Breast Cancer Case Study

Breast Cancer Case Study

Ms. J is a 30-year-old African-American woman who discovered a palpable mass in the upper quadrant of her left breast while showering. Ms. J immediately contacted her doctor and requested a diagnostic exam, which revealed she had breast cancer. Prior to discovering the mass, Ms. J experienced tenderness and soreness that she mistook for menstrual cramps. Ms. J’s family history includes her grandfather’s lung cancer and her older sister’s breast cancer with no metastasis. Ms. J smokes about a pack of cigarettes per day. She does not consume alcohol or use illegal drugs. Ms. J does not take any medications on a daily basis, but she does take a multivitamin. She claims she has no medication allergies and no seasonal allergies.

Pathophysiology

Breast cancer is the most common invasive cancer in women, and it typically manifests as a lump in the breast, with or without other symptoms (Kabel et al., 2015). Breast cancer most commonly develops in the cells that line the milk channels and the lobules that supply milk to the ducts.

According to Kabel and Baali (2015), “breast cancer is usually caused by a combination of environmental and genetic factors.” Normal cells are protected from cell suicide by the PI3K/AKT pathway and the RAS/MEK/ERK pathway. When the genes encoding these protective pathways are mutated, the cells lose their ability to commit suicide when they are no longer required, resulting in cancer development.”

“Hereditary breast-ovarian cancer syndrome refers to a familial tendency to develop breast cancers, and some cancer-related mutations, such as p53, BRCA1, and BRCA2, occur in mechanisms to correct errors in DNA, leading to uncontrolled division, lack of attachment, and metastasis to distant organs.” Inherited mutations in the BRCA1 or BRCA2 genes can prevent DNA cross-link and double-strand break repair. GATA-3 directly regulates the expression of estrogen receptors and other genes linked to epithelial differentiation and a poor prognosis caused by increased cancer cell invasion and distant metastasis (Kabel and Baali, 2015).

Around 6.6% of all breast cancer cases are diagnosed in women under the age of 40, 2.4% in women under the age of 35, and 0.65% in women under the age of 30 if plotted on a curve, the cumulative incidence of breast cancer appears to follow an exponential function below the age of 40, after which it appears to rise linearly (Assi et al., 2013).

Breast cancer symptoms include a lump in the breast, a change in breast shape, skin dimpling, nipple discharge, or a red scaly patch of skin (Kabel et al., 2015). Breast cancer is the most aggressive type of cancer in women. A lump that is different from the rest of the breast tissue is usually the first sign of breast cancer.

Age, reproductive factors, exo-endogenous hormonal exposures, personal and family history of cancer, lifestyle, and environmental factors such as alcohol consumption and diet have all been linked to the development of breast cancer (Ng et al., 2017).

Care Plan That Is Comprehensive

While showering, Ms. J noticed a palpable mass on her left breast in the upper quadrant. She immediately contacted her primary care physician, and a scheduled biopsy and diagnostic imaging of the lump on her left breast were performed. The biopsy was performed and sent to pathology for analysis. A cancer patient’s well-being is determined by how well her physical, psychological, emotional, and spiritual needs are met, and these needs are reflected in Maslow’s hierarchy (Ng et al., 2017).

Genetic/Genomic Guidance

Due to a family history of breast cancer and other cancers, genetic counseling was recommended. Unaffected individuals with hereditary risk must be identified, whether through a known genetic mutation in a family or through suggestive family history (Agnese et al., 2016). Ms. J agreed to BRCA 1 and 2 testing to determine her risk for breast cancer and treatment options if she was diagnosed. The advantages of genetic testing include the ability to make medical and lifestyle decisions while reducing the anxiety associated with not knowing one’s genetic background, as well as the ability to make proactive decisions about prophylactic surgery or chemoprevention (Agnese et al., 2016).

Patient Instruction

Thorough breast cancer education and communication with Ms. J are critical to her care. Breast cancer pamphlets and brochures are required to educate people about treatment options. Educational videos about the various stages of breast cancer should be shown. Ms. J should be aware of treatment options such as lumpectomy, chemotherapy, and radiation, with an emphasis on the benefits and drawbacks of each. The most important aspect of genetic testing education is psychosocial, religious, and ethical considerations. Locations and contact information for support groups should be provided. She should also be educated on nutrition and exercise. Information, both verbal and written, on what changes to expect, such as changes in body image, and what to do if changes occur. Continuous teaching and monitoring are essential throughout Ms. J’s care and treatment.

Treatment

According to the pathology report, Ms. J’s mass was Stage 1 invasive breast cancer with a tumor size of 1.5 cm and no metastasis to lymph nodes or other parts of the body. Because cancer had not spread beyond the breast, Ms. J underwent a lumpectomy and radiation treatments. Lumpectomy (partial or segmental mastectomy) is the surgical removal of a primary tumor with the goal of achieving widely negative margins, ideally 1cm (Shah et al., 2014). Radiation therapy is typically started three to four weeks after surgery. Radiation therapy is critical in the treatment of breast cancer and has long been known to reduce the risk of local recurrence by approximately 50%. (Shah et al., 2014).

Psychosocial Support

A breast cancer diagnosis can cause significant emotional, cognitive, social, and functional problems. To overcome these barriers to healing, additional support, such as family members, carers, and social groups are required. Concerns about their physical health, changes in their normal development, emotional or mental health issues, and social issues (e.g., financial concerns/economic burden, reemployment/early retirement, disability stigma, social and spiritual support concerns) have been identified (Weis, 2015). Ms. J scheduled an appointment with a social worker after her lumpectomy, who referred her to a therapist to begin counseling due to her emotional state as a result of her breast cancer diagnosis.

Spiritual Support

Ms. J prioritizes religion over everything else in her life. She volunteers at the church and teaches Sunday School. She serves on the Usher Board and helps the Youth Choir as needed. So, while we have the opportunity, let us do good to everyone, especially those in the household of faith (Galatians 6:10, KJV). Ms. J keeps a small bible in her pocketbook and reads scripture whenever she is feeling down. Despite her circumstances, she maintains a positive attitude and frequently says, “No worries, God has me.” Ms. J’s faith was strong, and when faced with a life-threatening disease like cancer, sometimes all you can do is belief in faith. Nurses and doctors should always provide a sense of peace and spiritual well-being to patients by being honest with them about treatments and their health.

Cultural Aspects

Culture influences beliefs about health, illness, death, and dying; expectations about diagnosis and prognosis disclosure; family decision-making roles; language; and perspectives on complementary and alternative medicine (Chaturvedi et al., 2014). Ms. J comes from a loving family that includes her mother, two brothers, and extended family. Ms. J will attend support groups where other women will share their breast cancer experiences. She has an excellent team of doctors, nurses, counselors, and dieticians who work together to provide care in a collaborative manner. She is a firm believer in God. Continuing education throughout the treatment process, genetic and genomic counseling, and stages of breast cancer are all available. Ms. J will be given a thorough education on diet and exercise to aid in her recovery. A breast cancer patient must receive education from the time of diagnosis, throughout treatment, and after treatment. All the ends of the earth, turn to me and be saved! Because I am God and there is no other (Isaiah 45:22, KJV).

References

Agnese, D. M., & Pollock, R. E. (2016). Breast Cancer Genetic Counseling: A Surgeon’s Perspective. Frontiers in Surgery, 3, 4. http://doi.org/10.3389/fsurg.2016.00004

Ahmed M. Kabel, and Fahad H. Baali, “Breast Cancer: Insights into Risk Factors, Pathogenesis, Diagnosis, and Management.” Journal of Cancer Research and Treatment, vol. 3, no. 2 (2015): 2833. doi 10.12691/jcrt-3-2-3.

Assi, H. A., Khoury, K. E., Dbouk, H., Khalil, L. E., Mouhieddine, T. H., & El Saghir, N. S. (2013). Epidemiology and prognosis of breast cancer in young women. Journal of Thoracic Disease, 5(Suppl 1), S2–S8. http://doi.org/10.3978/j.issn.2072-1439.2013.05.24

Chaturvedi, S. K., Strohschein, F. J., Saraf, G., & Loiselle, C. G. (2014). Communication in cancer care: psychosocial, interactional, and cultural issues. A general overview and the example of India. Frontiers in Psychology, 5, 1332. http://doi.org/10.3389/fpsyg.2014.01332

Holy Bible (KJV)

Kabel, A. M., & Baali, F. H. (2015). Breast Cancer: Insights into Risk Factors, Pathogenesis, Diagnosis, and Management. Journal of Cancer Research and Treatment, 3(2), 28-33.

Ng, Z. X., Ong, M. S., Jegadeesan, T., Deng, S., & Yap, C. T. (2017). Breast Cancer: Exploring the Facts and Holistic Needs during and beyond Treatment. Healthcare, 5(2), 26. http://doi.org/10.3390/healthcare5020026

Shah, R., Rosso, K., & Nathanson, S. D. (2014). Pathogenesis, prevention, diagnosis, and treatment of breast cancer. World Journal of Clinical Oncology, 5(3), 283–298. http://doi.org/10.5306/wjco.v5.i3.283

Weis, J. (2015). Psychosocial Care for Cancer Patients. Breast Care, 10(2), 84–86. http://doi.org/10.1159/000381969

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For this Discussion, The case is…

A woman comes in complaining of a breast mass she found on breast self-examination. You have performed a comprehensive assessment and concluded that it is benign.

Questions for the case:

1. Discuss the different types of benign mass.

2. Discuss how you differentiate them.

3. Discuss the different types of breast tissue sampling procedures done for these masses.

4. Discuss the clinical presentations of malignant Breast Cancer.

1. An effective health assessment incorporates not only physiological parameters; please suggest other parameters that should be considered and included in health assessments to reach maximal health potential in individuals.
2. Name the different family developmental stages and give examples of each one.
3. Describe family structure and function and the relationship with health care.

Your initial post should be at least 500 words, formatted and cited in the current APA style with support from at least 2 academic sources.