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Delilah Martindale is a married, 42- year old woman with 3 children and works as a part-time cashier at Circle K.  She has never smoked and has an occasional social drink.  Her past medical history includes plastic surgery for bilateral breast implants done 3 years ago and tonsillectomy when she was 10 years old.  Her mother is a breast cancer survivor and her father died of lung cancer two years ago.  When she returned for a physical check up with her primary MD, a lump was noted on her Right breast.  Her physician ordered an outpatient breast biopsy as soon as possible that revealed presence of malignant cells.  She elected to have R breast removed with axillary lymph node dissection.

Answer the following questions:

1.Delilah Martindale wants you to explain exactly what Stage IV: T4 N3 M1 mean.  Based on the TNM Classification System, what will you tell her?  (½ point)In the TNM system:

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2. Discuss the treatment modalities that Delilah Martindale may have other than the surgical procedure as mentioned in the case scenario.  (2 points)

3.Define metastasis and discuss its pathophysiologic mechanism. Based on the location of her malignancy, where are the sites of metastasis? (2 points)

4.Discuss the clinical manifestations of cancer, etiology, and general effects of malignancy that Delilah Martindale may or may not experience.  (2 points)

5.Martindale is to receive chemotherapy. Discuss the effects of chemotherapy to the body cells, both cancerous and non-cancerous. (½ point)

6. Describe the side effects of cancer therapy and possible treatment or ways to alleviate the discomforts or complications of these side effects. (2 points)

7.List the health education or teachings that you would provide the community or the public regarding the prevention of breast cancer. (1 point)