Delilah Martindale is a married, 42- year old woman with 3 children and works as a part-time cashier at Circle K. She has never smoked and has an occasional social drink. Her past medical history includes plastic surgery for bilateral breast implants done 3 years ago and tonsillectomy when she was 10 years old. Her mother is a breast cancer survivor and her father died of lung cancer two years ago. When she returned for a physical check up with her primary MD, a lump was noted on her Right breast. Her physician ordered an outpatient breast biopsy as soon as possible that revealed presence of malignant cells. She elected to have R breast removed with axillary lymph node dissection.
1. Delilah Martindale wants you to explain exactly what Stage IV: T4 N3 M1 mean. Based on the TNM Classification System, what will you tell her? (½ point)
2. Discuss the treatment modalities that Delilah Martindale may have other than the surgical procedure as mentioned in the case scenario. (2 points)
3. Define metastasis and discuss its pathophysiologic mechanism. Based on the location of her malignancy, where are the sites of metastasis? (2 points)
4. Discuss the clinical manifestations of cancer, etiology, and general effects of malignancy that Delilah Martindale may or may not experience. (2 points)
5. Delilah Martindale is to receive chemotherapy. Discuss the effects of chemotherapy to the body cells, both cancerous and non-cancerous. (½ point)
6. Describe the side effects of cancer therapy and possible treatment or ways to alleviate the discomforts or complications of these side effects. (2 points)
7. List the health education or teachings that you would provide the community or the public regarding the prevention of breast cancer. (1 point)
Expert Solution Preview
Introduction: In this case scenario, Delilah Martindale, a 42-year-old woman with a history of breast implants, was diagnosed with malignant cells in her right breast. As a medical professor, I will provide answers to the questions posed in this scenario.
1. Stage IV: T4 N3 M1 refers to the staging of cancer using the TNM Classification System. “T4” indicates that the tumor is large and invasive, usually involving the surrounding tissues. “N3” signifies that the cancer has spread to multiple lymph nodes, and “M1” means that distant metastasis has occurred, spreading to other organs or parts of the body.
2. Apart from the surgical procedure, Delilah Martindale may undergo several treatment modalities. These can include radiation therapy, which uses high-energy beams to destroy cancer cells, chemotherapy, which uses drugs to kill cancer cells throughout the body, targeted therapy that attacks specific genetic mutations within cancer cells, and hormone therapy that blocks the effects of hormones promoting cancer growth.
3. Metastasis refers to the spread of cancer cells from the primary tumor to other parts of the body. It occurs through the process of tumor cells invading blood vessels or lymphatic channels. In Delilah’s case, the potential sites of metastasis vary depending on the location of the primary tumor, which is her breast. Common sites of breast cancer metastasis include the bones, liver, lungs, and brain.
4. The clinical manifestations of cancer can vary depending on the type and location of the malignancy. Delilah may experience symptoms such as breast lump or thickening, nipple changes, breast pain, skin changes, enlarged lymph nodes, unexplained weight loss, fatigue, and generalized malaise. Etiology refers to the factors that contribute to cancer development, including genetic mutations, environmental exposures, and lifestyle factors. The general effects of malignancy can include physical and emotional distress, decreased quality of life, impaired organ function, and potential complications such as infections or bleeding.
5. Chemotherapy is a treatment modality that targets rapidly dividing cells, including cancer cells. It works by damaging the DNA or interfering with the cell division process. Chemotherapy affects both cancerous and non-cancerous cells, leading to side effects such as hair loss, nausea, vomiting, decreased blood cell production, increased risk of infections, and gastrointestinal disturbances.
6. Cancer therapy, including chemotherapy, can cause various side effects. Some common side effects include fatigue, nausea and vomiting, hair loss, mouth sores, diarrhea, and increased susceptibility to infections. To alleviate these discomforts or complications, supportive care measures can be adopted, such as the use of antiemetic drugs for nausea, scalp cooling to reduce hair loss, proper oral hygiene, dietary modifications, and the administration of growth factors to stimulate blood cell production.
7. Health education or teachings that could be provided to the community or the public regarding the prevention of breast cancer include promoting regular breast self-examination, encouraging mammographic screening according to age and risk factors, maintaining a healthy lifestyle with regular exercise and a balanced diet, minimizing alcohol consumption, avoiding smoking, and raising awareness about the importance of early detection and seeking medical attention for any breast changes.
Note: It is important for the medical professor to provide accurate and up-to-date information to the students and patients. These answers should serve as a starting point for further exploration and learning.