Week 4: Fai

A very interesting clinical experience of this week is breast cancer surgery which I saw both lumpectomy and mastectomy. Thank Casey for her help. Lumpectomy is an operation in which a small volume of breast tissue containing the tumor and some surrounding healthy tissue is removed to conserve the breast. The case I saw was one 30’s woman who had a small cancer (1.4 centimeters) in her left breast. I saw an X-ray image that two hooks on metal wire indicated the site of tumor. In order to access the tumor Dr. Tousimis cut around patient’s aureole (2/3 of aureole circumference). She told me the tissue area has a great ability to recovery and it is hard to see the scar on that area after the surgery. Even though the tumor is a few centimeters in size, the fat tissue which was taken out is about four times more than its size. The reason of doing this is to make sure the entire tumor is removed and taking out such a great amount of tissue have no any physiological and anatomical effect on the patient. For the case of mastectomy, I observed a 50’s female patient who was diagnosed with breast cancer. Mastectomy is usually done to treat breast cancer. However, the decision to do the mastectomy is based on various factors including breast size, number of lesions, biologic aggressiveness of a breast cancer, the availability of adjuvant radiation, and the willingness of the patient to accept higher rates of tumor recurrences after lumpectomy and radiation. Before the surgery, the patient was injected a radioactive dye to localize the sentinel lymph nodes and another dye (blue color) to visually identify the nodes. The sentinel lymph node is the hypothetical first lymph node or group of nodes reached by metastasizing cancer cells from a tumor. It is a rational why sentinel lymph node biopsy is routinely used to determine whether or not the cancer has spread. For the surgical procedure, firstly, the patient’s nipples and aureoles were completely removed. Then, the breast tissue was cut away from the skin and the entire breast was cut away from the muscle underneath. The whole tissue was taken out and replaced with a tissue expander filled with saline. The whole procedure took about 6 hours. Comparing between lumpectomy and mastectomy, I feel much more comfortable to see the former one.

Thanks to Michael, in this week I had a chance to follow him and his mentor –Dr. Cham in the department of radiology. Dr. Cham showed us a lot of x-ray/CT/ MRI images and kindly explained several things in detail. I learned a lot from him. The images came to this department with several reasons. In case of pre operation images, Dr. Cham had to check the images to make sure that the patient is ready for operation. There is nothing abnormal which can lead to failure of operation or bad consequences during or after operation. Dr. Cham also diagnosed disease from the images such as lung cancer, lung tumor, tubercle bacillus or Tuberculosis (TB), pneumonia, heart disease and skeleton disorders. For me, this work has a lot of pressure and it is vital to pay a lot of attention to every single detail -- missing a small dot can lead to very bad consequence if the dot is lung cancer! This must be the reason why every image has to be read by at least two radiologists. I think it is a good idea and it can reduce the kind of error. In some special cases, patients having unknown-cause symptoms, Dr. Cham have to figure out several probable diseases from the image and suggest possible causes of illness to the patient’s doctor. It seems hard to me that one person have to remember all illness and trying to connect any clue from black & white and blurry image to all of possible diseases.