her
final
staging
was
stage
[IB.
She
had
a
modified
radical
mastectomy
with
lymph
node
dissection.
The
sentinel
lymph
node
and
4
of
16
lymph
nodes
were
positive
for
tumor
cells.
An implanted
port
was
placed
during
surgery.
Describe
the
biopsy
technique
used
to
diagnose
M.D.’s
cancer.
The
biopsy
technique
used
to
diagnose
M.D.’s
cancer
was
stereotactic
needle
biopsy.
This
technique
involves
immobilizing
the
breast,
determining
tumors
present
through
an
x-ray
while
inserting
a
needle
to
aspirate
the
tumor
cells.
The
technique
leaves
minimal
scarring.
Discuss
the
implications
of
a
positive
sentinel
node.
Malignant
cells
are
observed.
Abnormal
cells
are
seen
with
cancer
present
in
the
node.
According
to
the
TNM
staging
system,
what
would
her
classification
be?
Stage
2,
primary
tumor
ad
lymph
nodes.
Is
she
a
candidate
for
tamoxifen
(Nolvadex)
therapy?
Explain
your
rationale.
Yes,
because
the
estrogen
receptor
is
positive.
Surgical
intervention
is
the
primary
treatment
for
breast
cancer.
Describe
the
surgical
procedure
that
M.D.
had.
M.D.
had
a
modified
radical
mastectomy
where
the
whole
breast
and
lymph
nodes
are
removed.
Describe
M.D.’s
risk
for
lymphedema
Risks include
amount
of
lymph
removed,
presence
of
obesity,
and
previous
axillary
surgery.
What
actions
will
you
teach
M.D.
to
reduce
her
risk
of
developing
lymphedema?
Do
not
sleep
in
dependent
position,
no
bp,
venipuncture,
or
injections
in
that
arm
Protect
from
trauma,
apply
compression
sleeves,
no
heavy
lifting
Case
Study
Progress
Eight
weeks
after
surgery,
M.D.
is
now
beginning
a
prescribed
a
chemotherapy
regimen
of
six
cycles
of
CAF(cyclophosphamide
[Cytoxan],
fluorouracil
[5-FU],
and
doxorubicin
[Adriamycin]).
M.D.
asks
you
why
she
has
to
have
chemotherapy
with
so
many
drugs
if
the
surgeon
removed
all
of
the
cancer.
How
would
you
respond?
There
is
a
high
risk
of
lymphedema
due
to
removal
of
lymph
nodes.
Compare
the
drug
actions
of
cyclophosphamide
(Cytoxan),
5
FU,
and
doxorubicin
(Adriamycin).
This
is
a
chenesirem——————fe®|
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