1. occurs prior to menstruation (Frazier & Dryzmkowski, 2016).

There are several factors in the patient’s
history that increase her risk of developing breast cancer. Firstly, a family
history of breast cancer may increase her risk of developing breast cancer, as
15% to 20% of cases are linked to a positive family history (Frazier & Dryzmkowski, 2016). Since her mother
and cousin had breast cancer, she may have an increased risk of developing the
disease. Secondly, nulliparous women have an increased risk of developing
breast cancer (Russo, Moral, Balogh, Mailo, & Russo, 2005). There are
several proposed mechanisms that suggest pregnant women are at a lower risk of developing
breast cancer. This includes the model that hormonal changes during pregnancy affect
the differentiation of breast tissue, which reduces the risk of developing
breast cancer later in life (Russo & Russo, 1995).


Based on her findings, Mrs. Thompson’s
breast lump is not consistent with the general features of a benign breast
lump, or the specific features of benign breast conditions. In general, benign
breast lumps tend to feel soft and firm, while malignant breast lumps tend to
be hard (Klein, 2005). As a result,
Mrs. Thompson’s observation that her breast lump felt hard is more consistent with
a malignant breast lump compared to a benign breast lump. The signs and
symptoms associated with Mrs. Thompson’s breast lump also do not correspond
with the specific signs and symptoms of commonly diagnosed benign breast
conditions and the at-risk age groups. More specifically, fibrocystic breast
conditions commonly affect women between the ages of 30 and 50 years old, and
are associated with tenderness and pain which occurs prior to menstruation (Frazier & Dryzmkowski, 2016). However, Mrs.
Thompson is slightly above the commonly affected age group, and more
importantly, she reports that the lump is painless even though she is
premenopausal. Therefore, there is a low chance that she has a fibrocystic
breast condition. Fibroadenomas of the breast are another benign breast
condition which can be associated with a breast lump. These benign tumors are
associated with no pain, and most commonly affect women between the ages of 30
and 35 years old (Frazier & Dryzmkowski, 2016). Although Mrs.
Thompson reports that the lump is painless, her age is significantly higher
than the age range which is commonly affected, and as a result, she is less
likely to have a fibroadenoma. In conclusion, Mrs. Thompson’s signs and symptoms
are inconsistent with a benign breast condition.

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The axillary lymph nodes were removed to
assist in determine if the cancer has metastasized and to assist in staging of
the cancer.  Breast cancer cells commonly
metastasize to the axillary lymph nodes. As a result, the axillary lymph nodes are
commonly removed and pathologically examined for the presence of cancerous
cells. The sentinel lymph nodes are commonly removed, as they are the lymph
nodes closest to the tumor’s location and are the first lymph nodes where
cancerous cells are likely to metastasize (American Cancer Society, 2013). Secondly,
evaluating the extent of lymph node metastasis assists in the staging of the
cancer. The TNM system of staging assesses a neoplasm based off the size of the
primary tumor (T), the involvement of the lymph nodes (N) and the occurrence of
distant metastases (M). As a result, findings concerning the lymph nodes are
valuable in evaluating whether the cancerous cells have affected the lymph
nodes and are valuable in determining a clinical stage for the neoplasm.
Assigning a stage to the neoplasm may assist physicians in determining the
appropriate treatment for the patient (Frazier & Dryzmkowski, 2016).


Positive estrogen receptors on tumors have
several implications for the patient. Firstly, this information suggests that
the tumor is better differentiated. Higher estrogen and progesterone receptors
are associated with well and moderately differentiated cancers, which may
improve the efficacy of treatment and its outcomes (McCarty et al., 1980). Secondly, this
suggests that the tumor can be treated with hormonal therapy. Many cases of
breast cancer will have tumors that express estrogen and progesterone
receptors, indicating that they may depend on estrogen and progesterone to grow
and proliferate. As a result, selective estrogen receptor modulators (SERMs)
such as tamoxifen can be used to reduce the growth of the tumor. The use of
tamoxifen over five years has been shown to reduce the mortality rate by 31% (Yip & Rhodes, 2014). Mrs. Thompson’s
breast cancer seems to be in its early stages, according to the TNM system of
staging. The primary tumor is small, regional lymph node involvement appears
minimal, and distant metastases have not been described (Frazier & Dryzmkowski, 2016). As a result, the
use of SERMs may be effective in inhibiting the proliferation of the tumor and
treating her cancer. This may result in a favorable prognosis for her
condition. The second implication is that the patient may need to undergo other
procedures or use other hormonal therapies to limit the production of female
reproductive hormones. Since Mrs. Thompson is premenopausal, her monthly
menstrual cycles produce estrogen and progesterone. Therefore, she is a
candidate for a prophylactic oophorectomy to limit the production of these
hormones. An equally effective alternative is Luteinizing Hormone Releasing
Hormone therapy, which suppresses the release of luteinizing hormone, and
therefore the release of ovarian hormones. This therapeutic option presents a
lower risk of morbidity from surgery, and is also reversible (Singh, 2012).


In addition to the lumpectomy, there are
additional treatments that are needed. This includes radiation therapy, hormone
therapy and chemotherapy (Frazier & Dryzmkowski, 2016). Radiation
therapy uses ionizing radiation to damage the DNA within the tumor cells. This
kills the cells and prevents proliferation and growth of the tumor (Braun & Anderson, 2017). As mentioned
prior, tumors that are positive for estrogen and progesterone receptors may be
responsive to hormonal therapy (Yip & Rhodes, 2014). Lastly,
chemotherapy can be administered to interfere with the growth of the tumor in a
systemic manner. Overall, combination therapy is recommended for Mrs. Thompson,
as it uses multiple different mechanisms to ensure that the neoplasm is
eradicated to reduce the risk of recurrence (Braun & Anderson, 2017).