Syndicate: Thurs 4 May
Syndicate Session: Thursday, May 4
Question One
Rather than merely treating the anaemia, the doctor should have pursued working out the reasons behind this. Given that the patient had a family history of bowel cancer, she is at increased risk of developing bowel cancer. Given also the fact that she is post menopausal, the standard associated of anaemia with dietary iron-deficiency could not be made.
An assumption was made by the attending physician that her anaemia was not caused by anything significant, when really, further investigations were required.
Question Two
What is radical mastectomy?
It is a surgical procedure in which the breast, underlying chest muscle and lymph nodes of the underarm are removed.
What were the underlying assumptions of this form of surgery?
That it would prevent breast cancer. An assumption was made that the cancer was localised, and by removing it, it would remove all problems. Given that cancer can spread through the lymphatic system, removing lymph nodes would remove a primary cause of metastasis. The assumption is also made that the cancer has not already progressed and metastasised.
What were the complications?
It is very invasive. Emotional complications need also to be considered: identity, and self-esteem need to be considered. Aseptic technique 100 years ago was not as advanced, and the risks of infection from surgery were considerably high.
Sometime after about 1970, radical mastectomy began to be abandoned, and replaced by simple mastectomy or even lumpectomy. What were the conceptual changes that led to this change in surgical practise?
Conceptual changes include early diagnosis, advances in oncopharmocology, for instance chemotherapy or radiotherapy. Targeted tyrosine-kinase receptor treatments have also been discovered.
What effects has this change had on the prognosis and complications of surgery for breast cancer.
Less complication will arise as the surgery is less invasive: the chance of complications arising from septicaemia will be lowered. Through the use of advanced imaging and diagnosis (mammography), cancer which has not progressed to such an extent can be removed. As this cancer can be diagnosed early, a radical mastectomy is generally not required. From early detection, the prognosis has improved dramatically.
Question One
Rather than merely treating the anaemia, the doctor should have pursued working out the reasons behind this. Given that the patient had a family history of bowel cancer, she is at increased risk of developing bowel cancer. Given also the fact that she is post menopausal, the standard associated of anaemia with dietary iron-deficiency could not be made.
An assumption was made by the attending physician that her anaemia was not caused by anything significant, when really, further investigations were required.
Question Two
What is radical mastectomy?
It is a surgical procedure in which the breast, underlying chest muscle and lymph nodes of the underarm are removed.
What were the underlying assumptions of this form of surgery?
That it would prevent breast cancer. An assumption was made that the cancer was localised, and by removing it, it would remove all problems. Given that cancer can spread through the lymphatic system, removing lymph nodes would remove a primary cause of metastasis. The assumption is also made that the cancer has not already progressed and metastasised.
What were the complications?
It is very invasive. Emotional complications need also to be considered: identity, and self-esteem need to be considered. Aseptic technique 100 years ago was not as advanced, and the risks of infection from surgery were considerably high.
Sometime after about 1970, radical mastectomy began to be abandoned, and replaced by simple mastectomy or even lumpectomy. What were the conceptual changes that led to this change in surgical practise?
Conceptual changes include early diagnosis, advances in oncopharmocology, for instance chemotherapy or radiotherapy. Targeted tyrosine-kinase receptor treatments have also been discovered.
What effects has this change had on the prognosis and complications of surgery for breast cancer.
Less complication will arise as the surgery is less invasive: the chance of complications arising from septicaemia will be lowered. Through the use of advanced imaging and diagnosis (mammography), cancer which has not progressed to such an extent can be removed. As this cancer can be diagnosed early, a radical mastectomy is generally not required. From early detection, the prognosis has improved dramatically.
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9:25 am
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