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breast cancer overview.. mgt, dx, tx and nsg dx... :)
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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