M.D. is a 50-year-old woman whose routine mammogram showed a 2.3-×4.5-cm lobulated mass at the 3 o’clock position in her left breast. M.D. underwent a stereotactic needle biopsy and was diagnosed with infiltrating ductal carcinoma, estrogen receptor positive. The staging workup was negative for distant metastasis. Her final staging was stage IIB. She had a modified radical mastectomy with lymph node dissection. The sentinel lymph node and 4 of 16 lymph nodes were positive for tumor cells. An implanted port was placed during surgery.

1.      Describe the biopsy technique used to diagnose M.D.’s cancer.

2.      Discuss the implications of a positive sentinel node.

3.      According to the TNM staging system, what would her classification be?

4.      Is she a candidate for tamoxifen (Nolvadex) therapy? Explain your rationale.

5.      Surgical intervention is the primary treatment for breast cancer. Describe the surgical procedure that M.D. had.

6.      Describe M.D.’s risk for lymphedema.

7.      What actions will you teach M.D. to reduce her risk of developing lymphedema?