Indexing Title:  MPadua’s Medical Anecdotal Report [04-8]

MAR Title:  Patient with Breast Cancer

Date of Medical Observation: May, 2004

Narration:

A.R. a 39-year-old female who had an ulcerating mass on her right breast consulted at Ospital ng Maynila last May 2004.  She noted the mass for more than a year and the ulceration for three months but only decided to tell anyone because of the pain she was suffering became intolerable.

Being single and living alone, she had no one to turn to but her sister.   After her sister knew of her condition, she was immediately brought to the out-patient clinic of Surgery Department at Ospital ng Maynila. At the time of consult, A.R. was in state of depression, she had generalized body weakness and had no appetite.   Physical examination revealed an eight centimeter mass over the entire right breast with a five centimeter ulcer over the upper outer quadrant with palpable axillary lymph nodes on the same side.  It was explained to her that we are highly entertaining malignancy and samples would taken for confirmation.  We told her that we cannot operate at that time due to the size of the tumor which will leave a gaping wound that cannot be closed primarily.  We offered her neo-adjuvant chemotherapy, this mode of treatment is used to shrink the tumor making it operable.  She agreed with the plan and after prescribing pain reliever, she went home awaiting for the biopsy report before treatment was started.

The next time I saw A.R. was at the emergency room one week after, she was still depressed and feeling more pain.  After prescribing her a stronger pain reliever, I talked to her sister and told her that A.R. needed moral support and that she cannot be left living alone.  Her sister listened to my advice and took her in.

Two weeks after, A.R. was about to start her treatment, she gained weight and smiles were seen on her face.  She had a better outlook in life and was eager to undergo treatment hoping for a successful outcome.

After three cycles of chemotherapy the tumor shrank and the ulcer healed, she was able to undergo modified radical mastectomy.  At present, she still has her monthly follow-ups at the out-patient clinic and still recovering with the help of her sister.

Insights: (Physical, Psychosocial, Ethical) / (Discovery, Stimulus, Reinforcements)

Patients with physical diseases are usually treated by physicians by means of prescribing medications and performing operations to achieve cure.  Sometimes these means are not enough because a patient suffering from a disease may also suffer from depression.  This should be addressed and most of the time caring family members is the key to this problem.  If A.R. was left alone with no one to support her, she may have given up easily and would not survived the chemotherapy and the operation.