Breast Cancer

• Is the leading type of cancer in women.Most breast cancer begins in

the lining of the milk ducts, sometimes the lobule.
• The cancer grows through the wall of the duct and into the fatty
tissue.
• Breast cancer metastasizes most commonly to auxiliary nodes, lung,
bone, liver, and the brain.
• The most significant risk factors for breast cancer are gender (being
a woman) and age (growing older).
• Other probable factors include nulliparity, first child after age 30, late
menopause, early menarche, long term estrogen replacement
therapy, and benign breast disease.
 • Controversial risk factors include oral contraceptive use, alcohol use,
obesity, and increased dietary fat intake.
• About 90% of breast cancers are due not to heredity, but to genetic
abnormalities that happen as a result of the aging process and life in
general.
• A woman’s risk of breast cancer approximately doubles if she has a
first-degree relative (mother, sister, daughter) who has been
diagnosed with breast cancer. About 20-30% of women diagnosed
with breast cancer have a family history of breast cancer.

STAGES OF BREAST CANCER

STAGE DEFINITION
Stage 0 Cancer cells remain inside the breast duct, without
invasion into normal adjacent breast tissue.
Stage I Cancer is 2 centimeters or less and is confined to the
breast (lymph nodes are clear).
Stage IIA No tumor can be found in the breast, but cancer cells
are found in the axillary lymph nodes (the lymph
nodes under the arm)

OR

the tumor measures 2 centimeters or smaller and has

spread to the axillary lymph nodes

OR

the tumor is larger than 2 but no larger than 5

centimeters and has not spread to the axillary lymph
nodes.
Stage IIB The tumor is larger than 2 but no larger than 5
centimeters and has spread to the axillary lymph
nodes

OR

the tumor is larger than 5 centimeters but has not

spread to the axillary lymph nodes.
Stage IIIA No tumor is found in the breast. Cancer is found in
axillary lymph nodes that are sticking together or to
 other structures, or cancer may be found in lymph
nodes near the breastbone

OR

the tumor is any size. Cancer has spread to the

axillary lymph nodes, which are sticking together or
to other structures, or cancer may be found in lymph
nodes near the breastbone.
Stage IIIB The tumor may be any size and has spread to the
chest wall and/or skin of the breast

AND

may have spread to axillary lymph nodes that are

clumped together or sticking to other structures, or
cancer may have spread to lymph nodes near the
breastbone.

Inflammatory breast cancer is considered at least

stage IIIB.
Stage IIIC There may either be no sign of cancer in the breast or
a tumor may be any size and may have spread to the
chest wall and/or the skin of the breast

AND

the cancer has spread to lymph nodes either above or

below the collarbone

AND

the cancer may have spread to axillary lymph nodes

or to lymph nodes near the breastbone.
Stage IV The cancer has spread — or metastasized — to other
parts of the body.

ASSESSMENT

• A firm lump or thickness in breast, usually painless; 50% are located

in the upper outer quadrant of the breast.
• Spontaneous nipple discharge; may be bloody, clear or serous.
• Asymmetry of the breast may be noted as the woman changes
positions; compare one breast with the other.
 • Nipple retraction or scalliness, especially in Paget’s disease.
• Enlargement of auxiliary or supraclavicular lymph nodes may
indicate metastasis.

DIAGNOSTIC EVALUATION

• Mammography (most accurate method of detecting non-palpable

lesions) shows lesions and cancerous changes, such as
microcalcification. Ultrasonography may be used to distinguish cysts
from solid masses.
• Biopsy or aspiration confirms diagnosis and determines the type of
breast cancer.
• Estrogen or progesterone receptor assays, proliferation or S phase
study (tumor aggressive), and other test of tumor cells determine
appropriate treatment and prognosis.
• Blood testing detects metastasis; this includes liver function tests to
detect liver metastasis and calcium and alkaline phosphatase levels
to detect bony metastasis.
• Chest x-rays, bone scans, or possible brain and chest CT scans
detect matastasis.

PHARMACOLOGIC INTERVENTIONS

1. Chemotherapy is the primary used as adjuvant treatment

postoperatively ; usually begins 4 weeks after surgery (very stressful
for a patient who just finished major surgery).
• Treatments are given every 3 to 4 weeks for 6 to 9 months.
Because the drugs differ in their mechanisms of action,
various combinations are used to treat cancer.
• Principal breast cancer drugs include cyclosphosphamide,
methotrexate, fluorouracil, doxorubicin, and paclitaxel.
 • Additional agents for advanced breast cancer include
docetaxel, vinorelbine, mitoxantrone, and fluorouracil.
• Herceptin is a monoclonal antibody directed against Her-2/neu
oncogene; may be effective for patients who express this gene
2. Indications for chemotherapy include large tumors, positive lymph
nodes, premenopausal women, and poor prognostic factors.
3. Chemotheraphy is also used as primary treatment in inflammatory
breast cancer and as palliative treatment in metastatic disease or
recurrence.
4. Anti-estrogens, such as tamoxifen, are used as adjuvant systemic
therapy after surgery.
5. Hormonal agents may be used in advanced disease to induce
remissions that last for months to several years.

SURGICAL INTERVENTIONS

1. Surgeries include lumpectomy (breast-preventing procedure),

mastectomy (breast removal), and mammoplasty (reconstructive
surgery).
2. Endocrine related surgeries to reduce endogenous estrogen as a
palliative measure.
3. Bone marrow transplantation may be combined with chemotherapy.
NURSING INTERVENTIONS

1. Monitor for adverse effects of radiation therapy such as fatigue, sore

throat, dry cough, nausea, anorexia.
2. Monitor for adverse effects of chemotherapy; bone marrow
suppression, nausea and vomiting, alopecia, weight gain or loss,
fatigue, stomatitis, anxiety, and depression.
3. Realize that a diagnosis of breast cancer is a devastating emotional
shock to the woman. Provide psychological support to the patient
throughout the diagnostic and treatment process.
4. Involve the patient in planning and treatment.
5. Describe surgical procedures to alleviate fear.
6. Prepare the patient for the effects of chemotherapy, and plan ahead
for alopecia, fatigue.
7. Administer antiemetics prophylactically, as directed, for patients
receiving chemotherapy.
8. Administer I.V. fluids and hyperalimentation as indicated.
9. Help patient identify and use support persons or family or
community.
10. Suggest to the patient the psychological interventions may be
necessary for anxiety, depression, or sexual problems.
11. Teach all women the recommended cancer-screening
procedures.