BREAST CANCER

I. INTRODUCTION AND OBJECTIVES

The objective of this case analysis is to comprehensively understand breast cancer,

including its pathophysiology, diagnostic approaches, management strategies, and implications

for nursing practice and research.

Cancer begins when healthy cells in the breast change and grow out of control,

forming a mass or sheet of cells called a tumor. A tumor can be cancerous or noncancerous,

also called benign. A cancerous tumor is malignant, meaning it can grow and spread to other

parts of the body. A benign tumor means the tumor can grow but has not spread. Breast cancer

is a disease in which abnormal breast cells grow out of control and form tumours. If left

unchecked, the tumours can spread throughout the body and become fatal. There are different

kinds of breast cancer. The kind of breast cancer depends on which cells in the breast turn into

cancer.

Breast cancer occurs in every country in the world. Breast cancer is one of the most

common cancers among women, second only to skin cancer. It’s most likely to affect women

over the age of 50. Breast cancer is the most commonly occurring cancer in women and the

most common cancer overall. There were more than 2.26 million new cases of breast cancer in

women in 2020. Breast cancer caused 685 000 deaths globally in 2020. There are 27,000 new

cases of breast cancer reported every year in the Philippines, of which 9,000 have died. In

2020, there were about 27.2 thousand new cases of breast cancer in the Philippines. Breast

cancer had the most amount of new cancer cases and the disease was considered one of the

leading causes of death in the Philippines.

Breast cancer continues to be a major focus in medical education, clinical practice,

and research due to its prevalence and impact on public health. Advances in these areas are

crucial for improving patient outcomes and reducing the burden of breast cancer on individuals

and society.
 II. PATHOPHYSIOLOGY AND MANAGEMENT

A. Diagram

ETIOLOGY MANAGEMENT

Genetic Factors: Inherited Medical: Surgery

mutations in BRCA1 and (lumpectomy or
BRCA2 genes significantly mastectomy),
increase the risk. chemotherapy,
radiation therapy,
Hormone Levels: Increased hormone therapy,
exposure to estrogen and targeted therapy, or
progesterone, such as early a combination of
menstruation or late SIGNS AND SYMPTOMS
these.
menopause, is a risk factor.  Lump or mass in the
Surgical: Breast-
Family History: A family breast.
conserving surgery
history of breast cancer raises  Changes in breast size,
(lumpectomy) or
the risk. shape, or appearance.
removal of the entire
 Nipple changes, such as
breast
Age: The risk increases with inversion or discharge.
(mastectomy).
age, especially after 50.  Skin changes on the
breast, including Nursing: Pre-
dimpling or redness. operative and post-
operative care,
wound care, patient
education on self-
breast examination,
Permanent Damage to DNA
and emotional
support.

Mutation of Genes DIAGNOSTIC/EVALUATION

TOOLS

Physical Assessment:
Activation of growth inducer genes, Clinical breast examination
Inhabitation of tumor suppressor and assessment of lymph
genes, Alteration in apoptotic genes nodes.

Medical Diagnostics:
Mammography, ultrasound,
Disrupted proliferation of cell,
MRI, and biopsy (fine needle,
Reduction in Apoptosis
core needle, or surgical)

Nursing Diagnosis
Growth of Colony (NANDA): "Risk for Impaired
Skin Integrity related to
breast surgery" or "Anxiety
related to breast cancer
Progression of Tumor diagnosis."

BREAST CANCER

IF NOT TREATED

Breast cancer can continue to
grow and spread to other parts of
the body (metastasize). There will
be low survival rate.
IF TREATED
MEDICAL SURGICAL NURSING
Achieve complete remission,
 Mastectomy prolonged disease-free periods, or
 Lumpectomy manage their condition as a chronic
 Radiation Therapy illness, leading to an overall positive
 Chemotherapy outlook on survival and quality of life.
 B. Narrative Discussion

Breast cancer develops due to different factors like genetic factors, hormone levels,

family history and age. In genetic factors, inherited mutations in BRCA1 and BRCA2 genes

significantly increase the risk. Increased exposure to estrogen and progesterone, such as early

menstruation or late menopause affects the hormone levels in the body making it a risk factor.

Having also a family history of having a breast cancer is also a risk as well as those who has

age after 50. These predisposing and causative factos leads to permanent damage to DNA.

When DNA is damaged there will be mutation of genes leading to the activation of growth

inducer genes, suppressor genes are inhibited and there will be an alteration in apoptosis.

When this happen, distrupted proliferation of cell is present as well as the reduction in apoptosis

causing growth of colony and progression of tumor.

In knowing the clues in having breast cancer and so that the doctor will diagnosis it

as a breast cancer and find treatment soon, breast cancer symptoms are present. Signs and

symptoms of breast cancer include lump or mass in the breast, changes in breast size, shape,

or appearance, nipple changes, such as inversion or discharge and skin changes on the breast,

including dimpling or redness. Diagnosing cancer at its earliest stages often provides the best

chance for a cure. For physical assessment, there will be clinical breast examination and

assessment to lymph nodes. Mammography, ultrasound, MRI AND biopsy are the medical

diagnostics for breast cancer.

Management for breast cancer needs medical, surgical and nursing intervention.

Surgery comes first for the management of breast cancer with different treatment modalities

including chemotherapy, radiation therapy, hormone therapy, targeted therapy. Having nursing

intervention is also important in pre-operative and post-operative care, wound care, patient

education on self-breast examination, and emotional support.

There will be consequences if breast cancer is not treated. If breast cancer is not

treated the disease will continue to grow and spread to other parts of the body (metastasize).

There will be low survival rate. If breast cancer is treated with medical, surgical and nursing

interventions and treatments, the patient will achieve complete remission, prolonged disease-

free periods, or manage their condition as a chronic illness, leading to an overall positive outlook
on survival and quality of life.

III. DISCHARGE PLANNING

1. Initial Assessment and Education:

Conduct a comprehensive assessment of the patient's physical and emotional

needs, including pain management, wound care, and emotional well-being. Educate the patient

and their family about the breast cancer diagnosis, treatment plan, and potential side effects.

Ensure they understand the importance of follow-up care.

2. Multidisciplinary Team Collaboration:

Collaborate with an interdisciplinary healthcare team, including oncologists, nurses,

social workers, physical therapists, and nutritionists, to provide holistic care.

3. Medication Management:

Review the patient's medication list, including pain medications, adjuvant therapies,

and any other prescribed drugs. Provide clear instructions on medication administration,

potential side effects, and the importance of adherence.

4. Wound Care and Post-Surgical Care:

If the patient has undergone surgery (e.g., mastectomy), provide detailed wound

care instructions. Educate the patient on signs of infection and when to seek medical attention.

5. Pain Management:

Discuss pain management strategies, including medications and non-

pharmacological methods. Ensure the patient knows how to monitor and report their pain levels.

6. Lymphedema Prevention:

Educate the patient on lymphedema prevention measures, such as avoiding heavy

lifting and protecting the affected arm (if applicable).

7. Emotional Support:

Offer emotional support and provide information about available counseling services

and support groups for breast cancer patients and their families
8. Cardiopulmonary Rehabilitation Program:

Collaborate with the rehabilitation team to create an individualized exercise and

education plan for the patient. Tailor the program to the patient's specific needs, taking into

account their fitness level, treatment history, and any coexisting conditions.

9. Diet and Nutrition:

Provide dietary guidance to support healing and overall health during and after

breast cancer treatment. Address any dietary restrictions or recommendations, such as

managing nausea or maintaining adequate protein intake.

10. Follow-Up Appointments:

Schedule and explain the importance of follow-up appointments with oncologists,

surgeons, and other specialists. Ensure the patient understands the schedule and purpose of

these appointments

11. Emergency Contacts:

Provide contact information for healthcare providers and instructions for contacting

them in case of urgent issues.

IV. RELATED NURSING THEORY

Self-Care Theory by Dorothea Orem

Dorothea Orem's Self-Care Theory emphasizes the importance of self-care and the

role of nurses in assisting individuals in meeting their self-care needs. In the context of breast

cancer, this theory can be applied to empower patients to actively participate in their care and

self-management.

Nurses can use Orem's theory to assess and support breast cancer patients in self-

care activities such as managing symptoms, adhering to treatment plans, and making informed

decisions about their care. Encouraging self-care can improve patient outcomes and overall
well-being.

Theory of Comfort by Katharine Kolcaba

Katharine Kolcaba's Theory of Comfort focuses on providing comfort as a central

goal of nursing care. Comfort is seen as a holistic concept that encompasses physical,

psychospiritual, and environmental dimensions. In the context of breast cancer, comfort care

can improve the patient's quality of life during treatment and recovery.

Nurses can apply the Theory of Comfort by assessing and addressing the physical

and emotional discomfort experienced by breast cancer patients. This includes managing pain,

promoting relaxation, and addressing anxiety and emotional distress. Comfort-oriented care

contributes to a positive patient experience.

V. REVIEW OF RELATED STUDIES/LITERATURE

According to (Giaquinto et. al, 2022) Breast cancer is the most commonly diagnosed

cancer among US women excluding nonmelanoma of the skin. It is the second leading cause of

cancer death among women overall, after lung cancer. This disease remains a major source of

illness for women, with one in every 20 individuals worldwide and one in every eight people in

high-income countries being affected by it (Zolfaghary et. al, 2023).

Breast cancer is a multifactorial disease. Although the disease occurs all over the

world, its incidence, mortality, and survival rates vary considerably among different parts of the

world, which could be due to many factors such as population structure, lifestyle, genetic

factors, and environment (Momenimovahed and Salehimiya, 2022). Reducing breast cancer

incidence will likely require both a population-based approach of reducing exposure to

modifiable risk factors and a precision-prevention approach of identifying women at increased

risk and targeting them for specific interventions, such as risk-reducing medication (Britt, Cuzick

and Phillips, 2020).

VI. REFERENCES

Alkabban, F. M. (2022, September 26). Breast Cancer. StatPearls - NCBI Bookshelf.

https://www.ncbi.nlm.nih.gov/books/NBK482286/#:~:text=Stage%200%20and%20stage
%20I,survive%20their%20next%205%20years.

Giaquinto, A. N., Sung, H., Miller, K. D., Kramer, J. L., Newman, L. A., Minihan, A. K., Jemal, A.,
& Siegel, R. L. (2022). Breast Cancer Statistics, 2022. CA: A Cancer Journal for Clinicians,
72(6), 524–541. https://doi.org/10.3322/caac.21754

World Health Organization: WHO & World Health Organization: WHO. (2023). Breast cancer.
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%20three%20pillars%20toward%20achieving,and%20comprehensive%20breast%20cancer
%20management.

Breast cancer screening can save lives. (n.d.). https://www.pids.gov.ph/details/news/in-the-

news/breast-cancer-screening-can-save-lives#:~:text=MORE%20lives%20can%20be
%20saved,of%20which%209%2C000%20have%20died.

WCRF International. (2022, April 14). Breast cancer statistics | World Cancer Research Fund
International. https://www.wcrf.org/cancer-trends/breast-cancer-statistics/

Alkabban, F. M. (2022b, September 26). Breast cancer. StatPearls - NCBI Bookshelf.

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Breast cancer Treatment | Treatment options for breast cancer. (n.d.). American Cancer
Society. https://www.cancer.org/cancer/types/breast-cancer/treatment.html

Breast cancer. (2020, December 31). Cancer.Net. https://www.cancer.net/cancer-types/breast-

cancer

Pathophysiology of Breast Cancer in Association with Risk Factor. (n.d.). ResearchGate.

https://www.researchgate.net/figure/Pathophysiology-of-Breast-Cancer-in-Association-with-
Risk-Factor_fig1_3636599

Britt, K., Cuzick, J., & Phillips, K. (2020). Key steps for effective breast cancer prevention.
Nature Reviews Cancer, 20(8), 417–436. https://doi.org/10.1038/s41568-020-0266-x