BREAST DISORDERS

CANCER OF THE BREAST

OBSTETRICS AND GYNAECOLOGY NURSING

RND20103
Definition.
Cancer is any malignant tumors,
including carcinomas and sarcomas. It
arises from abnormal cell division and
uncontrolled then invade and destroy
surrounding tissue. Cancer cells spread
and establish secondary tumors in areas
away from the original tumor.

(Dictionary nurses pp. 79)

 LEARNING OUTCOME
• At the end of this session the students will be able
to:
• define breast cancer;
• list the risk factors for breast cancer;
• explain the clinical manifestations for breast
cancer
• list the diagnostic methods for breast cancer
• describe the staging of breast cancer
• explain the management for breast cancer
 DEFINITION
• Breast cancer is a disease in which cancer
(malignant) cells are found in the tissue of
the breast
• Breast cancers arising from cells in the
breast tissue and the growing is not
controlled.
 RISK FACTOR
 Increasing age (over 50 years).
 Having a family member with breast
cancer.
 Had cancer in one breast.
 Start early menarche (before age 12) or
late menopause (after age 50).
 Never having children or having their
first child at the age of above 30 years.
 RISK FACTOR (cont..)
Exposure to carcinogens:
 Ionizing radiation;
 Chemical substances - known as
organochlorine (including pesticides,
Household cleaning products)
 Other factors that increase the risk of fatty
foods, alcohol, breast trauma, socioenomic
senior status, obesity and smoking.
 CLINICAL MANIFESTATIONS
 'Breast mass / lump' can be felt during a breast
examination. Lumps are not painful to the touch
and can be movable.
 Nipple - discharged either by blood or serous.
Into the Nipple (Nipple retraction).
 Changes in the skin in the breast where the skin
will look like Sunkist orange peel (peau
d'orange). In the case of breast cancer that
spreads quickly (advanced) This skin will
eventually become ulcers.
 CLINICAL MANIFESTATIONS (cont..)
 Breast asymmetry' that client will complain
breast shape and size difference when viewed
through a mirror.
 Chances are there is swelling of the lymph
nodes divided armpits.
 Client complained his weight decreased,
fatigue and anemia appear.
 Cachexia looking.
Sunkist orange peel
(peau d'orange)
 DIAGNOSTIC METHODS
• Fine needle aspiration biopsy
• Histological examination of cancer
cells
• Chest x-ray
• Bone scans
• Liver function test
 BIOPSY
There are 4 types of biopsy.

 Aspiration biopsy or needle

aspiration biopsy
The use of fine needle to draw fluid
from the cells or breast lesions.

 Incisional biopsy.
A piece of tissue removed by surgical
breast.
 BIOPSY (cont..)
 Excisional biopsy.
The entire lesion and surrounding tissue
removed by surgical.

 Tru-cut biopsy cores.

New techniques which biopsy device fitted
with a large hollow needle that much
anxious to remove tissue from the breast
lesion. A more convenient, cost-effective,
quick and less painful.
 STAGING OF BREAST CANCER

Stage 1
• Tumors are less than 2cm in diameter and
confined to breast
Stage 2
• Tumors are less than 5cm & axillary node
involvement
STAGING OF BREAST CANCER (cont..)

Stage 3
• Tumors are greater than 5cm & axillary
node involvement. More advanced lesions
with satellite nodules, fixed to skin & chest
wall, clavicular lymph node enlargement

Stage 4
• All tumors with distant metastases
 BREAST CANCER SCREENING
Screening for breast cancer including a series of
screening techniques.

Clinical Breast Examination.

Clinical breast examination (CBE)
are breast palpation and inspection and
axilla by a professional health trained staff.

Breast Self-Examination (BSE) is recommended

for? All women need? Taught to performing BSE
every month.
 BREAST CANCER SCREENING (cont..)

The ideal time to do BSE.

Breast self-examination should be done every
month from the age of 20 years and continues
throughout life.

Menstruating women:
Perform 7-10 days after menses. At the time of
tender and large breasts.
BREAST CANCERCONT….
SCREENING (cont..)

Menopausal women:
Perform the same day every month. Make
one day a month as a day of breast
screening.

Women taking oral contraceptives:

Do BSE every month on starting a new
package.
Breast Self
Examination (BSE)
BREAST CANCER SCREENING (cont..)
• Mammography is specialized medical imaging
that uses a low-dose x-ray system to see inside
the breasts.

• American Cancer Institute (1998) recommends

every 1-2 years for women aged 40 years and
above.

• During mammography, a specially qualified

radiologic technologist will position your breast
in the mammography unit. Your breast will be
placed on a special platform and compressed
with a clear plastic paddle. The technologist will
gradually compress your breast.
MAMOGRAPHY
 TREATMENTS FOR BREAST
CANCER

 Surgery (Mastectomy).
 Radiotherapy (Deep X'ray therapy)
 Chemotherapi (chemo Drugs).
 Physiotherapy (exercise) will be done
if required.
 SURGERY
There are a variety of Mastectomy for breast
cancer.
 Radical mastectomy is the removal of the entire
affected breast, chest muscles and lymph nodes
under the armpit.
 Modified radical mastectomy is the removal of
breast tissue and underarm lymph nodes without
removing the pectoral muscles.
 Simple mastectomy is the removal of the breast
only.
 Segmental mastectomy or lumpectomy is the
removal of the tumor and the surrounding areas.
 TREATMENT (cont..)
Radiotherapy (Deep X'ray therapy).
Given - external beam or tissue implants.
Use following breast cancer surgery to
destroy residual cancer cells that may
recur or metastasis.
Used to shrink large tumors before
surgery.
 TREATMENT (cont..)
• Palliative radiation therapy is
used to treat chest walls that have
recurrences and bone metastases.
Radiation therapy is often used in
combination with lumpectomy for
stage 1 or 2 cancer.
 TREATMENT (cont..)
Chemotherapy treatment.
The use of cytotoxic drugs to destroy cancer
cells and prevent metastasis.
Examples of drugs - Adriamycin, Cytoxan,
methotrexate, 5 - Fluorucil, Vinblastin,
Vincristine.

Side effects;
 Changes in ECG, tachycardia, nausea,
vomiting, mouth ulcers, hair loss.
 POST MASTECTOMY EXERCISES

 Physiotherapy (exercise) will be done if

needed such as:
 Wall climbing
 Rope turning
 Lifting the rod or Broomstick
 Tugging Pulley
 BREAST RECONSTRUCTION
SURGERY
 Some women may opt for reconstruction
surgery after mastectomy.
 Breast Reconstruction may be done during or
after the mastectomy where submuscular
implant installation, the use of tissue implants
followed EXPANDER, removal of muscle and
blood supply of the abdomen or the back and
often use tranverse rectus abdominis
myocutaneous flap.
BREAST RECONSTRUCTION
SURGERY
BREAST RECONSTRUCTION
SURGERY
 NURSING DIAGNOSIS

 Concerns related to lose breasts after

undergoing Mastectomy surgery.
 Anxiety related to radical mastectomy.
 Potential related infection surgical incisional.
 Pain associated with surgery.
 Deficient knowledge related to disease
process and treatment.
 Self-image disturbance associated with breast
loss.
 NURSING DIAGNOSIS
i. Deficient knowledge related to disease process
and treatment.
• Establish trusting relationship-teaching tailoring the
content to suit the patient level of understanding
• Explain disease process, causes and factors
contributing to symptoms to make patient understand
• Encourage her husband to discuss and patient to ask
questions and refer to doctor if necessary to give
them more in depth information related to her illness
 CONTINUE….

• Explain to patient the three common treatments for breast

cancer that are surgery, chemotherapy and radiation. Radiation
therapy works by causing severe damage to that abnormal
DNA, disrupting growth signals and preventing cell division.
Radiation technology is improving, becoming more targeted
and effective
• Chemotherapy is used to kill cancer cells and prevent
recurrence; Chemotherapy may be used in all stages of breast
cancer.
• Explains and reassure patient the important of treatment in
saving her life so that she will cooperate
 NURSING DIAGNOSIS
ii. Anxiety Related To Radical Mastectomy.
• Assess patient's readiness to learn by assessing
emotional response to illness: acceptance, anger,
anxiety, denial, depression, etc.
• Reassure patient that experienced surgeon will
perform the surgery so that the patient will feel safe
and confidence
• Introduced to patient who has successfully undergone
the surgery to make her feel confident to the surgery
• Explain to her that she will be given anesthesia- so
that she will never experience any pain.
 CONTINUE….

• Explain to her the pre-operation preparation

– skin preparation, blood investigations,
chest X-ray to detect any abnormality
• Give the patient time to ask questions, and
refer to doctor if necessary to clear her
doubt.
• Explain the important of post mastectomy
exercises; deep breathing and hand
exercises in promoting healing process.