20 Receiving a cancer diagnosis

Michelle finds a lump in her left breast while she is in the shower. It doesn’t hurt when she touches it, so she thinks it might result from hormone changes during her monthly menstrual cycle and decides to wait a few weeks to see if it disappears. A couple of weeks later the lump hasn’t gone so she makes an appointment with her GP. Her GP examines her and tells her that he is unsure of what the lump is, that it might be a simple cyst, but he would like to refer her to a specialist for further tests.

Michelle attends an appointment with a breast specialist, accompanied by Simon. The consultant reassures her that although he doesn’t know what the lump is at this stage, he will need to conduct a ‘triple assessment’, involving clinical, radiological and pathological evaluation of both her breasts. First, a clinical examination is performed and a clinical history is taken. Michelle then has a mammogram and an ultrasound of both breasts. She has an ultrasound-guided core biopsy of the lump, under a local anaesthetic, to obtain tissue for pathology. Michelle also has a blood test to check for the presence of tumour markers.

Activity

Diagnostic investigations

Make a list of what the consultant may want to know about Michelle’s personal and family history. Consider how this information might influence the management of her cancer.

Recall an experience of observing a patient having a specific investigation (a scan, X-ray, biopsy, etc.). Write a short reflective piece on how the patient was prepared (physically and mentally); how safety and patient comfort was maintained; what the advantages of this investigation were; what the potential risks were; and how the specimen (if taken) was processed.

Think about what Michelle’s concerns might be while she is undergoing the tests and while she is waiting for the results. How can a healthcare professional support Michelle during these procedures? What specific information might Michelle need once the results from the triple assessment have been gathered?

Register with the free Macmillan ‘Learn Zone’ on the following Website:

http://learnzone.macmillan.org.uk (accessed November 2011).

Follow the tab to the ‘health and social care professionals’ section and scroll down to the ‘information giving’ course and work through the exercises.

NMC Domain 1: 1.6

NMC Domain 2: 2.1; 2.2; 2.3; 2.4; 2.7

NMC Domain 3: 3.1; 3.3; 3.4; 3.8

Further reading

Johnson G.B.. Cancer diagnosis and staging. Langhorne M.E., Fulton J.S., Otto S.E. Oncology nursing, fifth ed., St Louis: Mosby, 2007.

Montgomery M., McCrone S. Psychological distress associated with the diagnostic phase for suspected breast cancer: systematic review. J. Adv. Nurs.. 2010;66(11):2372–2390.

Points to consider

A medical history attempts to identify relevant information that might provide clues to what the lump may be. It may also highlight any risk factors such as inherited cancer patterns or lifestyles behaviours, as well as many other factors that might influence treatment options.

Without pathology, a diagnosis cannot be made. Further diagnostic investigations are essential to identify the type, exact location, grade and stage to ensure appropriate treatment is delivered. Although the time period between seeing the consultant and receiving the results is only a matter of days, 2 weeks at the most, for the majority of patients it is a very scary time. It is often the ‘not knowing’ that is particularly difficult to deal with and a number of patients feel a sense of relief once a diagnosis has been confirmed (even if it is a cancer diagnosis).

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