Tumor progression: a clinical case in the practice of a general practitioner

The detection of cancer recurrences is one of the most important tasks of the healthcare system in Russia. Outpatient medical care is crucial for diagnosing tumor progression or relapses in a timely manner and referring patients to specialized treatment. Objective. To highlight the importance of an active diagnostic search for early detection of malignancies and improved prognosis for the patient in outpatient settings. Materials and methods. An outpatient clinical case is presented. Results. The patient visited her general practitioner due to periodic nausea, a fever up to 37.5 ◦C, which appeared about a month ago, and pain in the lumbar spine, which was associated with a history of osteochondrosis. In 2017, a resection of the right breast was performed for a malignancy. Blood tests showed decreased hemoglobin, increased erythrocyte sedimentation rate, and a pronounced increase in alkaline phosphatase. The general practitioner scheduled computed tomography of the pelvis, femur, and lumbar spine, which revealed multiple structural changes in the bones of the sacrum, iliac, ischial, and pubic bones, acetabulum, femur, and multiple structural changes in the ThXI, ThXII, LI—LV, vertebral arches, and spinous and articular processes. The patient was referred to an oncologist; according to the examination results, the patient was diagnosed with malignant neoplasm of the unspecified part of the breast, breast cancer on the right, T1CN0M0; Disease progression, multiple secondary bone lesions. T0N0M1; stage: IV. Conclusion. Improving the quality of medical care for patients with malignancies depends on primary healthcare professionals’ awareness of symptoms and signs indicating possible cancer, as well as on timely diagnosis and referral to appropriate specialists.