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BREAST CANCER

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

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BREAST CANCER

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  1. BREAST CANCER By : Preethi Vithana

  2. Content • Anatomy of Breast • What is Breast Cancer • Risk Factors • Pathophysiology • Spreading of Breast Cancer • Investigation • Treatment • Nursing care • Preventive care

  3. 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

  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 fat • Lymph vessels • Main blood supply by lateral thoracic artery • Coopers ligament give support to the breast

  6. Definition Breast cancer is an uncontrolled growth of breast cells. It can be ductal carcinomas or lobular carcinomas. Ductal Carcinoma Lobular Carcinoma

  7. Two type of tumors • Benign tumor -Benign tumors are noncancerous • Malignant tumor -Malignant tumors are cancerous Malignant Benign

  8. Risk Factors • Genetic BRACA 1 BRACA2 • Reproductive history Increased estrogen exposure • Early menarche • Late menopause • Nulliparity • Female • Family history • Age

  9. Other Risk Factors • Obesity • Race • Alcohol • Birth control pills • Environmental -Chemical -Radiation -Heat

  10. Inherited mutation; Genetic Environmental factor Pathophysiology Damage & failure of repair DNA Hormonal changes Mutation in genome Activation of growth promoting oncogenes Inactivation of tumor suppressor genes Alteration in genes that regulate apoptosis Decreased apoptosis Unregulated cell proliferation Tumor progression Colonial expansion Malignant neoplasm

  11. Spreading of breast cancer Breast cancer spreads in three different ways • through the lymph system • through the blood • Local spread

  12. 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

  13. 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

  14. Distant Metastases M0 = No distant metastases M1 = Distant metastases including ipsilateral supraclavicular nodes

  15. Clinical Staging and prognosis • Clinical Stage I T1 N0 M0 • Clinical Stage IIA T1 N1 M0 T2 N0 M0 • Clinical Stage IIB T2 N1 M0 T3 N0 M0

  16. Clinical Stage IIIA T1 N2 M0 T2 N2 M0 T3 N1 M0 T3 N2 M0 • Clinical Stage IIIB T4 any N M0 • Clinical Stage IV any T any N M1

  17. Staging prognosis for the 5 year survival rate -stage I 93% -stage II 72% -stage III 41% -stage IV 18%

  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

  19. Investigations Triple Assessment • Clinical -Physical examination -History

  20. Imaging -Mammograms -MRI -Ultrasound

  21. Histology/cytology FNAC (Fine needle aspiration cytology) • Histology Core biopsy

  22. Treatments • Surgical Treatments -Lumpectomy -Partial Mastectomy or Quadrantectomy -Total Mastectomy -Modified Radical Mastectomy

  23. Lumpectomy

  24. Quadrantectomy

  25. Total Mastectomy

  26. Modified Radical Mastectomy

  27. Radiation Therapy • Chemotherapy • cyclosphosphamide, methotrexate, and fluorouracil • Hormone blocking therapy • Tamoxifen or aromatase inhibitors • Ex, Arimidex

  28. Nursing Care and Interventions

  29. 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

  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.

  35. Preventive care • screening • physical activity • Limit alcohol • Breast-feed • Discontinue hormone therapy • Avoid exposure to environmental pollution • Breast self examination • Diet

  36. References • http://www.breastcancer.org/symptoms/diagnosis/staging.jsp • http://www.medicinenet.com/breast_cancer/article.htm • http://www.breastcancer.org/symptoms/testing/types/physical_exam.jsp • http://www.singhealth.com.sg/PatientCare/ConditionsAndTreatments/Pages/Breast-Cancer.aspx?gclid=CKnIi8_8vKwCFYka6wodoHXgow • http://www.yapstuff.org/page/healthy_breasts.html?gclid=CL_C0Mz8vKwCFUN76wod-hSipg

  37. Questions?

  38. Thank You!!!

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