Breast cancer

Many of you might already know that cancer ranks 3rd among the leading causes of mortality and morbidity in the Philippines. Infectious and cardiovascular diseases are the top two. Cancer prevention attitude here sucks, and a researcher has lamented that if this continues “it is

estimated for every 1800 Filipinos, 1 will develop cancer annually.”

In Asia, the Philippines has the highest reported incidence rate of breast cancer. From 43.2 in 1993-1995, the age standardized incidence rate

(ASR) is now 47.7 per 100,000 females. And this, figure exceeds the rate reported for several western countries including Spain, Italy, and most Eastern-European countries.

BREASTCANCER

Survival QUEST

By:Mike Pendon

Breast cancer is malignant

abnormal cell growth in the

breast.

Breast cancer is a relatively common cancer among women in the US, and it is the leading cause of death in women between 45 and 64 years of age.

Breast cancer maybe discovered while in situ (localized), or it may be discovered as a malignant (spreading) neoplasm.

Breast cancer is usually an adenocarcinoma found in the milk ducts.

Causes

Idiopathic; estrogen implicated by high incidence in women.

Anatomy

Types of Breast Cancer:

Ductal carcinoma (75%)

Lobular carcinoma (7%)

Paget’s Disease

Inflammatory carcinoma

Two major groups of Breast cancer: Noninvasive Carcinoma

DCIS – Ductal Carcinoma In SituLobular Carcinoma In Situ

Invasive CarcinomaGain access to the supporting tissue

between ducts, blood vessels, lymph, etc.

Classification:

I n f l a m m a t o r y M e d u l l a r y M u c i n o u s P a g e t ’ s d i s e a s e P h y l l o d e s t u m o r T u b u l a r S a r c o m a s L y m p h o m a s

Risk factors

Age (over age 50) 1st Pregnancy after age 30 HRT Menstruation before age 12 Menopause after age 50 Nulliparity

Risk Factors

Endometrial or ovarian cancer

Estrogen therapy Antihypertensives Obesity High fat diet Fibrocystic disease Exposure to low level

ionizing radiation Family history

1st pregnancy after age 31 Long menses Never been pregnant Unilateral breast cancer Asian and Indian

nationality Multiple pregnancies Pregnant before age 20

Other Factors

Alcohol use Family history Genetic Link History of breast biopsy Obesity History of breast cancer Sedentary lifestyle Race (Caucasian)

Pathophysiology

Proto-oncogens

Oncogens

Cell grow and divide faster than normal

1st

2nd

Tumor suppressor genes are turned off

Cell grow and divide very quickly

Hyperplasia of breast tissue

3rd

DNA repair genes get turned off

Cells continue to grow and divide

Hyperplasia of breast tissue

Malignant

Breast Cancer

Signs and Symptoms A lump or mass in the breast A change in symmetry or size of the breast. A change in breast skin (thickening, scaly,

dimpling) Unusual drainage or discharge A change in the nipple such as itching, burning,

erosion or retraction. Pain Bone metastasis, pathologic bone fractures and

hypercalcemia Edema of the arm

Staging of Breast Cancer

Stage 0Pre-cancerous conditionDCISPaget’s disease

Stage ITumor is <2cmNo lymph node involvement

Stage IIA<2cm and 1-3 axillary LN involved<5cm and no axillary LN involved

Stage IIB>2cm and 1-3 axillary LN involved>5cm and no axillary LN involved

Stage III A<5cm 4-9 axillary LN>5cm and 1-9 axillary LN

Stage III BChest wall and skin9 axillary LN

Stage III CTumor of any size10 or more axillary LN1 regional LNE.g., Inflammatory Breast Cancer

Stage IVTumor of any sizeHave spread to nearby LNMetastasis to bones, liver, lungs, brain and

distant LN

Diagnostic tests

Breast self examination Mammography Surgical biopsy/ fine needle aspiration Ultrasonography Bone scan/computed tomography scan Hormonal receptor assay

Diagnostic exams in Breast CA

Breast Self Examination

Starts from age 20. done after menstruation. Note for symmetry of the breast. Palpate the breast from periphery to the center in circular motion.

Mammogram

It involves x-ray examination of the breast, it is supported on flat, firm surface. It involves use of 2 x-ray films.

Biopsy

It is the examination of affected tissue in detecting presence of cancer cells.

Nuclear Magnetic Resonance Imaging

This is viewing the structure of the breast using a high tech radiation imaging in detecting presence of mass or tumors.

Treatment

In choosing the therapy,, the patient and practitioner should consider the stage of the disease, the woman’s age and menopausal status and the disfiguring effects of the surgery, treatment for breast cancer may include 1 or any combination of the following:

Surgery

Simple or total mastectomy Modified radical mastectomy Radical mastectomy Skin sparing mastectomy Subcutaneous mastectomy Partial mastectomy lumpectomy

Medical and Surgical Management: Surgery including mastectomy (either simple,

radical, or modified radical) and lumpectomy Primary radiation therapy Chemotherapy Anti-estrogen therapy

TamoxifenFulvestrantGoserelinAromatase inhibitors

Peripheral stem cell therapy Biological therapy Drug therapy

Nursing Consideration

Pre-operative

Obtain informed consent Provide good care for a breast care Be sure to know what kind of surgery to be

performed in order to prepare the patient If mastectomy is scheduled:

Prevent pulmonary complications and thromboembolism

Place patient on the affected side

Post-operative

inspect dressing anteriorly and posteriorly Check circulatory status MIO Encourage coughing exercises and turning

schedule every two hours Provide psychological and emotional support Explain to the patient that she may

experience phantom breast syndrome

Nursing Deficient knowledge about the planned surgical

treatments. Anxiety related to the diagnosis of cancer Fear related to specific treatments and body

image changes Risk for ineffective coping related to the

diagnosis of breast cancer Decisional conflict related to treatment options. Disturbed body image related to loss or

alteration of the breast

Diagnoses

end

THE