Female Reproductive System & Breast


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S30_F1.jpg"}},{"insert":"\n\nOctober has just begun, and pink ribbons are being handed over at every street corner. You are in your office reviewing a presentation on breast cancer awareness, when the first patient of the day arrives.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S30_F5.jpg"}},{"insert":"\n\nYou are introduced to 32-year-old Lisa, a teacher at the nearby high school. \u0022I\u0027ve got a lump in my left breast, doctor,\u0022 she says. \n\nFeeling concerned, you solicit more details.\n\nLisa discovered the lump last week, after doing a breast self-examination. \u0022I didn\u0027t take this stuff too seriously before, doctor, but you know, it\u0027s breast cancer month, and I thought that I might as well start now \u2013 after all, I\u0027m now growing any younger,\u0022 she explains.\n\nThe lump was painless, and she has no idea how long it might have existed. She is asymptomatic otherwise and has been in good health until now. There is no history of trauma to the breast or of previous breast lumps. She is not on any medications, including over-the-counter medications or supplements. Her family history is unremarkable.\n\nLisa is nulliparous. Her menarche was at the age of 12. Her menstrual cycles are regular, with an average 27-day duration. She has had several partners over the years, but is currently single. You ask about the use of oral contraceptive pills, to which she responds: \u0022well, I do take them when I have a partner, doctor, but I\u0027m not on them right now.\u0022\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/S30_F2.jpg"}},{"insert":"\n\nYou ask Lisa for permission to examine her, to which she consents. Her vital signs are stable. Her body mass index (BMI) is 22.1. The general examination is unremarkable.\n\nDuring the breast examination, the right breast and axilla are clinically normal. Inspection of the left breast reveals normal overlying skin and no visible masses. During palpation, you note a solitary lump in the upper outer quadrant, around 1 x 2 cm in size. The lump is not tender. It is discrete, with a smooth surface and clear margins. It is also widely mobile and rubbery in consistency. There is no nipple discharge. The left axilla is clinically normal.\n\nExamination of the abdomen and cardio-respiratory examination reveal no untoward findings.\n"}]}


{"ops":[{"insert":"\u0022Is this cancer, doctor?\u0022 Lisa asks. Although she appears calm and composed, you detect an undertone of fear in her voice.\n\nHow do you respond?\n"}]}
1. "Yes, I'm worried that this might be breast cancer."
2. "No, this is more likely to be a benign breast lump."
3. "I'm sorry – at this point, I can't say much at all."