Receiving a cancer diagnosis

Published on 09/04/2015 by admin

Filed under Hematology, Oncology and Palliative Medicine

Last modified 22/04/2025

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20 Receiving a cancer diagnosis

Michelle finds a lump in her left breast while she is in the shower. It doesn’t hurt when she touches it, so she thinks it might result from hormone changes during her monthly menstrual cycle and decides to wait a few weeks to see if it disappears. A couple of weeks later the lump hasn’t gone so she makes an appointment with her GP. Her GP examines her and tells her that he is unsure of what the lump is, that it might be a simple cyst, but he would like to refer her to a specialist for further tests.

Michelle attends an appointment with a breast specialist, accompanied by Simon. The consultant reassures her that although he doesn’t know what the lump is at this stage, he will need to conduct a ‘triple assessment’, involving clinical, radiological and pathological evaluation of both her breasts. First, a clinical examination is performed and a clinical history is taken. Michelle then has a mammogram and an ultrasound of both breasts. She has an ultrasound-guided core biopsy of the lump, under a local anaesthetic, to obtain tissue for pathology. Michelle also has a blood test to check for the presence of tumour markers.

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Diagnostic investigations

Make a list of what the consultant may want to know about Michelle’s personal and family history. Consider how this information might influence the management of her cancer.

Recall an experience of observing a patient having a specific investigation (a scan, X-ray, biopsy, etc.). Write a short reflective piece on how the patient was prepared (physically and mentally); how safety and patient comfort was maintained; what the advantages of this investigation were; what the potential risks were; and how the specimen (if taken) was processed.

Think about what Michelle’s concerns might be while she is undergoing the tests and while she is waiting for the results. How can a healthcare professional support Michelle during these procedures? What specific information might Michelle need once the results from the triple assessment have been gathered?

Register with the free Macmillan ‘Learn Zone’ on the following Website:

http://learnzone.macmillan.org.uk (accessed November 2011).

Follow the tab to the ‘health and social care professionals’ section and scroll down to the ‘information giving’ course and work through the exercises.

NMC Domain 1: 1.6

NMC Domain 2: 2.1; 2.2; 2.3; 2.4; 2.7

NMC Domain 3: 3.1; 3.3; 3.4; 3.8

Further reading

Johnson G.B.. Cancer diagnosis and staging. Langhorne M.E., Fulton J.S., Otto S.E. Oncology nursing, fifth ed., St Louis: Mosby, 2007.

Montgomery M., McCrone S. Psychological distress associated with the diagnostic phase for suspected breast cancer: systematic review. J. Adv. Nurs.. 2010;66(11):2372–2390.

Points to consider

A medical history attempts to identify relevant information that might provide clues to what the lump may be. It may also highlight any risk factors such as inherited cancer patterns or lifestyles behaviours, as well as many other factors that might influence treatment options.

Without pathology, a diagnosis cannot be made. Further diagnostic investigations are essential to identify the type, exact location, grade and stage to ensure appropriate treatment is delivered. Although the time period between seeing the consultant and receiving the results is only a matter of days, 2 weeks at the most, for the majority of patients it is a very scary time. It is often the ‘not knowing’ that is particularly difficult to deal with and a number of patients feel a sense of relief once a diagnosis has been confirmed (even if it is a cancer diagnosis).

Case update

Once all the investigations have been completed, Michelle returns to the clinic accompanied by Simon to hear the results. The consultant and breast nurse specialist check Michelle and Simon’s understanding about why the investigations were done and what they thought might be causing the lump. Michelle is told she has a ‘non-special type’ (NST) of breast cancer. Hearing this news, Michelle feels stunned and is in a state of shock: ‘How could she have cancer? She felt so well!’

The consultant gives them some time on their own, to digest the information. The nurse specialist then spends some time with them to reiterate and explain what had been said and answer any questions they have. When they feel able, Michelle and Simon return to the consultant to discuss the treatment options. The consultant suggests that Michelle has either a wide local excision (segment of breast removed) or a simple mastectomy (removal of the entire breast) with the option of an optional breast reconstruction immediately or later, and 5 weeks of radiotherapy. He discusses the advantages and disadvantages of both. Michelle decides to have a simple mastectomy, but wants to think about breast reconstruction at a later date.

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Receiving a diagnosis and decision making

Write a reflection of an observation where significant news was delivered. This may be a diagnosis, prognosis or disease progression. Reflect on the individual’s reactions to the news and the strategies that the healthcare professional used to give the information.

Refer back to Chapter 8. What would the consultant and Michelle have considered when deciding on treatment options?

NMC Domain 1: 1.2; 1.4; 1.5; 1.6; 1.9

NMC Domain 2: 2.1; 2.2; 2.3; 2.4; 2.5

NMC Domain 3: 3.6; 3.9; 3.10

Further reading

Fujimorl M., Uchitomi Y. Preferences of cancer patients regarding communication of bad news: a systematic literature review. J. Clin. Oncol.. 2009;39(4):201–216.

Thain C., Palmer C. Strategies to ensure effective and empathetic delivery of bad news. Cancer Nursing Practice. 2010;9(9):24–27.

Points to consider

For most individuals, hearing the news they have cancer is a shock, even if they suspected the diagnosis or if healthcare professionals had previously suggested this might be the cause of their symptoms. Often patients do not hear any information that is given straight after the diagnosis which is why it is important to give them time for the news to sink in before discussing treatment options. Not all patients will want to be solely responsible for treatment decision making and it is important that healthcare professionals discusse with the patient how much they would like to be involved in the decision. It is worth noting that patients may wish to take a greater role in decision making as time progresses, depending on the nature of the decision, and healthcare professionals need to constantly gauge patient involvement desire.

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Preoperative care

When consenting Michelle for her surgical procedure, what is the healthcare professional considering? Write a short outline of the main legal, ethical and professional aspects of accountability during the consent process. What information will Michelle need to sign the consent form?

When completing Michelle’s preoperative assessment, what do you consider the priorities of her care to be? Compare this to another patient who has undergone surgery. How similar are these and what influences the preoperative care required?

NMC Domain 1: 1.1; 1.2; 1.4; 1.7

NMC Domain 2: 2.1; 2.2 2.3; 2.7; 2.8

NMC Domain 3: 3.1; 3.3; 3.4; 3.6; 3.8; 3.10

NMC Domain 4: 4.3

Further reading

Caulfield H. Vital notes for nurses: accountability. Edinburgh: Wiley-Blackwell; 2005.

Ford L. Consent and capacity: a guide for district nurses. Br. J. Community Nurs.. 2010;15(9):456–460.

Mental Capacity Act. London: The Stationery Office; 2005.

Pudner R. Nursing the surgical patient, third ed. Edinburgh: Baillière Tindall; 2010.

Points to consider

The preoperative period can be full of mixed emotions. Patients often feel anxious about having a general anaesthetic and can be distressed anticipating the loss of a breast. A number of patients feel relieved that, after the wait for the results, progress is being made and the cancer will be removed. The majority will be concerned with the final pathology and the lymph node biopsy report.

Preoperative assessment is essential to identify any existing physical or psychological factors that may hamper the surgical procedure or the patient’s recovery. It is also important that the patient is prepared for theatre correctly to ensure patient safety.

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