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CASE PRESENTATION. BREAST CANCER. Breast cancer. Name, BM Aged 49 History of painful eyes, headches and cough in April 2015 at Mzimba district hospital (she initially went to a private clinic). She was seen by clinician and went home with medication(panadol, eyes drops)
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CASE PRESENTATION BREAST CANCER
Breast cancer • Name, BM • Aged 49 • History of painful eyes, headches and cough in April 2015 at Mzimba district hospital (she initially went to a private clinic). She was seen by clinician and went home with medication(panadol, eyes drops) • From start the patient noted the lump in her rt breast but it appears the clinicians never picked it.
Breast cancer • While at home the medication did not help at all she kept on having painful eyes,orbital masses, headches and cough. • She went to Mzimba hospital and they referred her to Mzuzu Central hospital. • At Mzuzu hospital they noted the orbital masses , severe painful eyes and the constant headaches that the patient was having.
Breast cancer • At Mzuzu hospital they ?? Orbital tumor and gave the patient ceftriaxone to cover for orbital cellulitis. She did not stay for long and on 22 Sept 2015 was referred to KCH for further management.
Breast cancer • At Eye department KCH they worked her up for TB, HIV the results came negative. • They did biopsy 2x of the orbital masses but failed to reveal malignancy. The first biopsy done in October 2015 got misplaced. • A repeat biopsy was done in November and results came out on 24/11/15 As Atrophic muscle tissues, no tumor.
Breast cancer • Patient went home for ?? Orbital tumor of the rt eye and was given analgesia, steroids and antibiotic to cover for orbital cellulitis. • Patient came again to Eye department mid April 2016 with severe painful eyes, orbital masses getting bigger, reduced vision more on the right eye. • The case was seen by one of the students from Health Sciences and discussed the case with the HoD
Breast cancer • The HoD referred the case to Oncology , Medical department at KCH this was in April this year. • Full one year gone for the patient to see the oncologist.
Breast cancer • Upon assessment of the breast patient had clinically inflammatory breast cancer Rt with mets. • She had orange skin appearance of nipple areola complex, nipple retraction and mobile axillary lymph nodes largest 3-5cm Right side.
Breast cancer • Reduced vision more on the right eye due to orbital metastases and proptosis as well. • At that time she was walking with support from guardian as she had significant reduced vision. • CXR showed moderate pleural effusion bilaterally more on the Right. Skeletal mets were noted on the ribs.
Breast cancer • The case was treated as emergency with the aim of restoring vision. • I mmediately started chemotherapy paclitaxel based regimen . • Full blood count, urea and electrolytes were normal. • As am talking the patient is doing well, coming alone to the clinic without support. She got the 5 cycle
What are the issues • We need to address issues at community as well as issues at hospital facility. • We need comprehensive cancer control programes (practical & sustainable) targeting, prevention, early detection, diagnosis and treatment, and finally rehabilitation and palliative care.
Issues • General public awareness on breast cancer problem. • Need to implement combined cost-effective and affordable interventions that target breast cancer as well as HIV related malignancies e.g. Cervical, KS, Lymphomas and NCD.
