Invasive Ductal

Carcinoma,
Left Breast
Status Post
Core Needle
Biopsy
BSN 4A GROUP 1
 General Objectives
By the successful completion of the course, BSN 4A nursing students will know more
about Invasive Ductal Carcinoma and be able to produce synthesis based on real
circumstances.

In this case study, we'll examine techniques for managing patients with invasive
ductal carcinoma and enhancing any nursing interventions that might be necessary
for their care.

The nursing students in BSN 4A will be able to define the following after finishing this
case study. The following activities are created with the intention of achieving the
General Goals.
 Specific Objectives
 Assess the patient's condition through building rapport, gathering all necessary information and perform
physical assessment on patient to attain baseline data.

 Determine the client's previous and present health history, and how it might impact the condition they
now have

 Recognize how the current illness is physio pathologically represented.

 Discuss the normal outcomes of an Invasive Ductal Carcinoma physical exam, diagnostic tests, patient
signs and symptoms, and nursing care for Invasive Ductal Carcinoma patients.

 To conduct a drug study to comprehend the purpose, side effects, and contraindications of the drug
given to the patient.

 Evaluate patient’s condition after treatment and establish a home care and health promotion plan.
 Overview of the disease
Invasive ductal carcinoma (IDC), sometimes called infiltrating ductal carcinoma the most
common histologic type of breast cancer—accounts for 80% of all cases. The tumors arise from
the duct

system and invade the surrounding tissues. They often form a solid irregular mass in the breast.

Invasive means that the cancer has "invaded” or spread to the surrounding breast tissues.

Ductal means that the cancer began in the milk ducts, which are the “pipes” that carry milk from
the milk-producing lobules to the nipple. Carcinoma refers to any cancer that begins in the skin
or other tissues that cover internal organs such as breast tissue. INVASIVE DUCTAL
CARCINOMA is a cancer that has penetrated through the milk duct wall and has begun to
invade the breast tissues.
Causes

The most common cause of invasive ductal carcinoma is DNA damage of breast tissue cells,
which can be the result of a wide range of triggers including age, gender, medical history, and
hormonal exposure.

Risk factors

 Mutation in BRCA Genes

 Personal and Family history of breast cancer or Ovarian cancer

 Early menarche

 Late menopause

 Obesity

 Alcohol intake and Smoking

Signs and Symptoms

A new lump or tumor in the breast that you or your doctor may feel is
sometimes the first sign of invasive ductal carcinoma. According to the
American Cancer Society, any of the following unusual changes in the
breast, including invasive ductal carcinoma, can be a first sign of breast
cancer: swelling of all or part of the breast, skin irritation or dimpling, breast
pain, nipple pain or the nipple turning inward, redness or thickening of the
nipple or breast skin, nipple discharge other than breast milk, lump in the
underarm area. Pain in one particular location of the breast or the nipple, is
an unusual symptom that occurs in about 5% of affected individuals
Diagnostic

To diagnose an invasive ductal carcinoma, a detailed medical history and physical examination,
specifically of the breast and the underarm area, is necessary. Some imaging may be required in order to
reveal an IDC, which tends to grow as a dense, solid mass with calcifications.

Digital mammography - is an X-ray examination of the breast. It is used to detect and diagnose breast
disease in women who either have breast problems, such as a lump, pain, or nipple discharge, as well as
for women who have no breast complaints.

Ultrasonography- is useful in assessing the consistency and size of breast lumps.

Magnetic Resonance Imaging (MRI) - ideal for describing lesions in soft tissues such as those found in
the breast.

Tissue Biopsy - necessary to confirm the diagnosis of IDC. The biopsy may be performed through a fine-
needle aspiration (FNA), core biopsy, or excisional biopsy.
Treatment

Treatment options include surgery, radiation therapy, chemotherapy, or various targeted

therapies depending on the severity and type of the carcinoma.

Surgical Management

The main goal of surgery is to gain local control of the disease. With breast cancer being
diagnosed today at earlier stages, options for less invasive, breast conserving surgical
procedures are available.

Lumpectomy - is a breast cancer surgery that removes a tumor plus a normal margin of
surrounding healthy breast tissue, may remove only the malignant lesion

Mastectomy - surgical procedure that totally remove the affected breast, or even remove both
breasts
Prevention

Like most cancers, knowing your family history can help you take
preventative steps, such as early screenings and mammograms.

 Maintain a healthy body weight

 Don’t smoke and limit alcohol intake

 Be physically active

 Eat a healthy well-balanced diet

 Undergo genetic testing for gene mutations if recommended based on

family history.
PATIENT’S PROFILE

Name: Patient PIA

Age: 60 years Old

Sex: Female

Date of Birth: January 03, 1963

Religion: Roman Catholic

Civil Status: Married

Educational Attainment: Elementary Graduate

Occupation: Housekeeper

Admission Date: March 22, 2023

Admission Time: 12:00 PM

Chief Complaint: Breast Mass (L)

Admitting Diagnosis: Invasive Ductal Carcinoma, Left Breast Status Post Core Needle Biopsy (02/22/2023)

Final Diagnosis: Invasive Ductal Carcinoma, Left Breast Status Post Core Needle Biopsy (02/22/2023)

Surgery Diagnosis: Modified Radical Mastectomy, Left (3/24/2023)

PRESENT MEDICAL HISTORY

December 2022, While having a bath, the patient palpated a little mass on her left breast with no
soreness, pain, or associated nipple discharge. The patient did not seek consultation because she
assumed it was a simple acne or pimple, and she ignored it because it was asymptomatic.

January 2023, the patient noticed that the mass on her left breast seemed to be growing. This time,
she tried to tell her husband about the situation; he initially assumed it was just some simple acne,
but when he tried to palpate it, he felt the mass as well. After she told her husband about the
situation, he persuaded her to see a doctor, but she declined right away. Her first kid, who was living
in Baguio City, was informed by her husband about the lump on her breast. Her daughter immediately
contacted and forced her to visit a doctor in Baguio City.
On February 10, the Patient and her husband travel to Lower Session, Baguio City, February 16,
the patient examination requested for sonomammogram at Baguio General Hospital and
Medical Center with the requesting Physician Dr. Christine Anne Saac, and an irregularly -
shaped nodule with speculation and microcalcifications measuring 2.39x1.79x1.50 cm is noted
along the 2-3 o’clock inner zone of the left breast, no visible focal lesion in the right breast and
recommend immediately for biopsy.

February 22, 2023, Dr. Arlene L. Quitasol performed a core needle biopsy on her left breast, and
on March 9, 2023, she was diagnosed with Consistent invasive carcinoma of no specific type.
She was referred to Southern Isabela Medical Center for a Modified Radical Mastectomy.

March 15, 2023, they travel back To Alicia, Isabela, and she scheduled a mastectomy, she was
admitted at Southern Isabela Medical Center on March 22, 2023, at 12:00 pm and had her
surgery on March 24 2023 at 2:12 pm and ended at 4:07 pm.
PAST MEDICAL HISTORY

The patient had a history of a mild stroke while in Baguio City

at the age of 40. She had her maintenance losartan and
there was no record of another mild stroke incidence after
that she mentioned that she was also diagnosed with asthma
at the age of 50 and home medication of Salbutamol, and her
husband accompany her to the hospital for her quarterly
checkup.
SOCIAL/PSYCHOLOGICAL HISTORY

According to the patient, her husband has been an active smoker since they got
married and can finish one pack of cigarettes each day. He only quit smoking 10
years ago, her husband is a heavy drinker also but quit 10 years ago while she drinks
occasionally only or when her friends will invite her to drink. When she was young and
single, she worked as a helper in Baguio City, but when she married, she and her
husband opened a souvenir shop, which has been their financial support, and when
the pandemic struck, they let their shop be rented by others, and went back at Alicia,
Isabela and when her first daughter gave birth to her second child, they stopped
working and focused solely on their grandchildren and also mentioned that she helps
her husband in their field.
OB HISTORY

The patient experienced menarche at the age of 16. Menstruation is regular 2-3 days
in duration and uses 3-4 pads a day, patients experienced occasional dysmenorrhea
and had her menopause at the age of 52

  YEAR

G1 1991

G2 1993

G3 1995
GYNECOLOGY HISTORY

The patient was 28 years old when she was

married and had sexual intercourse. The patient
had her IUD at the age of 42 and had it removed at
the age of 52.
PHYSICAL ASSESMENT (HEAD TO TOE)

GENERAL SURVEY: The 27 years old is on Semi- Fowler's position in bed, he is

conscious and coherent. Patient is oriented about place, time and date.

Date of Physical Assessment: March 12, 2023

Time: 3:00 am

Body built: Endomorph

Weight: 60 kg

Height: 5’6

BMI:

VITAL SIGN:

BP: 110/70 mm/hg

TEMP: 35.7 C

RR: 19 cpm

PR: 80 bpm SPO2: 98%

SOCIAL/PSYCHOLOGICAL HISTORY

According to the patient, her husband has been an active smoker since they got
married and can finish one pack of cigarettes each day. He only quit smoking 10
years ago, her husband is a heavy drinker also but quit 10 years ago while she
drinks occasionally only or when her friends will invite her to drink. When she
was young and single, she worked as a helper in Baguio City, but when she
married, she and her husband opened a souvenir shop, which has been their
financial support, and when the pandemic struck, they let their shop be rented
by others, and went back at Alicia, Isabela and when her first daughter gave
birth to her second child, they stopped working and focused solely on their
grandchildren and also mentioned that she helps her husband in their field.
AREAS TECHNIQUE FINDINGS INTERPRETATION
AREAS TECHNIQUE FINDINGS INTERPRETATION
AREAS TECHNIQUE FINDINGS INTERPRETATION
AREAS TECHNIQUE FINDINGS INTERPRETATION
AREAS TECHNIQUE FINDINGS INTERPRETATION
AREAS TECHNIQUE FINDINGS INTERPRETATION
AREAS TECHNIQUE FINDINGS INTERPRETATION
AREAS TECHNIQUE FINDINGS INTERPRETATION
AREAS TECHNIQUE FINDINGS INTERPRETATION
AREAS TECHNIQUE FINDINGS INTERPRETATION
AREAS TECHNIQUE FINDINGS INTERPRETATION
Gordon’s 11 Functional Health Patterns

DATE OF INTERVIEW: March 27 ,2023

TIME OF INTERVIEW: 8:25 am

Days of Confinement: 5 Days

LOC: Conscious and coherent

 FUNCTIONAL HEALTH BEFORE HOSPITALIZATION DURING HOSPITALIZATION
PATTERNS
HEALTH PERCEPTION
AND MANAGEMENT

NUTRITIONAL/
METABOLIC PATTERN

ELIMINATION PATTERN

EXERCISE AND ACTIVITY

PATTERN
 FUNCTIONAL HEALTH BEFORE HOSPITALIZATION DURING HOSPITALIZATION
PATTERNS
SLEEP/REST PATTERN

COGNITIVE PERCEPTION
PATTERN

SELF PERCEPTION AND

SELF CONCEPT PATTERN

ROLE RELATIONSHIP
PATTERN
 FUNCTIONAL HEALTH BEFORE HOSPITALIZATION DURING HOSPITALIZATION
PATTERNS
SEXUALITY AND
REPRODUCTIVE
PATTERN

COPING AND STRESS

TOLERANCE PATTERN

VALUE-BELIEF PATTERN
Anatomy and Physiology