Diagnostic Imaging for Breast Cancer Symptoms

Diagnostic Imaging for Breast Cancer Symptoms The role of diagnostic imaging in the initial investigation of female patients symptomatic for breast cancer, and its subsequent application in the staging process. Introduction Breast Cancer is the term used for cancers found within the breast tissue. Usually breast cancer is the result of a small change in the regulatory cycles that the tissue goes through. Any changes in these can result in malignant growths within the breast tissue. As stated by Breast Cancer Now (2016), Breast cancer is the most commonly diagnosed cancer in women in the UK with over 50,000 new cases diagnosed in women each year, in the UK alone, thus approximately 1 in 8 women will be diagnosed with some form of breast malignancy in their lifetime. Furthermore, not all breast cancer occurs in females, in the UK roughly 350 men are also diagnosed with breast cancer each year. The survival rate of breast cancer is quite high at around 90%, states Breast Cancer Care (2016), which highlights how effective treatment currently is. However, it is the most common cause of death in women aged 40-50. Vaidya, J.S. et al (2012a). Per Sestak, I. et al (2012), there are many factors that can predispose a person to the risk of breast cancer. These include: increasing age, geographical variation, breast density, age at first pregnancy, age at menarche and menopause, family history, genes, previous breast disease, radiation, lifestyle, oral contraceptives and hormone replacement therapy. As stated by Vaidya, J.S. et al (2012a), Breast cancer lumps are usually hard and painless, with an irregular shape. They are approximately 2cm before they are palpable and can be felt. Most lumps are found in the upper outer quadrant of the breast. A lump is the most common symptom but there are other signs and symptoms that can be indicative of breast cancer. These other symptoms include: bleeding from the nipple (rare), change in shape or size, ulceration, swelling in breast or arm due to blockage of lymphatic circulation, peau dorange which is usually the result of fluid in the dermis and axillary lumps. These symptoms are not present in all cases and are indicative of the different stages and kinds of breast cancer. Content Discussion People with breast cancer symptoms usually undergo what is known as a Triple Assessment. A triple assessment comprises of a clinical examination, imaging examinations and pathological evaluation. This assessment process is usually able to diagnose 95% of malignant breast cancers. Vaidya, J.S. et al (2012b) Vaidya, J.S. et al (2012b) also states that before a clinical examination occurs, the patients history is taken into consideration, as this can aid the diagnose or other potential causes of the symptoms. Usually the history that is considered includes: the history of the current complaint, family history of breast or ovarian cancers, HRT and oral contraceptives history, previous diseases and surgeries, allergies and smoking history. Clinical Assessment of Breast Cancer As stated before clinical examination is the first step in a triple assessment to diagnose breast cancer. Clinical examination is done to assess dimpling, which is usually an early sign, as it occurs because of the contraction of the ligaments of Cooper. Clinical examination can also distinguish between coarse nodular tissue and an actual lump in the breast tissue. The colour and site of any discharge at the nipple is also recorded and tested for any blood within the discharged fluid. Vaidya, J.S. et al (2012b). Imaging in Diagnosis of Breast Cancer As stated by Vaidya, J.S et al (2012b), Both mammography and ultrasonography have important roles in the diagnosis of breast cancer, but the use of other modalities, such as magnetic resonance and infrared imaging, is being developed. Mammography can detect over 95% of clinically detectable cancers. However, it does not aid the diagnosis of a patient with a discrete lump. In this case diagnosis relies heavier on cytology and histology. It may also be of use in the detection of cancer in patients with coarse nodular breasts and is particularly useful in dense breast tissues. Vaidya, J.S. et al (2012b) Another use for mammography is to accurately assess where the cancer is located. This information can also be used to aid biopsy and surgeries.ÂÂ   Mammography can also reveal that there is an impalpable lump in the other asymptomatic breast which otherwise would have gone undetected. Vaidya, J.S. et al (2012b) If a mass is detected on a mammogram, a range of codes are typically used to determine the potential malignancy of the mass. These are defined by Willet, A. et al, for the Association of Breast Surgery (2010) as: M1 Normal M2 Benign M3 Indeterminate/Likely Benign M4 Suspicion of Malignancy M5 Highly suspicious of Malignancy. Another key imaging technique used in the diagnosis of breast cancer is ultrasonography. Ultrasound shows the difference between a cyst or a more solid mass. Therefore, a mass can be confirmed to be a cyst and can be drained using needle aspiration. However, a blood-stained aspirate may be a result of a cancer within the cyst which was previously unidentified. The sensitivity and specificity of ultrasound in the diagnosis of breast lumps has continued to improve with growing technological advances. Benign lumps appear as well-defined masses with no acoustic shadow. Malignant lumps are ill-defined masses, with a varying echogenicity and/or have evidence of microcalcifications within them. Ultrasound is also the preferred imaging method in women under the age of 30, as their breasts tend to be less dense and are therefore radiosensitive. Vaidya, J.S. et al (2012b). The NICE Guidelines (2015), also state that, ultrasound evaluation of the axilla should be performed for all patients bein g investigated for early invasive breast cancer. Fine-needle aspiration cytology is also used in breast cancer diagnosis by inserting a small needle into a lump which is located during the examination using ultrasound. The aspirate on the needle is then examined under a microscope by a pathologist which can then diagnose a breast cancer with almost 100% specificity depending on their level of skill and training. Vaidya, J.S. et al (2012b) Imaging in Staging of Diagnosed Breast Cancer If the tumour is large and there is extensive lymph-node involvement, preoperative staging is prudent. Vaidya, J.S. et al (2012b) As stated by RCR guidelines (2014), the objectives of staging are to: assess the size of a tumour, assess for other involvement of the skin or chest wall, assess multifocality of tumour, to assess the nodal status and to assess for any metastatic spread. MRI is used in staging any indeterminate lesions. The expense of MRI is now becoming less of an issue as the cost of an MRI breast coil is considered relatively low. The injection of a contrast agent during MRI enables the vascularity of a lesion to be visualised. The downside of this is that a specifically trained team is required to undergo this route of imaging. Vaidya, J.S. et al (2012b) NICE guidelines (2015), state that MRI is not recommended in the preoperative assessment of patients with invasive breast cancer that has been proven by biopsy or ductal carcinoma in-situ. It should only be offered to those where the extent of metastases is indeterminate, breast density has caused mammography to be indefinite or to assess tumour size to aid surgery for invasive lobular cancer. Computed Tomography is stated by the RCR Guidelines (2014), to be used with patients who have advanced symptoms and are suspected to have a further progressed cancer. Reasons for request of a CT to stage breast cancer include: bone pain and breathlessness. If the use of CT for staging is used, intravascular contrast media should be employed during the scan. The scan should include the supraclavicular fossa, the chest and the liver. The RCR Guidelines (2014), state that Photon Emission Tomography should not be used for early stage breast cancer but should be used more to assess metastatic spread. It is also used to assess potentially multi-focal disease or suspected recurrence if a patient has particularly dense breasts. Axially node status is usually assessed by using US, with the use of fine-needle aspiration or biopsy of any suspicious nodes. RCR Guidelines (2014). Vaidya, J.S. et al (2012b) also suggest that routine staging in early breast cancer, as the results are usually less than 4%. Thus, these investigations can slow down the otherwise relatively quick treatment and can cause the patient unnecessary anxiety as they await results. Follow-up and Surveillance after treatment of Breast Cancer It is suggested by Vaidya, J.S. et al (2012b) that patients who have had a mastectomy are at a higher risk of developing cancer in the remaining breast and should therefore undergo regular mammograms for surveillance. They also suggest that colour Doppler ultrasound scanning of a breast that has had a malignant tumour postoperatively is likely to increase the chances of an early diagnosis should there be any recurrence. RCR guidelines (2013) state that women who have been treated for breast cancer under the age of 50 should have a yearly mammogram as surveillance follow up. After 50 the guidelines are unclear but it is currently recommended that surveillance mammograms are routinely performed every 2-3 years. NICE guidelines (2015), also state that an annual mammography should be offered to all those with early breast cancers, including DCIS until they reach the age for screening. These guidelines recommend that patients of the age for screening should have also annual mammograms for 5 years. The NICE guidelines (2015), further suggest that US nor MRI should be offered in post-treatment surveillance for those who have been treated for DCIS or other early stage breast cancers. Conclusion In summary, it is essential that patients presenting symptoms which usually pertain to a breast cancer undergo a thorough assessment, including multiple imaging examinations not just for the diagnosis of the cancer, but also the staging and the follow-up once the cancer has been successfully treated. Mammography and Ultrasound are the two key imaging techniques that are vital in my opinion within diagnosis. They enable a fast and usually efficient result which can then be used for staging. Ultrasound can be seen to have more benefits as it does not use ionising radiation unlike mammography, but mammography is essential is those patients who have highly dense breast tissue. This is usually postmenopausal patients who tend to be the high-risk group of developing breast cancer. CT and Ultrasound are mainly used during staging. This stage is vital in patients with more progressive breast cancer, but if the tumour has been caught in the early stages, staging methods can usually be skipped as it is more efficient to immediately commence treatment methods. Follow-up imaging is also essential as those who have undergone treatment of breast cancer are at higher risk of recurrence in either breast. In conclusion, imaging is one the most essential tools available in the diagnosis, staging and follow-up of breast cancer. Without the current imaging techniques, we have today the 95% survival rate of breast cancer would likely be nowhere near as high. Reference List: Breast Cancer Care. (2016). Prognosis. Available: https://www.breastcancercare.org.uk/information-support/facing-breast-cancer/diagnosed-breast-cancer/diagnosis/prognosis. Last accessed 27th Mar 2017. Breast Cancer Now. (2016). Breast Cancer Statistics. Available: http://breastcancernow.org/about-breast-cancer/what-is-breast-cancer/breast-cancer-statistics. Last accessed 27th Mar 2017. NICE guidelines. (2015). Early and locally advanced breast cancer: diagnosis and treatment. Breast Cancer. Last Accessed: 30th Mar 2017 Sestak, I et al. (2012). Breast Cancer: Epidemiology, Risk Factors and Genetics. In: Dickson, J ABC of Breast Disease. 4th ed. London: BMJ Books. p41-47. The Royal College of Radiologists (2013). Guidance on screening and symptomatic breast imaging. 3rd ed. London: The Royal College of Radiologists.ÂÂ   Pg.7 The Royal College of Radiologists (2014). Recommendations for cross-sectional imaging in cancer management. 2nd ed. London: The Royal College of Radiologists. P2-4 Vaidya, J.S., Joseph, D. Jones, A. (2012b), Fast Facts: Breast Cancer Diagnosis, 4th ed. edn, Health Press Limited, Abingdon.ÂÂ   P47-64 Vaidya, J.S., Joseph, D. Jones, A. (2012a), Fast Facts: Breast Cancer Pathophysiology, 4th ed. edn, Health Press Limited, Abingdon.ÂÂ   P28-46 Willet, A. et al. (2010). Diagnosis and Imaging.ÂÂ   Best Practice Diagnostic Guidelines for Imaging of Symptomatic Patient. Department of Health. p 49.

Compare the 1st and 2nd Great Awakening Essay

There are many factors that triggered the religious revivals known as the Great Awakenings. These awakenings encouraged citizens to partake in religious ceremonies and activities. Some agreed and joined the bandwagon, some refused. The awakenings had aspects that resulted in great long term benefits in government, education, and society. During the 1730s it was apparent that most colonies had established their own religions. Some strict churches preached that we are all sinful and that only a faithful few would be saved. The increase in production and manufacturing of goods increased colonial wealth, but led most colonists astray from their religion and influenced their temptation to live less godly lives. That is when the Great Awakening began. The Great Awakening was a Protestant religious revival movement that taught â€Å"rebirth† and that God was forgiving. Churches became amplified, preaching the need to become a new and better person of faith, which was said to be the ultimate religious experience. Preachers said that followers should accept that they are sinners and ask for salvation. Many religious men contributed to the Great Awakening. Two of the religious men were George Whitefield and Jonathan Edwards. Whitefield was a young Anglican preacher, everywhere he went he brought an ample amount of people and converted them. Whitefield claimed that God was lenient and forgiving, rather than telling people they were all going to hell because they were sinners. Edwards was the beginning of the revival, he emphasized the power of an extant and intimate religious experience. Like Whitefield, Edwards attracted large crowds with his powerful sermons. The Awakening was divided into two major groups called the â€Å"Old Lights† and the â€Å"New Lights.† The â€Å"New Lights† were one of the religious groups that grew as a result of the Great Awakening, they were Baptist. The â€Å"Old Lights† challenged authority and hierarchy and were a make-up of Congregationalists and Anglicans. With these new groups came religious diversity, but helped colonists become more aware of life beyond their town or church. In the 1790s, during a great migration west, the Second Great Awakening began. This revival saw converts in the thousands. It sparked numerous reform and social movements, as Christians began working to perfect society and bring fair treatment for all. One of the major influential religious leaders was Charles Finney. Finney was known as â€Å"The Father of Modern Revivalism,† he made significant innovations in preaching and religious meetings. Finney tended to be very outspoken and a hardcore criticizer of other Christian teachings. Another influential religious leader was James McGready. McGready became significant in sparking the Second Great Awakening. He hosted loose organized church meetings called frontier camps, which were meetings where preachers delivered informal sermons to large congregations. There was a major site where the largest Protestant revival movements happened, it was called Cane Ridge. At the Cane Ridge Revival a Presbyterian preacher named Barton Stone led the conferences. Stone wasn’t always the only speaker, at any given time 3 or 4 preachers would be delivering sermons. Also men weren’t the only ones that could participate in the Second Great Awakening revival. Due to women’s’ complete exclusion from politics, women jumped at the chance to participate in Christian work. Women became exceedingly important in the spreading of the religious teachings. Some other effects of the Second Great Awakening would include Crusaders fighting for women’s rights, abolition of slavery, temperance, education reform, etc. Although these two religious revivals seemed virtually the same, there are many key differences between the two Great Awakenings. One major difference would be the fact that the Second Great Awakening influenced social reform. Crusaders, who were just citizens, fought for the rights of not only women, but rights for blacks too in the Second Great Awakening. The first Great Awakening influenced more of a personal reform for ones’ self. Allowing colonists to see that there was light beyond their darkness. One similarity the two shared would be the emphasis of morality and religious teachings. Another difference would be that George Whitefield, a significant leader from the very first Great Awakening, tried to prevent slaves from attending religious teachings, while the Crusaders, a group of rebels fighting for social reform for women and slaves, wanted to include slaves and women in not only the religious ceremonies, but introduce them more in society also. One more similarity they shared was the influence of new Protestant based divisions including: Mormons, Seventh-Day Adventists, Presbyterianism, Methodism, and more. Both of the Great Awakenings were influential in many different ways, but the Second Great Awakening provided more diversity within society. The Second Great Awakening made people question government and society and inspired groups like the Crusaders to fight for peoples’ rights. The Crusaders fought deeply for the rights of enslaved black men and women and white women. They also fought for temperance and education reform. Alcohol became a major problem in the 1800s. People were getting drunk and wreaking havoc in the streets and causing disruption. That’s when the Temperance Movement began, the goal of this movement was to teach the evils of drinking, and ultimately get rid of drinking or limit it, but that all depended on the government and if the citizens would choose not to drink. In conclusion the historical legacy of these two movements paved the way for open-minded thinking and multiple reforms that shaped the way the nation is now. From the blacks being able to mingle with the whites, to the women of our nation being able to vote and drive. The Great Awakening left different footprints on all of the colonial religions and divisions. Its legacy was an urgent concern with individual salvation and faith, defining religious beliefs for oneself rather than accepting them from government authorities, selecting a minister for his charisma and preaching style rather than for his wealth and social status, and accepting those who shared a similar style and concerns no matter what the religion. Women became more influential in many congregations which believed that, if females were converted, they would lead their children and husbands to salvation. Responsibility for multiple congregations became more common among the smaller congregations that resulted from the divisions in churches. Both the Old and New persuasions formed intercolonial and interdenominational networks that helped to break down brutality and confinement, and prepared Americans for accepting the religious diversity that was on the horizon.

The Nuiances of Stanford Mba Essay Samples

The Nuiances of Stanford Mba Essay Samples You may also get many discounts on our site which will help you to save some more money for future orders or anything you want to spend them on. This has worked for any number of my clientele. Try as difficult as you can not to be repetitive. If this is the case, you aren't alone. Understanding Stanford Mba Essay Samples The huge difference between both questions is the audience. Choosing our service, you are going to see that studying can be simple if you gain from the aid of competent experts. One of the absolute most important things to keep in mind about this supplement, much like all supplements that lob a plethora of essays and short answer questions at you, is that every response is a chance to reveal something new about yourself to admissions. You should have your reasons, and our primary concern is that you wind up getting an excellent grade. Stanford Mba Essay Samples Features I will graduate equipped to get my best imp act yet. My work has been a direct portion of our institution's expansion out of our province into the remainder of China. As Professor Damon would say, we're helping you ensure your rudder steers you to the appropriate port. This would permit you to put your very best foot forward. I am rather grateful that my mom is currently healing and am motivated to permit other people to experience the exact same change I see in her. Excellent rating and excellent reviews should tell you whatever you want to understand about this excellent writing service. You don't have a good deal of space here, so make sure that you concentrate on personal and strong details which other men and women couldn't replicate. This usually means that we'll admit someone regardless of the application essays if we feel we've gotten a fantastic sense of the individual all around. Furthermore, the essays that follow are most likely to supply comfort, that there's no formula or singular method to craft a prosperous answer. The Ultimate Stanford Mba Essay Samples Trick These are things you are not able to receive at each b-school. What you opt to write about will give admissions an idea about what you truly care about and how you unde rstand the world. Such questions need deep introspection for you to get to the core of your nature and influences. And, since much as you are able to have fun with these. What Is So Fascinating About Stanford Mba Essay Samples? Finally, it is Durham itself. Show them which you'll be an important addition to any classroom setting. The ideal way to do so is regarding your desired post-MBA expert direction. Moreover, I think that my own distinct perspective as a global student will enrich our discussions. A seasoned professional will make an error-free assignment right away and can help you boost your grades. My long-term career objective is to launch or join an important startup devoted to bettering education and creating educational opportunities where they don't currently exist. It's quite the opposite. Or maybe you want more knowledge in entrepreneurship. As someone who's frequently contacted by those people who have failed to acquire admission to Stanford and need to understand why, I frequently realize that they don't make this decision. Inside my experience, Stanford highly values Thought Leaders in addition to individuals who demonstrate more standard types of leadership. Like so many other universities, it wants to get a feel for your commitments outside the classroom as well as in. Unshockingly, given that it is the most difficult university to get into in the country, this supplement is a doozie. Many schools have a variant of this sort of essay. If you take a close look at any good MBA essay examples which you will discover on the internet you will observe that the standard of writing employed is quite high. Write various other schools essays first. Stanford gives a good deal of suggestions and guidance on its website in regard to what it's searching for in the essays. PaperCoach will be able to help you with all your papers, so take a look at this time!

Should Same Sex Marriage Be Legalized - 1372 Words

The â€Å"date which will live in infamy† just had a child! As of June 26, 2015, same-sex marriage was legalized in all 50 states of America by the Supreme Court from a ruling that barely passed by a 5-4 vote. Wait a minute. Back up. Do you mean to tell me that boys can marry boys now? That girls can marry girls? That it’s legal?! Wake up America! Do you even realize what you have done? You have given gay people the right to marry. To marry! Who in their right mind would give gay people that cherished right; or any kind of rights for that matter? Gay people are not like the rest of us; they do not deserve the freedoms that we normal people enjoy. Homosexuals are not human, and there is nothing conceivably human about what they do; they are†¦show more content†¦Ã¢â‚¬Å"Whenever one violates the natural moral order established by God, one sins and offends God† (LGBT Community: Stop Gay Marriage). Same-sex marriage is a perfect example of this. So, it stands to reason that anyone who professes their love to God should be opposed to same-sex marriage. Furthermore, I have the perfect solution to rid our precious society of these vicious queers. We shall set ablaze every part of this great, green Earth in which these demons exist. Scorching-hot fire shall rain down upon every homosexual individual, and we shall watch as they burn; we shall watch as they are cleansed of their cursed impurities. We will deliver their punishment just as God unleashed his on the sinful cities that committed these heinous acts: â€Å"The Lord rained down sulphurous fire upon Sodom and Gomorrah. He overthrew those cities and the whole Plain, together with the inhabitants of the cities and the produce of the soil.† (Gen. 19:24-25) Of course, there is a fairly simpler alternative to abolishing the gays’ rights; one that is not quite as gruesome. Recall, if you will, the earlier decades of the 20th century, where â€Å"homosexuality was illegal in the United States under state sodomy laws and being gay was considered a mental illness by the American Psychiatric Association† (History of Gay Rights).Times were so straightforward back then. If someone was deemed gay, they would immediately be thrown into a psychiatric hospital, never to be seen or heard from