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Description Breast cancer is the growth of malignant cells lining the ducts or lobules of the breast that spread by way of the lymphatic system and the blood stream. The malignant cells travel through the right side of the heart to the lungs and to the other breast ,chest wall, liver, bone, and brain. Breast cancer is classified as:  Adenocarcinoma: the most common form that arises from the epithelial tissues. Intraductal : develops within the ducts. Infiltrating: occurs in the parenchymal tissue. Inflammatory (rare): 

grows rapidly, causing the overlying skin to become edematous ,inflamed ,and indurated. Lobular: involves the lobes of the glandular tissue. Medullary or circumscribed: enlarging tumor that grows rapidly.

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 Breast cancer is classified as invasive when it penetrates the tissue surrounding the mammary duct and grows in an irregular pattern.  Metastasis occurs via lymph nodes.  Common sites of metastasis are the bone, lungs, brain, liver, and skin.  Diagnosis is made by breast biopsy through a needle aspiration or by surgical removal of the tumor with microscopic examination for malignant cells.

RISK FACTORS: RISK FACTORS: Family History of Breast Cancer REASONS: Breast cancer in the client’s mother, sister, or daughter (first-degree relatives) increases the risk of developing breast cancer 2 to 3 times Longer exposure to estrogens that can cause cell mutations There are 2 separate genes for breast cancer. These genes are seen in less than 1% of women; however, if a female has one of these genes it increases her chances of getting breast cancer by 50% to 85% The earlier a client starts menses, the greater the chance of developing breast cancer due to longer exposure of estrogen that may cause cell mutations Longer exposure to estrogens that may cause cell mutations Most studies do not show a relationship between estrogen use and breast cancer, but use of estrogens is still listed as a risk factor as the jury is still out on this topic Immunosuppression and hormonal changes that cause cell mutations Longer exposure to estrogen that causes cell mutations Doubles the risk for breast cancer; longer exposure to estrogens that causes cell mutations Causes cell mutations and immunosuppression Make it easier for cancer-causing substances to enter and damage individual cells. Alcohol may temporarily increase the concentration of estrogens that circulate in the blood, causing cell mutations Risk is higher for postmenopausal, obese women due to estrogen changes and high-fat diet Fat triggers estrogen, fueling tumor growth

Age Breast Cancer Gene

Early onset of menses

Late menopause Estrogen Therapy

Endometrial / ovarian cancer 1st pregnancy after age 35 Nulligravida Radiation exposure especially before age 30 Alcohol or tobacco use


High fat diet

milky.Signs and symptoms and why: The signs and symptoms of breast cancer are caused by the travel of the malignant cells to body tissues and organs where they clump to form tumors. with possible breast Enlargement of the cervical. SIGNS & SYMPTOMS Painless lump or mass on palpation Clear. D. Surgical interventions: Surgical breast procedures.a tissue sample is taken by fine-needle aspiration for biopsy to identify the type and stage of the tumor. Treatments include:      Surgery. or bloody discharge Asymmetry of breasts Change in skin tissue— dimpling. Hormonal manipulation via the use of medication in postmenopausal women or other medications such as tamoxifen (Nolvadex) for estrogen receptor–positive tumors F.  Hormonal therapy: tamoxifen (Nolvadex). Nonsurgical interventions: 1. or axillary lymph nodes PATHOPHYSIOLOGY: Cancer is a disease process that begins when an abnormal cell is transformed by the genetic mutation of the cellular DNA. while the nipple is the second most common site.Once the tumor is located via mammography . The cells infiltrate these tissues and gain access to lymph and blood vessels. Chemotherapy 2. ignoring growth-regulating signals in the environment surrounding the cell. Early detection: Monthly BSE E. inflammation Change in breast tissue—thickening Nipple retraction or scaly skin around nipple Arm edema REASON Cells clump to form tumors but don’t carry pain nerve impulses Cells of breast tissue do not function properly Tumor growth in one breast Tumor pulls and retracts skin tissue Tumor growth displaces breast tissue Tumor growth displaces breast tissue Lymph nodes responsible for tissue drainage may be affected causing the edema. supraclavicular. The cells acquire invasive characteristics. Radiation. phenomenon is called metastasis (cancer spread to other parts of the body). the lower inner quadrant. Antiemetics.  Abduction or external rotation to the affected arm. Analgesics. Quickie tests and treatments:  Breast cancer is best detected by monthly self-breast examination (SBE)/ (BSE). and changes occur in surrounding tissues. the lower outer quadrant. not able to function effectively  Chemotherapy agents: cyclophosphamide (Cytoxan) methotrexate(Folex). Radiation therapy 3. and finally. (The arm associated with the side where mastectomy was performed)  Malnutrition. This . This abnormal cell forms a clone and begins to proliferate abnormally.  Screening mammography is recommended for all women over age 40 every 1 to 2 years and every year for women over age 50. which carry the cells to other areas of the body. Half of all breast cancers develop in the upper outer quadrant of the breast. Chemotherapy. followed by the upper inner quadrant.  Infection.  Calcification on mammography is indicative of breast cancer . arm edema may indicate metastasis Lymph node involvement.  Severe immunosuppression. Complications: / What can harm my client? :  Performing venipuncture or blood pressure monitoring on the affected Arm.

If a drain (usually a Jackson-Pratt) is in place. 2.  MODIFIED RADICAL MASTECTOMY Breast tissue. 4. Encourage coughing and deep breathing. 3. 7. Assess operative site for infection. Lymph nodes are left intact. or color changes of the skin. turn from the back to the unaffected side. or chest wall  Disturbed body image related to loss or alteration of the breast  Risk for impaired adjustment related to the diagnosis of cancer and surgical treatment  Self-care deficit related to partial immobility of upper extremity on operative side  Risk for sexual dysfunction related to loss of body part. the client will return from surgery with a surgical brassiere and the temporary prosthesis in place. NURSING DIAGNOSIS: PRE-OP:  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 (individual or family) related to the diagnosis of breast cancer  and related treatment options  Decisional conflict related to treatment options POST – OP:  Pain and discomfort related to surgical procedure  Disturbed sensory perception related to nerve irritation in affected arm. swelling.reconstruction:  LUMPECTOMY Tumor is excised and removed. with the affected arm elevated above the level of the heart to promote drainage and prevent lymphedema. Position the client in a semi-Fowler's position. Monitor vital signs. 6.  SIMPLE MASTECTOMY Breast tissue and the nipple are removed. Muscles are left intact. maintain suction and record the amount of drainage and drainage characteristics 5. or the presence of fluid collection under the skin flaps or in the arm. and lymph nodes are removed. G. breast. Postoperative interventions 1. change in self-image. If breast reconstruction was performed. and fear of partner's responses  Deficient knowledge: drain management after breast surgery  Deficient knowledge: arm exercises to regain mobility of affected extremity  Deficient knowledge: hand and arm care after an axillary lymph node dissection (ALND) . Monitor incision site for restriction of dressing. Lymph node dissection may also be performed. nipple. impaired sensation.