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BREAST CANCER By : Preethi Vithana Content • • • • • • • • • Anatomy of Breast What is Breast Cancer Risk Factors Pathophysiology Spreading of Breast Cancer Investigation Treatment Nursing care Preventive care Introduction • Most common female cancer • Incidence high in the west • 211,300 new cases yearly and rising • 40,000 deaths yearly • Incidence increasing 14 per 100000 in SL in 2000 Anatomy of Breast The breast consist with; • Lobules and ducts -lobules develop in pregnancy and puberty -15 to 20 lobules, each has separate ducts • Stroma -contains connective tissues and fat • Lymph vessels • Main blood supply by lateral thoracic artery • Coopers ligament give support to the breast Definition Breast cancer is an uncontrolled growth of breast cells. It can be ductal carcinomas or lobular carcinomas. Ductal Carcinoma Lobular Carcinoma Two type of tumors • Benign tumor -Benign tumors are noncancerous • Malignant tumor -Malignant tumors are cancerous Malignant Benign Risk Factors • Genetic BRACA 1 BRACA2 • Reproductive history Increased estrogen exposure –Early menarche –Late menopause –Nulliparity • Female • Family history • Age Other Risk Factors • • • • • Obesity Race Alcohol Birth control pills Environmental -Chemical -Radiation -Heat Environmental factor Pathophysiology Inherited mutation; Genetic Damage & failure of repair DNA Hormonal changes Activation of growth promoting oncogenes Mutation in genome Inactivation of tumor suppressor genes Decreased apoptosis Unregulated cell proliferation Tumor progression Colonial expansion Malignant neoplasm Alteration in genes that regulate apoptosis Spreading of breast cancer Breast cancer spreads in three different ways • through the lymph system • through the blood • Local spread Classification • Histopathology This is based upon characteristics seen upon light microscopy of biopsy specimens • Grade This focuses on the appearance of the breast cancer cell comparing with normal breast tissues • Stage TNM (tumor, node, metastasis) system • Receptor status According to estrogen progesterone receptor • DNA-based Staging • Primary Tumor T1 = Tumor < 2 cm. in greatest dimension T2 = Tumor > 2 cm. but < 5 cm. T3 = Tumor > 5 cm. in greatest dimension T4 = Tumor of any size with direct extension to chest wall or skin • Regional Lymph Nodes N0 = No palpable axillary nodes N1 = Metastases to movable axillary nodes N2 = Metastases to fixed, matted axillary nodes • Distant Metastases M0 = No distant metastases M1 = Distant metastases including ipsilateral supraclavicular nodes Clinical Staging and prognosis • Clinical Stage I T1 N0 M0 • Clinical Stage IIA T1 T2 N1 N0 M0 M0 • Clinical Stage IIB T2 T3 N1 N0 M0 M0 • Clinical Stage IIIA T1 T2 T3 T3 • Clinical Stage IIIB T4 any N M0 • Clinical Stage IV N2 N2 N1 N2 M0 M0 M0 M0 any T any N M1 • Staging prognosis for the 5 year survival rate -stage I 93% -stage II 72% -stage III 41% -stage IV 18% Clinical Manifestations • Painless lump or thickening • Thickening or swelling that persist • Axillary lymph node edema • Pain or Invasive nipple • Spontaneous discharge • A breast that appears to have enlarged • Peud’orange appearance Investigations Triple Assessment • Clinical -Physical examination -History • Imaging -Mammograms -MRI -Ultrasound • Histology/cytology FNAC (Fine needle aspiration cytology) • Histology Core biopsy Treatments • Surgical Treatments -Lumpectomy -Partial Mastectomy or Quadrantectomy -Total Mastectomy -Modified Radical Mastectomy Lumpectomy Quadrantectomy Total Mastectomy Modified Radical Mastectomy • Radiation Therapy • Chemotherapy cyclosphosphamide, and fluorouracil methotrexate, • Hormone blocking therapy Tamoxifen or aromatase inhibitors Ex, Arimidex Nursing Care and Interventions • After surgery -wound care • Long term complication -lymphedema, if present need to drainage fluid • After radiotherapy -skin reactions occur leading to erythema, swelling and soreness of the breast. applied hydrocortisone Nursing Interventions • Monitor for adverse effects of radiation therapy such as fatigue, sore throat, dry cough, nausea, anorexia. • Monitor for adverse effects of chemotherapy; bone marrow suppression, nausea and vomiting, alopecia, weight gain or loss, fatigue, stomatitis, anxiety, and depression. • Provide psychological support to the patient throughout the diagnostic and treatment process. • Involve the patient in planning and treatment. • Describe surgical procedures to alleviate fear. • Administer antiemetic prophylactically, as directed, for patients receiving chemotherapy. • Administer I.V. fluids and hyperalimentation as indicated. • Help patient identify and use support persons or family or community. • Suggest to the patient the psychological interventions may be necessary for anxiety, depression, or sexual problems. • Communicate feelings of comfort and decreased pain. • Participate in her own care at the highest level possible within the limitations of her illness. • Express positive feelings about self. • Express increased sense of well-being. • Use situational supports to reduce fear. • Maintain optimal muscle strength and joint range of motion. • Demonstrate adequate coping behaviors. • Free from signs and symptoms of infection. Preventive care • • • • • screening physical activity Limit alcohol Breast-feed Discontinue hormone therapy • Avoid exposure to environmental pollution • Breast self examination • Diet References • http://www.breastcancer.org/symptoms/diagnosis/staging.jsp • http://www.medicinenet.com/breast_cancer/article.htm • http://www.breastcancer.org/symptoms/testing/types/physic al_exam.jsp • http://www.singhealth.com.sg/PatientCare/ConditionsAndTre atments/Pages/BreastCancer.aspx?gclid=CKnIi8_8vKwCFYka6wodoHXgow • http://www.yapstuff.org/page/healthy_breasts.html?gclid=CL _C0Mz8vKwCFUN76wod-hSipg Questions?