Case Study 1:

Diane Brady, Age 26, Breast Cancer

Diane Brady is a 26-year-old fourth year medical student who recently found a lump in her left breast. She comes to the primary care physician's office for a clinical exam. The exam reveals a palpable 2 cm. mass in the upper left quadrant. The physician orders a mammogram and schedules an appointment with a breast surgeon. The mammogram is suggestive of a malignancy, and an interventional radiologist does an immediate core biopsy. The pathology report states that the sample is positive for infiltrating ductal carcinoma. The breast surgeon explains the surgical options to Diane. Diane chooses to aggressively treat her lesion by bilateral radical mastectomy and left axillary sentinel node biopsy. Reconstruction surgery will be postponed until after treatment. Diane and her fiancé are visibly upset by the diagnosis and treatment alternatives.

Diane's bilateral mastectomy and sentinel node biopsy are completed. Unfortunately, the sentinel node was positive for malignancy, and further resection revealed 3 additional nodes with malignancy. Her pathology report states that the tumor is aggressive, ER+, PR-, and Her2-neu +. Staging is given as Stage IIIA.

Following adequate surgical healing, Diane is started on Paclitaxol. After completing this regimen, she will receive Doxorubicin 60mg/m 2 , Cyclophosphamide 600 mg/m 2 every 3 weeks for 4 cycles. Diane attempts to complete her medical studies as she begins her treatment. Unfortunately, side effects such as alopecia, bone marrow suppression, and nausea prevent her from focusing on her work. She becomes depressed, anxious, and feels isolated. She no longer sees her friends.

A year after treatment, Diane has completed medical school and started a residency. However, she complains of persistent bone pain in her left upper arm and right thigh. A bone scan reveals metastatic lesions. The oncology nurse practitioner recommends treatment with Herceptin. Diane will receive Herceptin 4 mg/m 2 as a loading dose, then 2mg/m 2 weekly. Diane and her fiancé once again put their wedding on hold. Diane is unable to stop crying. Her fiancé is angry.

                                                                                                               Halstead, M. (2005)