Cancer Vijay

Breast Symptoms
Lump, lumpiness, change in texture in
Urgent: Consult as early as possible

1.  Discrete lump in any woman 30 years and older that persists after next period or presents after menopause 
2. At any age:
   1.  Discrete hard lump with fixation +/- skin tethering/dimpling/altered contour
   2.  A lump that enlarges 
   3. A persistent focal area of lumpiness or focal change in breast texture
   4. Progressive change in breast size with signs of oedema 
   5. Skin distortion
   6. Previous history of breast cancer with a new lump or suspicious symptoms
3. Male patients:
   1. Over 50 years with unilateral firm subareolar mass +/- nipple discharge or associated skin changes

Not Urgent

1. Under 30 years:
   1.  A lump that does not meet above criteria -

Nipple symptoms
Urgent: Consult as early as possible

1. Spontaneous unilateral blood stained nipple discharge
2. Unilateral nipple eczema or nipple change that does not respond to topical treatment
3. Recent nipple retraction or distortion
4. Male patients:
   1. Over 50 years with unilateral firm subareolar mass +/- nipple discharge or associated skin changes

Not Urgent

1. Women under 50 years who have nipple discharge that is from multiple ducts or is intermittent and is neither blood stained nor troublesome
2. Breast Pain
   1. Patient with minor/moderate degree of breast pain with no discrete palpable abnormality, when initial treatment fails and/or with unexplained persistent symptoms

Axillary symptoms
Urgent: Consult as early as possible

1. Axillary lump (in absence of clinical breast abnormality)
   1. Persistent unexplained axillary swelling

Lactating Mother
Urgent: Consult as early as possible

1. • Lactating mother with
   1. • Retracted nipple
      • Pain, swelling, redness and fever

1. • Re confirm previous advice
   • Difficulty in arriving Diagnosis
   • Difficulty in selecting treatment options
   • Special issues and need

1. • Best way is first do email with scan copy of relevant document
   1. Then call if needed
   • It will be easier to help you if you
   1. • Ask doctor
      1. When to call
      2. on what number
      3. Prefix How you will identify yourself
      • To the point
      1. For what you are calling
      • Keep relevant document ready -

1. • Prefix appointment
   • If you have many issues to discuss or group of people need to discuss tell the doctor so you will be allocated adequate time

1. • Before you leave hospital
   1. Give your contact person name and contact numbers -more than one are better
   2. Understand pre operative instructions and write it in your own word
      1. Food , liquid and water- when to stop
      2. Saving- if yes- which parts
      3. Enema- if yes - when
      4. Bath- when
      5. Drugs to be taken-
         1. which drugs
         2. In what orders
         3. When
      6. Diabetes, Hypertension, Ischemic heart diseases, Respiratory problems
      7. Allergies
      8. Special issues
   • At home
   1. Reconfirm your appointment
      1.   few days before
      2.  and again day before operation
   2. Inform if any change at your earliest
   3. Keep all document ready- they are very importants
      1. Consulting papers,
      2. FNAC , Biopsy,
      3. Breast Sonography , Mammography
      4. X Ray chest , Abdominal sonography, Other
      5. Blood reports including :
         1. Blood group
         2. CBC, S creatinine, PPBS
         3. PT, APTT, SGPT
         4. HIV, HbsAg
         5. Other
      6. Preop Physician evaluation
   4. Understand and follow  pre op instructions
      1. Food , liquid and water- when to stop
      2. Saving- if yes- which parts
      3. Enema- if yes - when
      4. Bath- when
      5. Drugs to be taken-
         1. which drugs
         2. In what orders
         3. When
      6. Diabetes, Hypertension, Ischemic heart diseases, Respiratory problems
      7. Allergies
      8. Special issues
   5. Do not bring unimportant things, Ornaments and childrens in hospital
   6. Bring loose and easily removable cloths
   • At Hospital
   1. • Try to reach before time
      • Inform staff that you are arrived
      • Understand and sign on  consent form for operation.
      • Hand over all ornaments, important documents,money etc  to relatives
      • Wear loose and easily removable cloths
      • Emotional upset is natural - express your feeling - we will try to help you.
      • Do not take anything by mouth

1. • Understand
   1. • Chemotherapy cycle
      1. How many cycle has to be taken
      2. After  how many days next cycle start
      3. How long you have to stay in hospital in each cycle
      4. What are likely toxicities
      5. What care you have to take
      6. When to inform and whom to inform
      • At every cycle
      1. Take  an appointment - reconform a day before
      2. You will need certain reports at every cycle
      3. To save a time you may do it one day ahead
      • If you cannot tolerate chemotherapy
      1. • inform immediately
         • You may need some form of extra support or change in treatment plan

1. • Be in constant touch
   • Inform your situation
   1. • If you cannot tolerate radiotherapy
      1. • inform immediately
         1. • You may need some form of extra support or change in treatment plan

1. • Understand follow up plan
   1. What examination will be done
   2. What  investigations will be needed and when
   • Stick to it - Be regular
   • Always take appointment and reconform day before.

1. • You need to discuss personally for your breast reconstruction options
   • Be open to discuss
   1. • your needs and expectations
      • Advantages and disadvantages