Faisal Musa, MD
Throughout fellowship, my experiences working with patients in clinic have taught me many lessons. In particular, I’ve learned the true value of a physical exam. While working in a continuity clinic alongside my program director, who has a special interest in breast cancer, I’ve had a special opportunity to observe and learn from him the proper way to conduct a breast exam. Working with this program director has also taught me to be mindful of certain important considerations in patients with metastatic disease.
In this article, I present the case of a woman with widespread disease in the bone, lung, and colon. Initially, she was thought to have colon cancer based on imaging results. However, a simple physical breast exam revealed something very different.
Patient Case Explored
Our patient is a 66-year-old woman with an unremarkable past medical history. In fact, this patient reported no history of ever being seen by any healthcare provider. She presented to the emergency department with worsening neck pain and right-sided chest pain, which had been bothering her for weeks. She denied symptoms of weakness, tingling, numbness, and urinary or fecal incontinence. When she was seen by our team, her initial physical exam was normal.
I communicated these findings to the initial oncologist who had seen this woman, and he was very appreciative of my attentiveness and willingness to dig deeper into this patient’s case. He explained to me that, “We, as oncologists, sometimes forget to do a breast physical exam because of all of the imaging technology available. But this patient serves as an excellent example of why it is important to conduct a complete physical exam, especially during an initial patient encounter.”
Cases such as this one highlight an important principle in oncology. We frequently talk about pathology and imaging results, but we rarely talk about physical exam findings, even in tumor boards. This case clearly demonstrates the importance of the physical examination in oncology, as it can play a huge role in a patient’s diagnosis and treatment.
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