BREAST CANCER

FERRER, Froilan D.SEPTEMBER 12, 2015

BREAST CANCERHOSPITAL PROFILEManila Doctors Hospital (MDH)is a premiere private tertiary hospital operating at 667 United Nations Avenue, Ermita, Manila, Philippines. It was founded in 1956 by a group of doctors, under the corporate name Manila Medical Services Inc. (MMSI). In 1979, Metrobank Foundation, Inc. (MBFI) acquired majority shares of MMSI.MDH operates only in the Philippines, but it serves many international clients and plays an active role in promoting medical tourism in the country.2015 MDH ThemeStrengthening the hospitals capacity to provide quality and safe patient care through integrated value-based healthcare serviceMDH GoalTo provide holistic quality and safe patient care for all Filipino and International ClientsVision and MissionIn keeping with our goal to serve as a health and wellness center for all Filipino and international clients, MDH adheres to a three-fold mission:To operate a world-class hospitalTo undertake training and research programs to consistently improve quality services, as well as pave the way for medical breakthroughsTo continuously pursue corporate social responsibility programs

MDH Corporate ObjectivesTo provide health care services that meet the needs of:Clients or customersAll pertinent statutory and regulatory requirements, andThe expectations of MDH top managementTo conduct research that will continuously improve servicesTo provide competent staff at all timesTo implement and continuously improve the quality management systemTo provide corporate social responsibility programs for the underprivileged and underserved in the community

INTRODUCTIONCancer is a major health problem worldwide and the morbidity and mortality from cancer give rise to much suffering. The risk of developing cancer in an individual's lifetime is about 33%, and the risk of dying of cancer is 25%. Cancer is not only a disease of the elderly although for many cancers the incidence increases with age. Breast cancer in the US and Western Europe is the commonest female cancer, and accounts for the most cancer deaths in women. Eighteen percent of women who develop breast cancer will be under 50 years of age and with an average of 50% mortality this will produce a significant number of deaths in a population of wives and mothers who are making major contributions to the nurture of future generations and the economy.In Asia, the Republic of the Philippines has the highest reported incidence rate of breast cancer. From 43.2 in 2003-2005, 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. Many breast cancers are diagnosed among 35 to 50-year-old Filipino women. In terms of breast cancer detection, a local study revealed that the use of breast self-examination (BSE) and aspiration biopsy/open biopsy are the most cost-effective strategies in the Philippine setting, incurring savings for the government by almost 3 million Philippine Pesos or US $60,000 (1989 value) per year per 100,000 women. Mammography is neither readily available nor affordable especially in the rural areas.

PATHOPHYSIOLOGYOF BREAST CANCER

PRECIPITATING FACTORS: UnknownPREDISPOSING FACTORS: Age (Pt. is 61 y/o) Gender (Pt. Is female) Lifestyle (Stress) Hereditary (Pt.s grandmother died because of cancer)Neoplasm formation in the breastPrimary tumor begins in the breastTumor becomes invasiveS/Sx: pain on the left upper breast Surgery (Pt. undergone mastectomy)It becomes systemicPrimary cancer spreadsTravel (metastasize) to other organ systems in the bodyProgress beyond breast to regional lymph nodes Chemotherapy Radiotherapy Interstitial laser thermotherapyProgress beyond breast to regional lymph nodesCancer cell destroyed/ removedRemoval of the breastCancer cell spreads into major organsSome cancer cell remainsLUNGSBONESLIVERBRAINNECKS/Sx: DOB, Cough, Pleural EfussionS/Sx: Back & bone painS/Sx: RLQ painS/Sx: HeadacheS/Sx: Horseness of voicePATIENTS PROFILEName: Patient VTRAge: 61 years oldAddress: Los Banos, LagunaGender: FemaleBirth Date: March 29, 1954Birth Place: Gapan, Nueva EcijaReligion: Roman CatholicCivil Status: MarriedNationality: FilipinoOccupation: Employee at International Rice Research InstituteDate and Time of Admission: July 22, 2015 at 11:40 amFinal Diagnosis: Left Breast CancerAdmitting Physician: Dr. CabalunaInstitution: Manila Doctors Hospital (MDH)Operations/ Treatment: S/P Total Mastectomy, Left Breast (July 23, 2015; 9am)Chief Complaint: Breast Mass, Left FAMILY HISTORYThe patient verbalized that on her father side, her grandmother died due to cancer at the age of 82. No other serious illnesses were noted base from the family genealogy. PAST HISTORYAccording to the patient, she had measles and chicken pox in her grade school. She didnt recall if she had immunizations. She had coughs and colds once in a while and managed it with OTC (over the counter) drugs. Furthermore, she does not have any allergy on foods or medicines. Aside from that no other illnesses were noted.PRESENT HISTORYPatient was diagnosed a case of endometrial cancer way back in 2010 at Asian Hospital. TAHBSO and chemo-therapy for 6 cycles were done as her treatment. 5 months PTC the patient was scheduled for routine check-up were upon physical exam, a breast mass was palpated at the left breast. No symptoms were noted. Mammogram and ultrasound were done which revealed a mass on the left breast suspicious for malignancy. She was advised to undergo surgery hence subsequent admission. GORDONS 11 FUNCTIONAL HEALTH PATTERNS

LABS AND DIAGNOSTIC TESTSSURGICAL TREATMENT

MASTECTOMYMastectomy is an operation in which the entire breast, usually including the nipple and the areola, is removed. Mastectomy is usually performed as a treatment of breast cancer.In general, women with breast cancer can decide whether to be treated with a lumpectomyor a mastectomy.A lumpectomy is the removal of the cancerous breast tissue as well as a surrounding rim of healthy breast tissue. A lumpectomy is a breast-conserving surgery that is usually followed byradiation therapy(high-doseX-raysor other high-energy rays to kill cancer cells).MASTECTOMYThere are four main types:Total mastectomy - removal of breast tissue and nippleModified radical mastectomy - removal of the breast, most of the lymph nodes under the arm and often the lining over the chest musclesLumpectomy - surgery to remove the tumor and a small amount of normal tissue around itRadical mastectomy - the removal of the breast, lymph nodes and chest muscles. This is no longer commonWhich surgery you have depends on the stage of cancer, size of the tumor, size of the breast and whether the lymph nodes are involved. Many women havebreast reconstructionto rebuild the breast after a mastectomy.NURSING CARE PLANDRUG STUDYREFLECTIVE JOURNALThank You...