BREAST CANCER
• Breast cancer is a malignant tumor that starts in the cells of the breast.

• A malignant tumor is a group of cancer cells that can grow into (invade) surrounding tissues or spread (metastasize) to distant areas of the body.

• The disease occurs almost entirely in women, but men can get it, too.
– One of every 13 Filipino women are expected to develop breast cancer in her lifetime. (Philippine Star, 2013) – Breast cancer is the most common cancer in the Philippines, taking at least 16 percent of the 50,000 cases diagnosed. (Department of Health and Philippine Cancer Society, 2010) – In men , less than 1% of all breast cancers. (Dr. Aldine Basa, 2010)

The Normal Breast

The Lymphatic System of the Breast .

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Cells proliferate to replace worn-out cells.Pathogenesis of Breast Cancer • Normal cells in the body communicate with each other and regulate each other's proliferation (division). . • When cancer occurs. cells escape the normal controls on their growth and proliferation.

How do cells escape their normal growth and proliferation? • By acquiring damage (mutations) to genes that normally regulate cell proliferation. .

• Proto-oncogenes – responsible for promoting cell growth. .What are the genes that are being damaged? • Tumor Suppressor Genes – they control the processes of cell growth and cell death (called apoptosis).

What happens to the genes when mutated? • Tumor Suppressor Genes (acquired/inherited) – this can lead to tumor formation or growth • Proto-oncogenes (acquired) – they become oncogenes and then can promote tumor formation or growth. .

• Lobular Carcinoma in Situ – abnormal cells grow inside the lobules of the breast. but have not spread to the nearby tissue or beyond. .Two Categories of Breast Cancer Noninvasive Breast Cancer • Ductal Carcinoma in Situ – located within the duct and have not invaded the surrounding fatty breast tissue. Invasive Breast Cancer • Infiltrating Ductal Carcinoma – originates in the mammary glands and grows in the epithelial cells lining these ducts.

• 20% suffer from lung and liver metastases. • 10% suffer from brain metastases. .Possible Outcomes of Metastasis of Breast Cancer • 70% of breast cancer patients suffer from bone metastases.

Manifestation of Metastases • Metastatic breast cancer to the lung or pleura causes – chronic cough. – dyspnea – abnormal chest X-ray – chest pain .

Manifestation of Metastases • Metastatic disease to the bone causes – severe. – progressive pain – less commonly – pathological fracture – erythema over the affected bone – swelling .

– vertigo. .Manifestation of Metastases • Metastatic breast cancer to the brain causes the following symptoms: – persistent. – increased intracranial pressure. – seizures. – progressively worsening headache. nausea or vomiting. – behavioral and personality changes. – visual changes.

Manifestation of Metastases • Metastatic disease to the liver causes – Jaundice – elevated liver enzymes – abdominal pain – loss of appetite – nausea – vomiting .

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but this disease is about 100 times more common among women than men. • This is likely because men have less of the female hormones estrogen and progesterone. which can promote breast cancer cell growth . • Men can develop breast cancer.Gender • Simply being a woman is the main risk factor for developing breast cancer.

while about 2 of 3 invasive breast cancers are found in women age 55 or older.Aging • Your risk of developing breast cancer increases as you get older. • About 1 out of 8 invasive breast cancers are found in women younger than 45. .

• The BRCA1 and BRCA2 are Tumor Suppressor Genes that are inherited. .Genetics • Inherited DNA changes can increase the risk for developing cancer and are responsible for the cancers.

.to 4-fold increased risk of developing a new cancer in the other breast or in another part of the same breast.Personal history of Breast Cancer • A woman with cancer in one breast has a 3.

Race and Ethnicity • Overall. Hispanic. White women are slightly more likely to develop breast cancer than are African-American women. breast cancer is more common in African-American women. and Native-American women have a lower risk of developing and dying from breast cancer. • Asian. in women under 45 years of age. . but African-American women are more likely to die of this cancer. • However.

Dense Breast Tissue • Women with dense breasts is four to five times more likely to get breast cancer than women with less dense breasts. .

• They seem to raise a woman's risk of breast cancer slightly (1½ to 2 times normal). .Certain benign breast conditions • Non-proliferative lesions: These conditions are not associated with overgrowth of breast tissue. • Proliferative lesions without atypia: These conditions show excessive growth of cells in the ducts or lobules of the breast tissue.

. raising it 3 1/2 to 5 times higher than normal. with some of the cells no longer appearing normal. there is an overgrowth of cells in the ducts or lobules of the breast tissue.• Proliferative lesions with atypia: In these conditions. • They have a stronger effect on breast cancer risk.

Menstrual periods • Women who have had more menstrual cycles because they started menstruating early (before age 12) and/or went through menopause later (after age 55) have a slightly higher risk of breast cancer. . • The increase in risk may be due to a longer lifetime exposure to the hormones estrogen and progesterone.

.Having children • Women who have had no children or who had their first child after age 30 have a slightly higher breast cancer risk.

.Hormone Therapy and Birth Control Pills • Women using this therapeutic regimens can increase the risk of developing breast cancer due to the prolonged exposure of estrogen and progesterone.

Alcohol • Alcohol causes cancer cells' blood vessels to grow which in turn fuels the growth of the tumor. . a process known as angiogenesis.

Overweight and Obese • Most of a woman's estrogen comes from fat tissue. Having more fat tissue especially after menopause can increase your chance of getting breast cancer by raising the estrogen levels. .

The Health Consequences of Involuntary Exposure to Tobacco Smoke) . the International Agency for Research on Cancer concluded that there is limited evidence that tobacco smoking causes breast cancer. (The 2006 US Surgeon General's report. • It is “Suggestive but not Sufficient” evidence of a link at this point. studies found no link between cigarette smoking and breast cancer.Tobacco Smoking • For a long time. – In 2009.

hard mass that has irregular edges is more likely to be cancerous.Signs and Symptoms • The most common symptom of breast cancer is a new lump or mass. . They can even be painful. or rounded. soft. but breast cancers can be tender. A painless.

.• Other possible signs and symptoms: – Swelling of all or part of a breast (even if no distinct lump is felt) – Skin irritation or dimpling – Breast or nipple pain – Nipple retraction (turning inward) – Redness. or thickening of the nipple or breast skin – Nipple discharge (other than breast milk) – Lymph nodes under the arm •. scaliness.

women should have a CBE by a health professional every year.• Women age 40 and older should have a mammogram every year and should continue to do so for as long as they are in good health. Starting at age 40. Early Cancer Detection • Women in their 20s and 30s should have a clinical breast exam (CBE) as part of a periodic (regular) health exam by a health professional preferably every 3 years. .

. Women should report any breast changes to their health professional right away. Women should be told about the benefits and limitations of BSE. Early Cancer Detection • Women at high risk (greater than 20% lifetime risk) should get an MRI and a mammogram every year.• Breast self-examination (BSE) is an option for women starting in their 20s.

• 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 .Nursing Diagnosis • Deficient knowledge related to planned surgical treatments.

Screening Procedures • Self-Breast Examination • Clinical Breast Examination • Mammogram .

Diagnostic exams in Breast CA 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. Ductogram • A type of X-ray that helps determine the cause of nipple discharge. A ductogram can show if there is a mass inside the duct at the nipple .

Treatment • • • • • • • Lumpectomy Partial or segmental mastectomy Simple mastectomy Modified radical mastectomy Axillary lymph node dissection Chemotherapy Radiation Therapy .

Surgical Nursing Intervention • 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 .

Surgical Nursing Intervention • Post-operative – Inspect dressing anteriorly and posteriorly – Check circulatory status – 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 .

nausea and vomiting. dry cough. • Realize that a diagnosis of breast cancer is a devastating emotional shock to the woman.Nursing Interventions • Monitor for adverse effects of radiation therapy such as fatigue. alopecia. anorexia. fatigue. . • Monitor for adverse effects of chemotherapy. nausea. anxiety. • Involve the patient in planning and treatment. weight gain or loss. Provide psychological support to the patient throughout the diagnostic and treatment process. and depression. bone marrow suppression. stomatitis. sore throat.

• Suggest to the patient the psychological interventions may be necessary for anxiety. and plan ahead for alopecia. fatigue. depression. • Prepare the patient for the effects of chemotherapy. • Administer I. or sexual problems. fluids and hyperalimentation as indicated. • Teach all women the recommended cancer-screening procedures. as directed. • Administer antiemetics prophylactically.V. .Nursing Interventions • Describe surgical procedures to alleviate fear. for patients receiving chemotherapy. • Help patient identify and use support persons or family or community.

Medications • Trastuzumab (Herceptin) • Pertuzumab (Perjeta) • Ado-trastuzumab emtansine (KadcylaLapatinib (Tykerb) • Bevacizumab (Avastin) .

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