Breast Cancer
Breast cancer is second only to lung cancer as a cause of cancer deaths in American women ‡ One out of every seven women will be diagnosed with breast cancer in 2007 ‡ Fortunately, radical mastectomy (surgical removal) is rarely needed today with better treatment options 2

What exactly is Breast Cancer?

It is usually caused by mutations in somatic cell genes that regulate cell growth.What is Cancer? Cancer involves the abnormal multiplication and spread of cells in the body. However. . some even generate many different types of cancer. cancer mostly occurs in cells that divide and reproduce more than other cells. Almost every tissue in the body can produce cancer.

. The area around the center of the breast is where most cancers occur. It is fairly rare for cancers to form in the fat or nonglandular tissues of the breast.Breast Cancer Breast Cancer occurs when a mutation takes place in the cells that line the lobules that manufacture milk or more commonly in the ducts that carry it to the nipple.

How does someone get Breast Cancer? . This is a picture of breast cancer cells.asp?SearchStr=cancer .com/store/search.The causes of breast cancer are not completely understood and are not set in stone. But certain women are more susceptible of developing one form of cancer.

Risk Factors that cause Breast Cancer Factors that Cannot be Prevented Gender Aging Genetic Risk Factors (inherited) Family History Personal History Race Menstrual Cycle Estrogen Lifestyle Risks Oral Contraceptive Use Not Having Children Hormone Replacement Therapy Not Breast Feeding Alcohol Use Obesity High Fat Diets Physical Inactivity Smoking .

htm .cellsalive.Environmental Factors Exposure to Estrogen Radiation Electromagnetic Fields Xenoestrogens Exposure to Chemicals This is a Breast Cancer Cell

Exogenous Estrogen ‡ Hormonal replacement therapy(HRT) ± 30% increased risk with long term use ‡ Oral Contraceptives(OC) ± risk slight ± risk returns to normal once the use of OC¶s has been discontinued .

Risk Factors for Breast Cancer ‡ Radiation exposure ‡ Breast disease ± Atpyical Hyperplasia ± Intraductal carcinoma in situ ± Intralobular carcinoma in situ ‡ Obesity ‡ Diet ± Fat ± Alcohol .

c-myc . c-erB2.Genetics ‡ ‡ ‡ ‡ BRCA-1 BRCA-2 P53. Rb-1 Her-2/neu.

Mutations in BRCA1 or BRCA2 account for 4050% of all cases of inherited breast cancer. These genes can be inherited either from the mother or the father. If a woman has a mutation on either one of these genes.BRCA 1 and BRCA 2 Both of these genes code for DNA repair. These genes are also associated with ovarian cancer in women and prostate cancer in men. . the risk of her getting breast cancer increases from 10% to 80% in her lifetime.

Signs and Symptoms Most common: lump or thickening in breast. like the skin of an orange Change in color or appearance of areola 14 . Often painless Discharge or bleeding Change in size or contours of breast Redness or pitting of skin over the breast.

Types of Breast Cancer .

Ductal Carcinoma in situ (DCIS) Ductal cancer cells 16 Illustration © Mary K. Bryson Norma l ductal cell .

Invasive Ductal Carcinoma (IDC ² 80% of breast cancer) Ductal cancer cells breaking through the wall ‡ The cancer has spread to the surrounding tissues ‡ Carcinoma refers to any cancer that begins in the skin or other tissues that cover internal organs 17 Illustration © Mary K. Bryson .

Invasive Lobular Carcinoma (ILC) 18 Illustration © Mary K. Bryson Lobular cancer cells breaking through the wall .

Cancer Can also Invade Lymph or Blood Vessels Cancer cells invade lymph duct Cancer cells invade blood vessel 19 Illustration © Mary K. Bryson .

Staging of Breast Cancer ‡ The American Joint Committee on Cancer (AJCC) has designated staging by TNM ‡ T= tumor size ‡ N = lymph node involvement ‡ M = metastasis .

0 cm in greatest dimension ‡ No nodal involvement (N0) ‡ No metastases (M0) .Stage 1 ‡ Tumor < 2.

Stage II
‡ Tumor > 2.0 < 5 cm or ‡ Ipsilateral axillary lymph node (N1) ‡ No Metastasis (M0)

Stage III
‡ Tumor > 5 cm (T3) ‡ or ipsilateral axillary lymph nodes fixed to each other or other structures (N2) ‡ involvement of ipsilateral internal mammary nodes (N3) ‡ Inflammatory carcinoma (T4d)

Stage IV (Metastatic breast cancer)
‡ Any T ‡ Any N ‡ Metastasis (M1)

How do you detect Breast Cancer? .

continue monthly .Breast Self Examination ‡ Opportunity for woman to become familiar with her breasts ‡ Monthly exam of the breasts and underarm area ‡ May discover any changes early ‡ Begin at age 20.

5 to 7 days after the beginning of their period ‡ Menopausal women same date each month ‡ Pregnant women ± same date each month ‡ Takes about 20 minutes ‡ Perform BSE at least once a month ‡ Examine all breast tissue .When to do BSE ‡ Menstruating women.

The doctor will check both of your breasts. Your doctor will likely check your breasts in varying positions.Breast Exam Breast exam. feeling for any lumps or other abnormalities. such as with your arms above your head and at your side. .

http://www. When should a mammogram be performed? If a lump has been found during self-examination or by a physician Younger women who have a strong history of breast cancer in their family All women over forty Women who have had previous diagnosis of breast cancer.asp?Se archStr=cancer . lobes. and blood fibrous tissues. ducts.Mammogram A Mammogram is a X-ray of the breast that takes pictures of the fat.photostogo.

Ultrasound uses sound waves to produce images of structures deep within the body. which may be either benign or cancerous. . Breast ultrasound is helpful to guide radiologic biopsy to get a sample of breast tissue if a solid mass is found. Your doctor may recommend an ultrasound to help determine whether a breast abnormality is likely to be a fluidfilled cyst or a solid mass.Breast Ultrasoud ‡ Breast ultrasound.

which can be sectioned to allow more accurate evaluation. but needle biopsy should be restricted to fluid-filled cysts and advanced malignant lesions. .Breast Biopsy Breast biopsy is necessary to confirm or rule out cancer. Needle biopsy or fine-needle biopsy can provide a core of tissue or a fluid aspirate. Open biopsy provides a complete tissue specimen.

lobular carcinoma. every 30 minutes for 2 hours. colloid carcinoma. cystosarcoma. intraductal and infiltrating carcinoma. sarcoma. intraductal papilloma. adenofibroma. mammary fat necrosis. ‡ Malignant tumors may suggest adenocarcinoma. If she has received a general anesthetic. ‡Provide emotional support to the patient awaiting diagnosis. and provide ice bags for comfort. every hour for the next 4 hours. or plasma cell mastitis. and then every 4 hours. check her vital signs every 15 minutes for 1 hour.Nursing Interventions: ‡If the patient has received a general or local anesthetic. monitor the patient·s vital signs regularly. ‡Instruct the patient to wear a support bra at all times until healing is complete. ‡Observe for and report bleeding. ‡Administer analgesics for pain. inflammatory carcinoma. or Paget¶s disease. and redness at the biopsy site. Abnormal Results: ‡ Benign tumors may suggest fibrocystic disease. tenderness. medullary or circumscribed carcinoma. as ordered. .

This test may be ordered after a breast biopsy confirms cancer. you receive an injection of dye. Before a breast MRI. . An MRI machine uses a magnet and radio waves to create pictures of the interior of your breast. but before surgery to give your doctor an idea of the extent of the cancer and to see if there's any evidence of cancer in the other breast.Breast magnetic resonance imaging (MRI). ‡ Breast magnetic resonance imaging (MRI).

Cancer can have a unique appearance ± many small irregular white areas that turned out to be Top-to-Bottom cancer (used for diagnosis) 34 .Different Views Side-to-Side MRI .

Treatments of Breast Cancer There is no ´cureµ for breast cancer. .

Treatment of Breast Cancer Chemotherapy Radiation Therapy Drugs Surgery .

Chemotherapy is used for treatment of breast cancer because there is a possibility of the cancer to spread to other parts of the body. . Systemic chemotherapy can prevent the spread of cancer.Chemotherapy Chemotherapy works by destroying cells that are dividing and multiplying all the time. Chemotherapy works better for premenopausal women. Chemotherapy drugs are administered intravenously.

. at high energy levels.Radiation Radiation. Radiation usually destroys rapidly dividing cancerous cells. Normal cells have the ability to repair themselves. including normal and abnormal cells Fortunately new technologies have found a way to battle cancer with radiation. has the ability to destroy what is in its path.

so there is an overlapping effectiveness. Most of the time as well. There are four drugs that are commonly used to battle breast cancer. . three or four drugs are used at the same time.Drugs Usually drugs used to battle cancer are taken while receiving some other type of treatment.

. Antimetabolites Methotrexate & 5fluorouracil This type of drug interferes with the making of nucleotides. These drugs interfere with cell structure as well as cell division. Hormones Prednisone Hormones affect the growth of hormones and usually enhances the effects of other cytotoxic drugs.Types of Drugs used to Treat Breast Cancer Alkylating Agents Cytoxan These types of drugs usually damage the programs that control the growth in tumor cells. which are the substances that make up DNA. Natural Products Vincristine (Oncovin and vinblastine (Velban) come from the periwinkle plant.

Surgical Management: ‡ Lumpectomy: Surgery to remove a tumor (lump) and a small amount of normal tissue around it. . This procedure is also called a segmental mastectomy. ‡ Partial mastectomy: Surgery to remove the part of the breast that has cancer and some normal tissue around it.

This procedure is also called a simple mastectomy. . Some of the lymph nodes under the arm may be removed for biopsy at the same time as the breast surgery or after.Surgical Management: ‡ Total mastectomy: Surgery to remove the whole breast that has cancer. This is done through a separate incision.

and all of the lymph nodes under the arm.Surgical Management: ‡ Modified radical mastectomy: Surgery to remove the whole breast that has cancer. This procedure is sometimes called a Halsted radical mastectomy. and sometimes. ‡ Radical mastectomy: Surgery to remove the breast that has cancer. many of the lymph nodes under the arm. the lining over the chest muscles. . chest wall muscles under the breast. part of the chest wall muscles.

Psychological Impacts of Breast Cancer .

What do Patients Go Through After Diagnosis? Depression Anxiety Hostility Fear Changes in life patterns due to discomfort and pain Marital/sexual disruptions Reduction of activities Panic Guilt Difficulty adapting to illness Overwhelmed Disappointment .

Risk for ineffective coping (individual or family coping)related to the diagnosis of breast cancer and related treatment options. Decisional conflict related to treatment options. Anxiety related to breast cancer diagnosis. Fear related to specific treatments. body image changes or possible death. .Preoperative Nursing Diagnoses: Knowledge deficit about breast cancer and treatment option.

The nurse caring for the patient with breast cancer should be knowledgeable enough to inform her patient about the things she should learn . and anxiety. 3. Promoting decision making ability   Careful guidance and supportive counseling are the interventions the nurse can use to help such patients. The nurse also discusses the implications of treatment course and lifestyle.   2. Methods to compensate for physical changes related to mastectomy are also discussed. dread. The patient must be given time to absorb significance of diagnosis and in any formation that will help her to evaluate available treatment options. . Encouraging one step of the treatment process at a time can be helpful. Reducing fear and anxiety and improving coping ability    Fears and concerns are common and are discussed with the patient The nurse provides anticipatory teaching and counseling at each stage of the process and identifies sensations that can be expected during additional diagnostic procedures. Explain breast cancer and treatment options  The patient confronting the diagnosis of breast cancer reacts with feelings of fear.Nursing interventions: 1.

. Risk for sexual dysfunction related to loss of body part.Postoperative Nursing Diagnoses Pain related to surgical procedure Impaired skin integrity related to surgical incision Risk for infection related to surgical incision and presence of surgical drain. Body image disturbance related to loss or alteration of the breast related to the surgical procedure Self-care deficit related to partial immobility of upper extremity on operative side. and fear of partners responses. change in self-image .

Nursing Interventions 1. by the following day after surgery after the patient takes in food and fluid and anesthesia has cleared sufficiently oral analgesics can be effective in relieving pain. promotes circulation. Give intravenous or intramuscular opioid analgesics to manage pain. Patients should be encourage to take analgesic like Acethaminophen before exercise or at bedtime. Take warm shower twice daily (2nd postoperative day) to alleviate discomfort that comes from referred muscle pain. patient teaching before discharge is important in managing discomfort after surgery.      . and prevents venous congestion on the affected extremity. Relieving pain and discomfort   Assess pain and discomfort Moderately elevate the involved extremity to relieve pain because it decreases tension on the surgical incision.

initially. the fluid in the surgical drain appears bloody . After incision is completely healed (usually 4-6 weeks) . lotions or creams may be applied to the area to increase skin elasticity.2.    . The dressing and drain should be inspected for bleeding and the extent of drainage monitored regularly. Dry dressing should be applied to the incision each day for 7 days. but it gradually change into serosanguinos and then serous fluid during the next several days. Maintaining skin integrity and preventing infection    Maintain the patency of the surgical drain. the 2nd day the patient may shower and wash the incision and drain site with soap and water to prevent infection.

. support and education as well.  Answering questions and addressing the patients concerns about treatment options that may follow surgery. acknowledging her feelings and allowing her to express her emotions. Patients support system is important and the patients spouse or partner may need guidance. Allowing her to express what she perceives. Reducing stress and improving coping skills    Privacy is a consideration when assisting the woman to view her incision for the first time.3.

Exercise are initiated on the 2nd day to increase circulation and muscle strength.( 3 times daily)      . Heavy lifting is avoided Driving may begin after the drain is removed and patient has full ROM women are encourage to elevate the arm above the level of the heart on a pillow for 45 minutes at a time.   ambulation is encourage when client is free of post anesthesia nausea and can tolerate fluid. Promoting participation in care. prevent joint stiffness.4. and restore full range of motion. combing etc. exercise is performed 3 times daily for 20 mins. contractures. Showering before exercising loosens stiff muscle encourage self care activities such as brushing.

 Performing the exercises may decrease the sensations. Managing postoperative sensation  Common sensations are tightness. .  Acetaminophen assist in managing this discomfort. pulling. and tingling along the chest wall in the axilla and along the inside aspect of the upper arm are normal part of the healing process.5. burning.

Prevention .

which promotes breast cancer. Diets high in fat are associated with the increasing breast density in mammograms. which makes interpretation more difficult. .Fat Research shows that dietary fat should be 20% or less in order to gain meaningful protection against cancer. Fat cells make estrogen.

The amount of fiber in the diet affects the activities of intestinal bacteria. which affects the amount of reabsorbed estrogens. .Fiber Fiber provides protection against breast cancer because it has a mechanism that decreases the amount of estrogen in the body.

Antioxidant Nutrients Antioxidants are important in fighting breast cancer because they can disarm cancer-causing substances called free radicals. Vitamin C Vitamin E Beta-carotene Vitamin A Selenium .

Other Preventative Measures Early Detection!!!! Exercise No Smoking!! Good Diet .

Research shows that breast cancer cells die when exposed to garlic in test tubes. 2. but we love the supreme cancer-fighting power it wields. . They also have a natural anti-inflammatory agent and antioxidants. 5. improves blood flow characteristics. sliced. reduces inflammation. brussel sprouts and mustard greens. cancer-fighting antioxidant and anti-inflammatory.10 Super Foods to Fight Breast Cancer 1. Garlic Strong in smell but wonderful as a seasoning for soups and sauces. heirlooms) and enjoy! 4. and stimulate the immune system. Rich with fish oil. especially if salmon is on the menu. 3. Crunchy Vegetables Broccoli may not win cool points with kids. this super food contains essential omega-3 fatty acids. Cherries Pretty and perfect for popping into your mouth as a treat. grape. pasted or sundried. Salmon Studies show eating some fish twice a week is good for your health. which research shows lowers the risk of breast cancer. garlic contains a group of compounds that work to kill bacteria and fungus. Choose your variety (cherry. Tomatoes Whether diced. tomatoes are well-known for containing lycopene. It's no wonder this garden vegetable is the most popular in the United States. a powerful. cherries contain an alcohol that fights many kinds of cancer. and may improve response to chemotherapy. including breast cancer. all contain antioxidants and help to covert unhealthy estrogens into healthy ones. pureed. Grouped with cauliflower.

8.6. including breast cancer. Studies show that people who regularly drink green tea reduce their risk of many cancers. 9. Turmeric Very popular in East Indian dishes. often ground into a yelloworange powder. As a health benefit. Berries They¶re yummy to eat. Its potent antioxidants also discourage cancer cells from growing. raspberries and blackberries especially contain an abundance of antioxidants that can help reduce the risk of a number of cancers. for example. age-fighting and skin protection. Flaxseeds are packed with fiber and omega-3 fatty acids that fight inflammation in the body. turmeric contains aromatic oils that demonstrate antiinflammatory and anti-cancer activity. blackberries and raspberries contain a common and powerful cancer fighter called ellagic acid. Blueberries. 10. but strawberries. is mainly used for adding flavor and color to foods. Flaxseed This tiny wonder food contains cancer-fighting compounds that protect because of their ability to reduce the chances of cancer cells spreading. . this ginger-based herb. Think curry-based dishes. Green Tea There¶s no doubt you¶ve heard about the many health benefits of green tea ± for weight loss. Soy Vegetarians dig soy for its versatility and its usefulness as a protein source in place of red meat. But there¶s more to soy than meets the eye. yes. Soy also contains phytochemicals that are known to greatly reduce your risk of developing breast cancer. It also protects against free radicals. 7.

This table shows the recommendations and benefits of these recommendations by age to prevent breast cancer from occurring.Prevention Table Recommendations for Women of Different Ages.html http://rex.nih.

Unfortunately.Prognosis Breast cancer is the second most lethal cancer in women.) The good news is that early detection and new treatments have improved survival rates. breast cancer mortality rates declined by about 25% since 1990. . They include: Location of the tumor and how far it has spread Whether the tumor is hormone receptor-positive or -negative Tumor markers Gene expression Tumor size and shape Rate of cell division The good news is that women are living longer with breast cancer. Recurrences of cancer usually develop within 5 years of treatment. About 88% of women diagnosed with breast cancer will survive at least 10 years. However. The 5-year survival rate for women diagnosed with cancer is 80%. survivors must live with the uncertainties of possible recurrent cancer and some risk for complications from the treatment itself. About 25% of recurrences and half of new cancers in the opposite breast occur after 5 years. (Lung cancer is the leading cancer killer in women. Due to better treatment options. Several factors are used to determine the risk for recurrence and the likelihood of successful treatment. women in lower social and economic groups still have significantly lower survival rates than women in higher groups.