Inquiry of information medications, including current or previous use of over the counter products, vitamins and other herbal supplements. I can inquire about the history of pregnancies, miscarriages, abortions and deliveries, and lactation history in gynecologic and obstetric history. Early menarche, nulliparity or childbirth after 30 years are essential facts to collect from the patient as they prolong exposure to estrogen, which can predispose a person to malignant breast cancer. I can further assess any irradiation history involving the breast region or surrounding tissues (Hsu et al., 2020). Inquiry can be made on any changes in the patient’s skin and hair noted.
Further systemic information can be obtained in different areas with symptoms such as mood changes and temperature intolerance. Hematologic/ lymphatic system problems such as anemia, easy bruising, fatigue, history of blood transfusion, and family history of anemia are also vital to obtain. I can also inquire on malignancy in other body systems, especially colon cancer, ovarian or endometrial cancer, which predispose the patient to breast cancer. Lifestyle factors like dietary factors and alcohol consumption may alter estrogen metabolism and are crucial data to inquire (Hsu et al., 2020).
Other Objective Findings to Assess
Objective data to obtain include assessing for swollen legs and hands, which may be due to the tumor in the breast’s dermal lymphatics. Check the thyroid for enlargement or, if fair, assess the throat for any mass or any prominent lymphadenopathy, the mouth mucous membranes, and any lesions (Hsu et al., 2020).
Diagnostic Exams to Order
Mammography can be conducted to reveal the lump’s size and exact location and for early detection and diagnosis. Another test is a biopsy, either a fine needle biopsy or a tissue specimen taken from the lump to confirm whether the tumor is benign or malignant. Ultrasound may also be conducted to measure the lump’s size and check if it has affected the axillary region; it may also be used in guiding biopsy to obtain a section of the lump (Ultrasound-guided procedure). Breast Magnetic Resonance Imaging may also use magnetic and radio waves to create pictures of the breast’s interior (Abu-Naser & Bastami, 2016).
Three Differential Diagnoses
The rationale for Differential Diagnosis
The patient presents with a non-tender, unilateral, firm, painless, located in the upper outer quadrant; however, the lump is non-mobile and 5mm in size, different from the very mobile lump fibroadenoma, which usually is 1-3cm. Breast cysts present with a lump in the breast; however, the lump is very mobile, and the breast is painful or tender. Breast cancer presents with a non-mobile, non-tender, firm lump in the upper outer quadrant of the breast; however, the lump is problematic irregular and poorly delineated, there is also nipple discharge, nipple retraction, dimpling of the skin over the lump, skin ulceration, enlarged nipples and breast pains which are not apparent in the last stages (Aksanh et al., 2020).
Reassuring the patient on their image mainly because of the difference in size between their breasts; encourages them to express fears, feelings and concerns. Advice the patient to report any complications such as fever. Prepare the patient psychologically to accept the diagnosis they will be given and to be ready to follow the measures for treatment and prevention as will be appropriate.
Abu-Naser, S. S., & Bastami, B. G. (2016). A proposed rule based system for breasts cancer diagnosis. http://dstore.alazhar.edu.ps/xmlui/handle/123456789/297
Aksan, H., Kundaktepe, B. P., Sayili, U., Velidedeoglu, M., Simsek, G., Koksal, S., … & Uzun, H. (2020). Circulating miR‐155, let‐7c, miR‐21, and PTEN levels in differential diagnosis and prognosis of idiopathic granulomatous mastitis and breast cancer. BioFactors. https://iubmb.onlinelibrary.wiley.com/doi/abs/10.1002/biof.1676
Hsu, Y. H., Chen, V. C. H., Hsieh, C. C., Weng, Y. P., Hsu, Y. T., Hsiao, H. P., … & Gossop, M. (2020). Subjective and objective cognitive functioning among patients with breast cancer: effects of chemotherapy and mood symptoms. Breast Cancer, 1-10. https://link.springer.com/article/10.1007/s12282-020-01168-y
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