By Tedler D. Depaynos, MD

The patient was a vendor at the Hilltop market who was referred to a surgeon by a co-vendor who was operated by the same surgeon 6 years ago due to a similar breast lesion and obviously has recovered.
The breast lesion was a mass found on the left breast, very distinct, palpable, even movable and non-tender. The patient just thought of consulting a doctor when she felt that the mass suddenly enlarged.
After a prolonged hesitation she finally consented to an excision biopsy under sedation because she cannot bear being awake and experience the feeling of being cut and the pain that may come along with it. Besides even after sedation, she could still go home after the operation.
Excision biopsy as explained is actually removing the whole lesion. If the lesion is too large, just a portion of it is removed and that is what is sent to the laboratory for study. This is called incision biopsy. For her case, excision of the whole lesion was easily done.
Because other masses in her breasts maybe present and could not be palpated, ultrasound of both breasts were first done.
This is actually now a routine and a must procedure in most medical centers before any minor surgery in the breast is made. Thru ultrasound, the locations of the non-palpable masses were marked and wide excisions were done on those areas to insure that the masses appreciated thru ultrasound were removed.
After a week, the bad news came out! The official result of the biopsy was unfortunately, cancer. The surgeon had to text her to return for follow up and that the result of the biopsy was already available.
The patient came with a sister and when the official histopath result was shown to them, the sister was more aggressive in asking a number of clarifying questions. Apparently, they wanted a non-surgical treatment. The surgeon was patient in answering their inquiries and explained repeatedly the current treatment and possible consequences of the malignant lesion. Finally, the surgeon insisted that the treatment is surgery and possible chemotherapy after.
The surgery as explained was complete removal of the left breast to insure the removal of the primary lesion and dissection of the left axillary area to remove the lymphatics where the malignant lesion may spread initially. This is called MRM or Modified Radical Mastectomy and ideally it is done early to prevent metastasis.
It was a week after when the patient requested that they would like the specimen to be brought to another laboratory. A second opinion is understandable but the surgeon advised them that if the second opinion is contradictory to the first, a third opinion should be sought for final conclusion. The second can also be erroneous.
It was just less than a year, however, when the patient finally returned. She never underwent further surgery and neither did she consult another pathologist. Her breast mass has enlarged a little but this time very firm, fixed and no longer movable. Multiple marble-like painless lesions could be palpated at her left axilla and because of her dry coughing, a chest x-ray was done which revealed multiple metastasis. Her case is sadly now in the 4th stage.
On further interview, she confessed with tears rolling down her cheeks that she was very afraid of undergoing surgery. When another colleague of her selling at Hilltop advised her to take herbal medicines, she immediately agreed. She took bottles of different capsules and tablets faithfully for months. She even traveled somewhere in Pangasinan to seek consultation with a well known “healer”.
With a heavy heart, the surgeon advised her that the treatment he could only give is palliative which is to make her more comfortable and that the disease is no longer curable. She was referred to a chemotherapist.
This is not a solitary case, the surgeon emphasized. Throughout his practice he encountered similar other cases where proper treatment were either not done or delayed for various reasons. Hence he always emphasized early diagnosis and early treatment for breast cancer lesions and for other malignant lesions for that matter. **