Nurse 680 Week 5: Breast Cancer in Men Case Study Assignment   Paper

 Nurse 680 Week 5: Breast Cancer in Men Case Study Assignment   Paper

 Nurse 680 Week 5: Breast Cancer in Men Case Study Assignment  Paper

Assessment Questions

A 49-year-old patient presents with breast fullness on his armpit and nipple, which could mean an infection or tumor-related conditions. Further assessment is necessary to collect enough information to make a diagnosis. First, I would ask the patient if he has noticed any of these symptoms: redness or scaling of the nipple, changes in the skin on the breast, for example, dimpling or scaring. Secondly, I would evaluate the presence of risk factors that could have exposed the patient to breast cancer. I will ask them about their family’s medical history to determine if there is a family history of cancer, as genetics is one of the risk factors for cancer (Hassett et al., 2020). Similarly, recent exposure to estrogen hormone can also increase the risk of breast cancer. Thus, I will ask the patient if he has been taking any estrogen-related drugs commonly used for hormone therapy. Finally, some diseases/conditions create the risk of breast cancer in men—for example, obesity, Klinefelter’s syndrome, liver disease, and testicle disease.

Tests would also be necessary to support accurate diagnosis, apart from the patient’s medical history. First, I will conduct a breast exam, which can help identify lumps and inflammation on the affected breast. Some tests that could be carried out to determine the problem include biopsy, mammogram, and other imaging tests such as ultrasound. A biopsy is the most accurate and effective test for breast cancer in males. The process involves removing a sample from the breast and sending it to the lab for testing to determine if its cancerous (Khattab et al., 2021). The imaging testing will show any abnormalities in the breast. Finally, a blood count test will also be necessary to pick an infection or anaemia.

Assessment:

Pertinent positives and negatives

The pertinent positives include nipple discharge, nipple fullness, tenderness to palpitation, signs of scarring and inflammation, and age. The pertinent negatives are negative family history of breast cancer, absence of obesity, no use of hormonal drugs, and absence of Klinefelter’s syndrome or liver disease.

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Differential diagnosis

Primary diagnosis

Breast cancer – breast cancer in men is rare, accounting for 1% of all cancers in the United States (Khattab et al., 2021). The risk factors of breast cancer in men include obesity, family history of cancer, high estrogen levels, radiation exposure, African American descent, age, hepatic dysfunction and Klinefelter syndrome (Zongo et al., 2018). Nevertheless, a number of men who get breast cancer do not have the mentioned breast cancer. These could be due to dietary patterns and lifestyles that encourage unhealthy eating and sedentary lifestyle. Patients with male breast cancer often present at an advanced stage because of a lack of awareness. The diagnostic symptoms include nipple scaling or redness, nipple retraction, breast mass, and axillary lymphadenopathy (Khattab et al., 2021). The common type of breast cancer in men is due to ductal carcinoma. Diagnostic tests include a breast examination, imaging, and biopsy.

Secondary diagnosis

Metastatic disease – the disease occurs in someone with a prior cancerous tumor. When the tumor breaks, the cancerous cells travel through the bloodstream or the lymph to other body parts. For example, if the patient had prostrate cancer, a metastatic disease is a likely diagnosis. However, the medical history information reveals no history of cancer (Kale & Rammohan, 2020). The symptoms include weight loss, pain, loss of energy, and shortness of breath.

Gynecomastia – refers to an imbalance in estrogen hormone in men, causing an increase in breast glands. Risk factors include age, medical conditions, or medications. The diagnostic symptoms are breast tenderness, nipple sensitivity, swelling, and pain. Tests involve a mammogram to rule out breast cancer. Additionally, biopsy, blood test, and urine tests may also be conducted to rule out other conditions and check for pathologies causing the gynecomastia.

Plan.

Tests – tests to determine the stage of cancer will be necessary to inform treatment options. The patient will be scheduled for further blood and urine tests will be conducted to check the presence of infections and organ functioning, including the kidney.

Treatment – for stage 1 and 2 cancers, mastectomy will be the most effective treatment option to remove the affected tissues. For stage 3, resection followed by radiotherapy will be the treatment option (Khattab et al., 2021). Additionally, the patient will be put on endocrine therapy as hormone therapy to support the effective management of cancer. The patient may also need pain medications to manage the pain associated with cancer. For example, the patient will be placed on Gabapentin therapy for pain management.

Patient Education

Health education is important to enhance effective self-management since cancer is a chronic condition. The patient will be advised on lifestyle modifications, including change of diet and the need for physical activity. Additionally, the patient will be advised to avoid caffeine, smoking, alcohol, and hard drugs that can exacerbate the condition.

The patient will be scheduled to take yearly examinations to check for breast and prostate cancer, whose risk becomes magnified with increasing age.

Follow-up visits will occur after two weeks to check for progress and response.

References

Hassett, M. J., Somerfield, M., Baker, E., Cardoso, F., Kansal, K., & Kwait, D. (2020). Management of Male Breast Cancer: ASCO Guideline. Journal of Clinical Oncology, 36(16).

Kale, S., & Rammohan, R. (2020). Male Breast Cancer: Reevaluate Our Opinion. Case Report in Oncology and Medicine, https://doi.org/10.1155/2020/6245415.

Khattab, A., Kashyap, S., & Monga, D. (2021). Male Breast Cancer. Treasure Island (FL): StatPearls Publishing.

Zongo, N., Ouédraogo, S., & Korsaga-Somé, N. (2018). Male breast cancer: diagnosis stages, treatment and survival in a country with limited resources. World J Surg Onc, 16, 4. https://doi.org/10.1186/s12957-017-1297-y.

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1. A 49-year-old man reports feeling fullness in his right armpit and nipple discharge at his right areola. He denies other symptoms, significant medical history, or allergies.
Listed below are the most common causes of nipple discharge in men:
2. Hormonal disorders: Deficiency of key male hormones like testosterone often presents with nipple discharge
3. Gynecomastia: Excessive growth of breast tissue in males is regarded as gynecomastia. It is often associated with nipple discharge due to excessive glandular growth
4. Tumors of pituitary glands: Anterior pituitary gland is responsible for secreting hormones that are responsible for milk secretion. Excessive secretion of certain hormones such as prolactin can also lead to discharge from nipple

For the case you have chosen, post to the discussion:
• Discuss what questions you would ask the patient, what physical exam elements you would include, and what further testing you would want to have performed.
• In SOAP format, list:
o Pertinent positive and negative information
o Differential and working diagnosis
o Treatment plan, including pharmacotherapy with complementary and OTC therapy, diagnostics (labs and testing), health education and lifestyle changes, age-appropriate preventive care, and follow-up to this visit.