A 55-year-old postmenopausal, retired school teacher, with a family history of b

Question

A 55-year-old postmenopausal, retired school teacher, with a family history of breast cancerin her mother and sister, noticed a painless hard lump in the upper-outer quadrant of theright breast. A history and physical exam were followed by a mammogram that identified a1cm lump in the right breast. She chose a breast conserving treatment consisting of localizedsurgery called a lumpectomy to remove what turned out to be an adenocarcinoma of thebreast, followed by removal of some of the axillary lymph nodes. She was started onTamoxifen, a drug that acts as an anti-estrogen toward breast cancers, but has estrogenicaffects on certain other tissues such as the endometrium. This individual has two daughters,ages 35 and 37 who were strongly encouraged to have yearly physicals and mammogramsby their mother's doctor, and to perform monthly self breast exams. 1. What is the function of lymph nodes? 2. What problem could develop in the arm as a result of removing the axillary lymph nodes? 3. What histologic changes would you expect in the lining of the uterus if Tamoxifen hasestrogenic effects on the endometrium? 4. What role do progesterones have on the uterus in the normal menstrual cycle? 5. What uterine symptoms might this postmenopausal woman develop while takingunopposed continuous estrogens (no progesterone)? 6. What is BRCA 1 and 2? 7. Why might genetic counseling be of value for this family? 8. Discuss potential insurance problems with genetic testing.

Explanation / Answer

1.Lymph nodes store lymph and are the sites for maturation of lymphocytes.

2. Due to removal of axillary lymph node, arm can develop swelling and infection.

3. It will promote development of endometrial lining

4. Progesterone thickens lining of uterus and prepares it for implantation

5. Postmenopausal women can have uterine atrophy

6. BRCA 1&2 are the tumour suppressor genes that inhibits uncontrolled cell division. BRCA 1 IS located on chromosome 17 and BRCA 2 IS present on chromosome 13.

7. genetic counselling will help daughters to minimise risk of breast cancer.

..8. Genetic testing will deprive females getting life insurance if tests bring positive results of brest cancer in case of daughters.

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