Clinical Case 006

(as before, answer the question is sequence fully before uncovering answers)

A 57 year old woman presents to her GP with a right breast lump and axillary lump. The GP undertakes some actions:

Q1. Has the GP undertaken appropriate investigation?
Q2. What is the role of breast cancer tumour markers in this instance?
Q3. What features of history are relevant for future management?

The patient undergoes an operation:

Q4. What operation should be undertaken initially?

Q5. Based on this report, what are the relevant therapy decisions?
Q6. The patient (appropriately or inappropriately) returned to surgery, what operation would you advise based on the pathology report?

Q7. What do you believe are the risks for locoregional and distant failure in this patient?
Q8. Discuss the evidence that radiotherapy improves survival in breast cancer.
Q9. List the treatments required with justification. Also provide the specific details of all these therapies you list.
Q10. Table the local, regional & distant recurrence rates before the treatment you specify, and the rates with the treatment package you specify.
Q11. Table the major side effects (with rates) for all the treatments you describe.

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