Breast cancer is the second most common type of cancer after lung cancer. Breast cancer is a cancer that starts in the cells of the breast in women and men. The breast is composed of identical tissues in both males and females. Therefore it is very important for healthcare providers to understand all the facts regarding breast cancer.
The number one cure for breast cancer is early detection. In this paper, the medical record of a patient with breast cancer will be reviewed and analyzed, to identity the patient's diagnosis and trace the course of treatment. We will identify the medical record number, review the health history, and report the admitting diagnosis for the patient's hospitalization.
We will also evaluate results from physical examination and diagnostic testing such laboratory examinations and radiology final results, including the course of treatment and medication administration. The patient condition will be evaluated upon discharge.
Will compare and contrast the patient actual treatment received, from Sundance Health Care System medical staff versus the recommendation from the Merck Manuals online Medical Library for patients with breast cancer. Identify the Patient's diagnosis and trace the course of treatment
Jane Dare is a single white female admitted to the Sundance Health Care Systems under the care of Doctor A.M Everett as the primary physician and Doctor A. W. Bushfield as the consulting physician in this case. The patient was diagnosed for right breast prophylactic mastectomy with bilateral reconstruction in the morning. The course of treatment for this patient was surgery.
The surgical procedure which was performed was a prophylactic right simple mastectomy, followed by sub muscular implant reconstruction of the right breast and left breast reconstruction with sub muscular implant. This operation was performed under general anesthesia.
Report the following information from the health record
The patient Medical Record number is 661944, the patient was hospitalized for a right breast prophylactic mastectomy with bilateral reconstruction in the morning. The patient has a history of carcinoma of left breast, status post mastectomy one and half year ago; she has a family history of breast cancer. The patient's grandmother died from breast carcinoma.
Furthermore the patient has a history of tonsillectomy and adenoidectomy. Physical findings revealed that the patient had a left breast mass which was biopsied. The biopsy revealed a malignancy, with no auxiliary nodes was found. After surgery it was confirmed that the patient has a multi-focal lobular carcinoma in situ with focal stromal invasion, right breast.
After surgery a chest X-ray was performed, the X-ray revealed a normal chest film, with the absent of the left breast. Electrocardiogram performed, and no abnormal finding. Laboratory examinations were performed with a complete blood count, urinalysis, Venereal Disease Research Laboratory test (VDRL), blood urea nitrogen , creatinine, blood glucose, electrolyes, prothrombin times, partial prothrombin times, platelets, calcium, phosphorus, alkaline phosphatase, bilirubin, LDH, SGOT, SGPT, CPK , type and crossmatch 2 units of blood. The hemoglobin and hematocrit are abnormally low Lymphocytes are abnormally high. Urinalysis revealed cloudiness and a PH of 7.5 which is higher than normal.
The course of treatment was mastectomy followed by implant reconstruction. Intravenous Fluid administered, patient received a total of 900 milliliters of D51/2 Normal Saline starting at 0830 A.M and later on at 1630 another 180 milliliters. Vistaril 50 mg and Demerol 50 mg administered in the surgical unit prior to surgery for sedation purpose.
Post operatively patient vital signs were monitor every 15 minutes until the patient condition became stable, thereafter every 30 minute times two, then every hour times two, later on every four hours times four, and then return to the hospital for routine vital signs.
This post operative female was placed on bed rest with the head of the bed elevated to 30 degrees. Patient was able to use bathroom only with help. The patient was on Intravenous Fluid and as well as liquid by mouth. The patient thereafter was placed on a regular diet.
During surgery two Jackson Pratts drainage were placed at the right and the left side of chest to collect excessive drainage. Patient also received antibiotic treatment, Ancef 1 grams intravenously every 6 hours. Demerol 75 mg Intramuscular every 3 hours as needed for pain.
Tigan suppository ordered every 6 hours as needed for nausea and vomiting. Milk of Magnesia 30 milliliters by mouth prescribed every other day as needed for constipation. Dalmane 30 mg by mouth as needed for sleep. Iron sulfate 300 mg by mouth three times a day with meals, the third day of post operation the physician ordered a bra for patient to wear.
Patient Condition upon discharge, vital sign were stable, no fever. The chest wounds were well healed. The implant on the right side was slightly more firmed than the one on the left. On the day of discharge the Jackson Pratts drains were removed.
Discharge medications were: Percocet one tablet by mouth every four hours as needed for pain, Ancef 500 mg by mouth four times a day, iron sulfate 300 mg by mouth three times a day. Hematocrit was 38.5 as previously before surgery and white blood cells was 7,500. Urinalysis was normal as well as the chest X-ray and the electrocardiogram.
Merck Manuals online Medical Library of Diagnosis and Therapy Pathology of the Disease
Most breast cancers are epithelial tumors with develop from cell lining ducts. Non epithelial cell breast is less common. Cancers are divided into carcinoma in situ and invasive cancer. Breast cancer can invade surrounding tissues, such as lymph nodes, auxiliary gland.
Cancer cells can also be in the blood stream and spread out to other vital organs in the body. When breast cancer becomes metastasized, the primary organs are affected such as the lungs, liver, bone, skin, and brain.
Estrogen and progesterone receptors, present in some breast cancers. Postmenopausal patients have an estrogen-receptor and are usually positive for tumor. Evidence of tumors is lower among premenopausal patients.
Signs and Symptoms
Breast cancer is usually discovered during a physical examination, where a lump is palpable, or during a mammogram. Symptoms that are associated with breast cancer are breast pain, enlargement, thickens of the nipples, and discharge may be present.
They may be some skin change such as scaling, redness, and crusting. These symptoms are very vague; most of the times are ignored by the person experiencing them, therefore delaying the process of early diagnosis. A few patients with breast cancer present with metastasis symptoms due to delayed diagnosis.
Laboratory Findings
The unlucky factor of developing breast cancer in the U.S is about 14 percent and an average of 4% of those who have been diagnosed died from breast cancer. Therefore it is recommended, to screen individual for breast cancer.
Screening includes mammography, breast examination by health care practitioners, and monthly breast self-examination. According to the American Cancer Society an annual mammogram is recommended for women 50 years old or older. Routine breast examination can reduce the mortality rate of breast cancer by 25 to 35 percent
Diagnosis
Diagnosing breast cancer is complete by performing a physical examination, followed by a mammogram and thereafter a biopsy of the lump. The biopsy may be done as a needle biopsy, incisional biopsy, or excisional biopsy if the tumor is small enough. If the biopsy specimen is positive for cancer further testing is required.
Specimen should be analyzed for estrogen and progesterone receptors. White blood cell should be tested for genes when family history includes multiple cases of early-onset breast cancer.
Chest x-ray, complete blood count, and liver function tests should be done to check for metastasis disease. In general they will measure the serum carcinoembryonic antigen level or cancer antigen, to determine the presence of cancer cells.
A bone scan is to be completed if the patient's tumor is greater than two centimeters, skeletal pain involved, lymphadenopathy, or elevated serum alkaline phosphatase or calcium levels.
Abdominal Computer Tomography (CT) is done if patients have abnormal liver function test, hepatomegaly, or advanced cancer with or without involvement of axillary lymph node.
Prognosis
Long-term prognosis depends on the extent of lymph node involvement, number of axillary lymph nodes involved, size of primary tumor, tumor grade, stage, presence of estrogen and progesterone receptors, patient age, and the larger the tumor is, the worse the prognosis could be.
Treatment Alternatives
Treatment for breast cancer is usually surgery, such as removal of the lump, or mastectomy. When the cancer is in an advanced stage, and metastases, usually surgery is not recommended. Surgery usually follows by radiation or chemotherapy.
Radiation or chemotherapy decreases the change of the cancer reappearing and invading surrounding tissue such as the chest wall. After treatment is completed reconstructive surgery usually follows. Depending on the physician they may use silicon or saline for the breast implant.
Comparing the information from the Merck Manuals online Medical Library and to the patient actual treatment
According to the patient's medical record, this patient has a history of breast cancer originates in the left breast, a mastectomy was performed. The patient did not receive any chemotherapy, nor radiation therapy, post mastectomy.
Later on, patient was admitted to the Sundance Health Care Systems for a prophylactic mastectomy, and bilateral breast reconstruction. After surgery patient was stable and was discharged home. Prior to the prophylactic mastectomy, there was no work-up to detect any cancer cells.
While reviewing this patient medical record, I noted a chest X-ray, electrocardiogram, and some lab work were completed, however nothing specific related to breast cancer. The discharge instruction, did not specified, any future plans for any radiation or chemotherapy. No follow-up is scheduled for any future examination, to ensure that the patient is free of cancer cells.
Merck Manuals online Medical Library of breast cancer, there are a few guidelines which physicians usually follow when treating a patient with breast cancer. During the diagnostic phase some blood work may be ordered such as measuring serum carcinoembryonic antigen or the cancer antigen.
A bone scan may be performed to detect if any cancerous cells, that may be circulation throughout the body. When a patient is diagnosed with breast cancer, sometimes depending on the physician radiation may be giving prior to removal of the breast or the lump in the breast. Surgery is usually the choice if cancer in not too advanced. The cancerous cancer is removed and usually followed by chemotherapy or radiation.
To compare and contrast the information provided by the patient's medical record, and Merck Manuals Online Medical Library, there are a few similarities and the administration of care. However, I feel that the physician failed to make sure that the patient was cancer free.
The physician did not perform the necessary test, such as a simple blood test like the cancer antigen or bone scan. The patient should have received some form of chemotherapy or radiation, after the first surgery, to prevent further reoccurrences.
According to research regardless of the type of treatment a patient receives for breast cancer, there is a possibility of reoccurrence, but with chemotherapy or radiation the prevalence of not reoccurring is greater.
Reference
Merck Manuals online Medical Librarys Medical Library. Breast Cancer. Retrieved on October 18, 2008 from http://www.merck.com/mmpe/print/sec18/ch253/ch253e.html
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