2 Content Anatomy of Breast What is Breast Cancer Risk Factors PathophysiologySpreading of Breast CancerInvestigationTreatmentNursing carePreventive care
3 Introduction Most common female cancer Incidence high in the west 211,300 new cases yearly and rising40,000 deaths yearlyIncidence increasing 14 per in SL in 2000
4 Anatomy of Breast The breast consist with; Lobules and ducts -lobules develop in pregnancy and puberty-15 to 20 lobules, each has separate ducts
5 Stroma-contains connective tissues and fatLymph vesselsMain blood supply by lateral thoracic arteryCoopers ligament give support to the breast
6 Definition It can be ductal carcinomas or lobular carcinomas. Breast cancer is an uncontrolled growth of breast cells.It can be ductal carcinomas or lobular carcinomas.Ductal CarcinomaLobular Carcinoma
7 Two type of tumors Benign tumor -Benign tumors are noncancerous Malignant tumor-Malignant tumors arecancerousMalignant Benign
9 Other Risk Factors Obesity Race Alcohol Birth control pills Environmental-Chemical-Radiation-Heat
10 Pathophysiology Inherited mutation; Environmental factor Genetic Damage & failure of repair DNAHormonal changesMutation in genomeActivation of growth promoting oncogenesInactivation of tumor suppressor genesAlteration in genes that regulate apoptosisDecreasedapoptosisUnregulated cell proliferationTumor progressionColonial expansionMalignant neoplasm
11 Spreading of breast cancer Breast cancer spreads in three different waysthrough the lymph systemthrough the bloodLocal spread
12 Classification Histopathology This is based upon characteristics seen upon light microscopy of biopsy specimensGradeThis focuses on the appearance of the breast cancer cell comparing with normal breast tissuesStageTNM (tumor, node, metastasis) systemReceptor statusAccording to estrogen progesterone receptorDNA-based
13 Staging Primary Tumor T1 = Tumor < 2 cm. in greatest dimension T2 = Tumor > 2 cm. but < 5 cm.T3 = Tumor > 5 cm. in greatest dimensionT4 = Tumor of any size with direct extension to chest wall or skinRegional Lymph NodesN0 = No palpable axillary nodesN1 = Metastases to movable axillary nodesN2 = Metastases to fixed, matted axillary nodes
14 Distant MetastasesM0 = No distant metastasesM1 = Distant metastases including ipsilateral supraclavicular nodes
15 Clinical Staging and prognosis Clinical Stage I T1 N M0Clinical Stage IIA T1 N M0T2 N M0Clinical Stage IIB T2 N M0T3 N M0
16 Clinical Stage IIIA T1 N2 M0 Clinical Stage IIIB T4 any N M0Clinical Stage IV any T any N M1
17 Staging prognosis for the 5 year survival rate -stage I %-stage II %-stage III %-stage IV %
18 Clinical Manifestations Painless lump or thickeningThickening or swelling thatpersistAxillary lymph node edemaPain or Invasive nippleSpontaneous dischargeA breast that appears to haveenlargedPeud’orange appearance
29 After surgery-wound careLong term complication-lymphedema, if present need to drainage fluidAfter radiotherapy-skin reactions occur leading to erythema, swelling and soreness of the breast. applied hydrocortisone
30 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.
31 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.
32 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.
33 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.
34 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.