CASE PRESENTATION

GROUP 2

INTRODUCTION

GENERAL OBJECTIVE

• This presentation aims to identify and further discuss the case of
Invasive ductal carcinoma left breast with pulmonary
metastases. With the data collection, gathering and analysis,
the team shall be able to concisely discuss the health history,
laboratory and diagnostic examinations, anatomy and
physiology of the system in which the illness evidently affects,
pathophysiology, clinical manifestations, risk factors,
complications and other necessary information.

• To discuss its types.SPECIFIC OBJECTIVE • To define Invasive ductal carcinoma left breast with pulmonary metastases. • To discuss the anatomy and physiology of the disease. and clinical manifestations of the disease • To distinguish and present laboratory results and tests done to the client and correlate it to the disease process. etiology. . risk factors.

• Toelaborately discuss the relations between the health history. pathophysiology and the complications that would occur with the disease process • To state and describe the treatment modalities and medical management used in the management of the disease. • Toprovide and rationalize adequate nursing interventions for the patient • To discuss the prognosis and recommendations intended for the client. .

Breast cancer mortality could be reduced by 30% through early detection using routine screening mammography alone or together with annual clinical breast examination by a primary health care provider beginning between 40 and 50 years of age . second only to lung cancer for cancer mortality.INTRODUCTION TO THE DISEASE PROCESS: BREAST CANCER • The most commonly diagnosed cancer in women.

but majority of cases occur in women over 50 of age.ETIOLOGY AND RISK FACTOR • Gender. • Personal history of cancer. sister. • Family history of cancer and genetics – women with a family history of breast cancer in one-degree relative (mother. • Age – the incidence of breast cancer increases with age. or daughter) increases risk of developing breast cancer. .women are more likely than men to develop breast cancer. Most breast cancer cases are diagnosed in women 40 years of age and older.previous diagnosis of breast increases a woman’s lifetime risk for developing a second breast cancer in the opposite (collateral) breast.

This is risk is thought to be due to the total lifetime exposure of the breast to estrogen and progesterone. • Having no children (nulliparity) or he first full term pregnancy after age 30 . late menopause (at 55 or above). Early onset of menarche (before age 12) . and greater total duration of years of regular menses are associated with an increased risk of breast cancer. with fluctuation in cell and change in the breast tissues with each ovulatory cycle.• Hormonal factor – exact role of hormones in developing breast cancer has not precisely determined. • Use of oral contraceptive or hormone replacement therapy • Non-breastfeeding women .

radial scar. . include ductal epithelial hyperplasia of then (common) type.when found alone. encompasses a broad array of histopathologic tissue diagnosis • Fibrocystic changes. and intraductal papillomas.normal breast changes • Non proliferative lesions.• Benign breast disease. sclerosing adenosis.increased growth of epithelial cells in the ductal or lobular tissue of the breast. are generally not associated with any increased risk of breast cancer. • Proliferative lesions without atypia.

• RADIATION EXPOSURE • ALCOHOL CONSUMPTION .the proliferation of abnormal-looking cells within ducts or lobules. or typical hyperplasia. • OBESITY AND DIETARY FAT • high socioeconomic status and increased consumption of dietary fat. This constitute the third category of benign breast disease.• Proliferative lesions with atypia.

private. . • DIAGNOSTIC MAMMOGRAPHY-consist of additional views of the breast to help delineate an area of concern found or a screening mammogram or a palpable mass.a free. and relatively simple examination. • SCREENING MAMMOGRAPHY. • BREAST SELF-EXAMINATION. • CLINICAL BREAST EXAMINATION -important adjunct to mammography.PREVENTION.consist of two views of each breast: one from side to side that includes then axilla and the upper outer quadrant of the breast(mediolateral oblique) and one from the top to bottom(craniocaudal). SCREENING AND DETECTION • MAMMOGRAPHY -only proven means of detecting breast cancer before it can be discovered BY CBE or BSE. This is used in detecting cancer in asymptomatic women.

arose in the ductal system • Lobular carcinoma in situ – in the lobule system • Infiltrating or invasive ductal/lobular carcinoma. .CLASSIFICATION • Noninvasive – a malignancy confined to the ducts or lobules • Ductal carcinoma in situ.when malignant cells penetrate the tissue outside the ducts or lobules.

DIAGNOSIS • Tissue diagnosis • FINE-NEEDLE ASPIRATION (FNA) BIOPSY • CORE NEEDLE BIOPSY • Mammogram • Ultrasound • MRI .

ulceration.CLINICAL FEATURES • Mass (particularly if hard. irregular. bloody. shape. nontender) or thickening in breast or axilla. or watery. unilateral nipple discharge that is seroussanguineous. • Spontaneous. or texture of breast (asymmetry) • Dimpling or puckering of skin • Scaly skin around the nipple • Redness. persisitent. edema. • Nipple retraction or inversion • Change in size. or dilated veins • Peau d’ orange skin changes • Enlargement of lymphnodes on axilla .

of less than 2mm). T3-N0. all M0) • Stage 111A. or any size tumor with involved internal mammary lymph nodes (T0-N2. all M0) . STAGING • Stage 0 .T2-N2.carcinoma in situ (Tis-NO-M0) • Stage 1 – tumor of under 2 cm with negative nodes (T1-N0-M0) • (includes microinvasive T1.no evidence of primary tumor or tumor of less than 2 cm with involved lymph nodes. T1-N2. T1-N1. or 2 to 5 cm with negative nodes (T0-N1.1 cm) • Stage 11A – tumor of 0 to 2 cm with positive nodes (including micrometastasis N1. T3-NI. T3-N2.tumor of 2 to 5 cm with positive nodes or greater than 5 cm with negatives nodes (T2-N1. all M0) • Stage 11B . T2-N0. less than 0.

or any size tumor with involved internal mammary lymph node (T4-any N. all M0)) • Stage1V. any T-N3. CA 27-29. with or without involved lymph nodes.• Stage 111b. CA 15-3. • Three tumors markers with some value in breast cancer treatment are carcinoembryonic antigen (CEA) .any distant metastasis (includes ipsilateral supraclavicular nodes). • Statistical reports commonly refer stage as Local (lymph nodes or surrounding tissue involved) and Distant (metastasis present).tumor of any size with direct extension to chest wall or skin. .

00%) S-PHASE Low (≤4%) ONCOGENES HER2/neu Low expression TUMOR SUPPRESS GENES P53 Low expression .PROGNOSTIC INDICATORS PROGNOSTIC INDICATORS PROGNOSTIC FACTOR FAVORABLE RANGE TUMOR SIZE Noninvasive AXILLARY LYMPHNODE STATUS Negative ESTROGEN RECEPTORS Positive PROGESTERONE RECEPTORS Positive HISTOLOGIC GRADE Well-differentiated NUCLEAR GRADE Low grade DNA CONTENT PLOIDY Diploid (DNA=1.

MEDICAL MANAGEMENT • Surgery • Modified radical mastectomy • Total mastectomy • Lumptectomy /segmental mastectomy • Quadrantectomy • Breast-conserving treatment • Breast reconstruction • Radiation therapy • Chemotherapy • Targeted therapy .

and depression. anorexia. weight gain or loss. • 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. dry cough. fatigue. • Involve the patient in planning and treatment. • Monitor for adverse effects of chemotherapy. stomatitis. sore throat. Provide psychological support to the patient throughout the diagnostic and treatment process. nausea. anxiety. . alopecia. nausea and vomiting. • Describe surgical procedures to alleviate fear. bone marrow suppression.

Help patient identify and use support persons or family or community. 12.Prepare the patient for the effects of chemotherapy. depression. and plan ahead for alopecia.7.Administer I.Suggest to the patient the psychological interventions may be necessary for anxiety.Administer antiemetics prophylactically. fluids and hyperalimentation as indicated. 8. or sexual problems.V. 11. fatigue.Teach all women the recommended cancer-screening procedures. . as directed. for patients receiving chemotherapy. 10. 9.

CONSIDERATIONS Prevention and detection • Incorporate assessments of cognitive function. physical limitations and sensory deficits. .g. advocate. knowledge and confidence in mammography and clinical breast examination (CBE). case manager) to enhance continuity and participation in care. and belief about benefits of early detection in all patient education. • Community-based breast cancer screening. and support network into baseline and follow-up assessments. Annual screening mammography should begin at age 40 with no upper age limit for discontinuation. may be beneficial. • Attempt to coordinate care with one or as few provides as possible (e. going to whether seniors live and socialize. • Address knowledge and confidence in breast self-examination (BSE). • Health care provider education is still needed to encourage regularly scheduled screening of elderly women.

• Early comprehensive discharge must involve the patient and significant other. • Side effects with radiation and chemotherapy may be enhanced or prolonged. • Most trials or systemic therapy have excluded women over 70 years old. • Physical illness can impair developmental task completion. • Age alone does not determine the type or extent of surgery or subsequent therapy. • Depression in elderly women may be masked by physical symptoms. . • Psychosexual assessment and intervention should be incorporated as appropriate for all ages. • Care throughout the operative phase includes careful preoperative assessment and intraoperative and postoperative physiologic monitoring.DIAGNOSIS AND TREATMENT • Patient involvement in decision making is important at every age. Rehabilitation • Return to or maintenance of precancer level of functioning is a reasonable goal at any age.

If some cells break away from the primary cancer. .PULMONARY METASTASES • Where a cancer starts is called the primary cancer. where they can form a new tumour. Secondary cancers are also called metastases . they can move through the bloodstream of lymph system and spread to another part of the body. • Sometimes breast cancer cells spread to one or both lungs through the blood or lymph system. When breast cancer spreads to the lungs it can be treated but it can't be cured. It is not the same as having cancer that starts in the lungs (a lung cancer). This is called a secondary cancer. The cells that have spread to the lungs are breast cancer cells.

CAUSES: METASTATIC TUMORS IN THE LUNGS ARE MALIGNANCIES (CANCERS) THAT DEVELOPED AT OTHER SITES AND SPREAD VIA THE BLOOD STREAM TO THE LUNGS. • Bladder Cancer • Breast Cnacer • Colon Cancer • Kidney cancer • Neuroblastoma • Prostate cancer • Sarcoma • Wilms Tumor .

• These tests diagnose secondary lung cancer and can also show any build up of fluid around the lungs (pleural effusion). Symptoms • Breathlessness • Cough • Pain • Pleural effusion • Loss of appetite and weight loss .TESTS • may include a chest X-ray and CT scan.

• *These treatments can be given alone or in combination.TREATMENT • The aim of treatment is to control and slow down the spread of the cancer. relieve symptoms and give you the best quality of life for as long as possible. . • treatment may include: • chemotherapy • hormone therapy • targeted therapies.

• Instruct the patient to inspire fully and cough two to three times in one breath. . • Teach breathing retraining exercises to increase diaphragmatic excursion and reduce work of breathing. • Teach relaxation techniques to reduce anxiety associated with dyspnea. • Encourage the patient to conserve energy by decreasing activities. • Augment the patient’s ability to cough effectively by splinting the patient’s chest manually. Allow the severely dyspneic patient to sleep in reclining chair. • Provide humidifier or vaporizer to provide moisture to loosen secretions.NURSING INTERVENTIONS • Elevate the head of the bed to ease the work of breathing and to prevent fluid collection in upper body (from superior vena cava syndrome).

• Provide humidifier or vaporizer to provide moisture to loosen secretions. Allow the severely dyspneic patient to sleep in reclining chair. • Teach relaxation techniques to reduce anxiety associated with dyspnea.• Instruct the patient to inspire fully and cough two to three times in one breath. . • Encourage the patient to conserve energy by decreasing activities.

and chicken. oral nutritional supplements. • Suggest eating the major meal in the morning if rapid satiety is the problem. and fish if other treatments are not tolerated – to promote healing and prevent edema.• Ensure adequate protein intake such as milk. rather than three daily meals. eggs. . • Advise the patient to eat small amounts of high-calorie and high-protein foods frequently.

. such as biofeedback and relaxation methods. to increase the patient’s sense of control.• Change the diet consistency to soft or liquid if patient has esophagitis from radiation therapy. • Teach the patient to use prescribed medications as needed for pain without being overly concerned about addiction. • Consider alternative pain control methods.