Download Breast Cancer File

BREAST DISORDERS
BREAST CANCER MASS (MALIGNANT TUMOR)
Usually occurs as a single mass (lump) in one
breast
 Usually nontender
 Irregular shape
 Firm, hard, embedded in surrounding tissue
 Referral and biopsy indicated for definitive
diagnosis

BREAST CYST (BENIGN MASS)
Occur as single or multiple lumps in one or both
breasts
 Usually tender (omitting caffeine reduces
tenderness); tenderness increases during
premenstrual period
 Round shape
 Soft or firm, mobile
 Referral and biopsy indicated for definitive
diagnosis, especially for first mass; later masses
may be evaluated over time by a specialist

FIBROADENOMA (BENIGN BREAST LUMP)
Usually occurs as a single mass in women aged
15–35 years
 Usually nontender
 May be round or lobular
 Firm, mobile, and not fixed to breast tissue or
chest wall
 No premenstrual changes
 Referral and biopsy indicated for definitive
diagnosis

ACUTE MASTITIS (INFLAMMATION OF THE
BREASTS)
Associated with lactation but may occur at any
age
 Nipple cracks or abrasions noted
 Breast skin reddened and warm to touch
 Tenderness
 Systemic signs include fever and increased pulse

DIAGNOSTIC EVALUATION
Breast Self-Examination
Mammography
 Ultrasonography
 Magnetic Resonance Imaging
 Procedures for Tissue Analysis:
 Percutaneous Biopsy
 Fine-Needle Aspiration (FNA)



Mammography is a breast-imaging technique
that has been shown to reduce breast cancer
mortality rates. It can detect nonpalpable lesions
and assist in diagnosing palpable masses.
The procedure takes about 15 minutes and can be
performed in a hospital radiology department or
independent imaging center. Two views are
taken of each breast. The breast is mechanically
compressed from top to bottom (craniocaudal
view) and side to side

Mammography may detect a breast tumor before
it is clinically palpable (ie, smaller than 1 cm);
however, it has limitations. The false-negative
rate ranges between 5% and 10%. Younger
women, or those taking HT, may have dense
breast tissue, making it more difficult to detect
lesions with mammography
SURGICAL BIOPSY

Surgical biopsy is usually performed using local
anesthesia and IV sedation. After an incision is
made, the lesion is excised and sent to a
laboratory for pathologic examination
TYPES OF SURGICAL BREAST BIOPSY
Excisional Biopsy
 Excisional biopsy is the standard procedure for
complete pathological assessment of a palpable
breast mass. The entire mass, plus a margin of
surrounding tissue, is removed.

Incisional biopsy surgically removes a portion of
a mass. This is performed to confirm a diagnosis
and to conduct special studies that will aid in
determining treatment
 Complete excision of the area may not be
possible or immediately beneficial to the patient,
depending on the clinical situation

BREAST CANCER
RISK FACTORS FOR BREAST CANCER
Female gender
 Increasing age
 Personal history of breast cancer
 Family history of breast cancer
 Genetic mutations (BRCA-1 and BRCA-2
mutations are responsible for majority of
inherited breast cancer cases)


Hormonal factors
Early menarche
 Late menopause
 Nulliparity
 First child after 30 years of age
 Hormone therapy (HT)

Exposure to ionizing radiation during
adolescence and early adulthood
 History of benign proliferative breast disease
 Obesity
 High-fat diet (controversial)
 Alcohol intake

MANAGMENT
Chemoprevention
 Chemoprevention is a primary prevention
modality that aims at preventing the disease
before it starts

PROPHYLACTIC MASTECTOMY




Prophylactic mastectomy is another primary
prevention modality. This procedure can reduce the
risk of cancer by 90% and is sometimes referred to as
a “risk-reducing” mastectomy.
The procedure consists of a total mastectomy
(removal of breast tissue only) and is usually
accompanied by immediate breast reconstruction.
Possible candidates include women with a strong
family history of breast cancer, atypical hyperplasia,
a BRCA gene mutation, an extreme fear of cancer
(“cancer phobia”), or previous cancer in one breast.
A patient who is considering prophylactic mastectomy
is often faced with a very controversial and emotional
decision
Prognosis
 Several different factors must be taken into
consideration when determining the prognosis of
a patient with breast cancer. The two most
important factors are tumor size and whether the
tumor has spread to the lymph nodes under the
arm (axilla).

SURGICAL MANAGEMENT

The main goal of surgery is to obtain local control
of the disease. With breast cancer being
diagnosed today at earlier stages, options for less
invasive surgical procedures are available.
Surgical treatment options for noninvasive and
invasive breast cancer
MODIFIED RADICAL MASTECTOMY
Modified radical mastectomy is performed to
treat invasive breast cancer. The procedure
involves removal of the entire breast tissue,
including the nipple-areola complex. In addition,
a portion of the axillary lymph nodes are also
removed in axillary lymph node dissection
(ALND).
 If immediate breast reconstruction is desired,
the patient is referred to a plastic surgeon prior
to the mastectomy so that she has the
opportunity to explore all available options.
Radical mastectomy is rarely performed today

TOTAL MASTECTOMY


Like modified radical mastectomy, total
mastectomy (i.e., simple mastectomy) also
involves removal of the breast and nipple-areola
complex but does not include ALND.
Total mastectomy may be performed for patients
with noninvasive breast cancer, which does not
have a tendency to spread to the lymph nodes. It
may also be performed prophylactically for
patients who are at high risk for breast cancer
(eg, LCIS, BRCA mutation). A total mastectomy
may also be performed in conjunction with
sentinel lymph node biopsy (SLNB) for patients
with invasive breast cancer
PREOPERATIVE NURSING DIAGNOSES
Deficient knowledge about the planned surgical
treatments
 Anxiety related to the diagnosis of cancer
 Fear related to specific treatments and body
image changes
 Risk for ineffective coping (individual or family)
related to the diagnosis of breast cancer and
related treatment options
 Decisional conflict related to treatment options

POSTOPERATIVE NURSING DIAGNOSES
Pain and discomfort related to surgical procedure
 Disturbed sensory perception related to nerve
irritation in affected arm, breast, or chest wall
 Disturbed body image related to loss or alteration
of the breast
 Risk for impaired adjustment related to the
diagnosis of cancer and surgical treatment
 Self-care deficit related to partial immobility of
upper extremity on operative side

Risk for sexual dysfunction related to loss of body
part, change in self-image, and fear of partner's
responses
 Deficient knowledge: drain management after
breast surgery
 Deficient knowledge: arm exercises to regain
mobility of affected extremity
 Deficient knowledge: hand and arm care after an
axillary lymph node dissection (ALND
