Scenario M.D. is a 50-year-old woman whose routine mammogram showed a 2.3- × 4.5-cm lobulated mass…

Scenario

M.D. is a 50-year-old woman whose routine mammogram showed a 2.3- × 4.5-cm lobulated mass at the 3 o’clock position in her left breast. M.D. underwent a stereotactic needle biopsy and was diagnosed with invasive ductal carcinoma, estrogen and progesterone receptor positive, HER-2 negative. The staging workup was negative for distant metastasis. Her final staging was stage IIB. She had a modified radical mastectomy with axillary 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.

1. What are the risk factors for breast cancer?

2. Describe the biopsy technique used to diagnose M.D.’s cancer.

3. Breast cancer is classified as noninvasive or invasive. Compare these terms.

4. Discuss the implications of a positive sentinel node.

5. What factors affect prognosis and treatment for breast cancer?

6. Is she a candidate for tamoxifen therapy? Explain your reasoning.

7. Surgical intervention is the primary treatment for breast cancer. Describe the surgical procedure that M.D. had.

8. Describe M.D.’s risk for lymphedema.

9. What actions will you teach M.D. to reduce her risk for developing lymphedema?

CASE STUDY PROGRESS

Eight weeks after surgery, M.D. is now beginning a prescribed chemotherapy regimen of 6 cycles of CAF (cyclophosphamide, doxorubicin, and fluorouracil).

10. M.D. asks you why she has to have chemotherapy with so many drugs if the surgeon removed all the cancer. How would you respond?

11. Name the common side effects experienced by patients receiving a chemotherapy regimen.

12. What information would you want to review with M.D. about the signs and symptoms of infection and when to seek treatment?

13. M.D. is ordered doxorubicin at 75 mg/m². Her height is 5 feet, 7 inches (170 cm), and her weight is 155 pounds. Calculate the dose she will receive.