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Breast Cancer

Breast Cancer. Hitham G. Falahi 4NU04. The most common cancer in females…. A malignant tumor of the breast, usually a carcinoma, rarely a sarcoma. Risk Factors. Genetics- BRCA1 And BRCA 2 Increasing age ( > 50yo) Family History of breast cancer Early menarche and late menopause

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Breast Cancer

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  1. Breast Cancer Hitham G. Falahi 4NU04

  2. The most common cancer in females…

  3. A malignant tumor of the breast, usually a carcinoma, rarely a sarcoma

  4. Risk Factors • Genetics- BRCA1 And BRCA 2 • Increasing age ( > 50yo) • Family History of breast cancer • Early menarche and late menopause • Late age at pregnancy • Nulliparity • Obesity • Hormonal replacement • Alcohol • Exposure to radiation

  5. Protective factors • Exercise • Breast feeding • Pregnancy before 30 yo

  6. Pathophysiology • Modifications of DNA of the breast epithelial duct cells • Chromosomal alterations, gene mutations, suppression of apoptosis • Modification of specific oncogenes or the loss of specific suppressor genes • Proliferation of breast cells • Tumor formation

  7. Types of Breast Cancer • Ductal Carcinoma in Situ • Invasive Ductal Carcinoma - tubular - medullary -mucinous -papillary -cribriform

  8. Invasive Lobular Carcinoma • Inflammatory Breast Cancer • Lobular Carcinoma in Situ • Paget’s Disease

  9. Clinical Manifestations • Local pain • Dimpling of the skin • Nipple retraction • Skin retraction • Edema • Nipple or areolar eczema • Pitting of the skin (peau d’ orange) • Reddened skin, local tenderness, and warmth

  10. Dilated blood vessels • Nipple discharge in nonlactating women • Ulceration • Hemorrhage • Edema of the arm • Chest pain

  11. Medical Management • Chemotherapy • Tamoxifen Therapy • Radiation Therapy

  12. Surgical Management • Radical Mastectomy • Modified Radical Mastectomy • Lumpectomy

  13. Breast Cancer NURSING INTERVENTION : PRE-OP • 1. Explain breast cancer and treatment options • 2. Reduce fear and anxiety and improve coping abilities • 3. Promote decision making abilities • 4. Provide routine pre-op care: • Consent, NPO, Meds, Teaching about breathing exercise

  14. Breast Cancer NURSING INTERVENTION : Post-OP 1. Position patient: • Supine • Affected extremity elevated to reduce edema

  15. Breast Cancer NURSING INTERVENTION : Post-OP 2. Relieve pain and discomfort • Moderate elevation of extremity • IM/IV injection of pain meds • Warm shower on 2nd day post-op

  16. Breast Cancer NURSING INTERVENTION : Post-OP 3. Maintain skin integrity • Immediate post-op: snug dressing with drainage • Maintain patency of drain (JP) • Monitor for hematoma w/in 12H and apply bandage and ice, refer to surgeon

  17. Breast Cancer NURSING INTERVENTION : Post-OP 3. Maintain skin integrity • Drainage is removed when the discharge is less than 30 ml in 24 H • Lotions, Creams are applied ONLY when the incision is healed in 4-6 weeks

  18. Breast Cancer NURSING INTERVENTION : Post-OP Promote activity • Support operative site when moving • Hand, shoulder exercise done on 2ndday • Post-op mastectomy exercise 20 mins TID • NO BP or IV procedure on operative site

  19. Breast Cancer NURSING INTERVENTION : Post-OP Promote activity • Heavy lifting is avoided • Elevate the arm at the level of the heart • On a pillow for 45 minutes TID to relieve transient edema

  20. Breast Cancer NURSING INTERVENTION : Post-OP MANAGE COMPLICATIONS • Lymphedema • 10-20% of patients • Elevate arms, elbow above shoulder and hand above elbow • Hand exercise while elevated • Refer to surgeon and physical therapist

  21. Breast Cancer NURSING INTERVENTION : Post-OP MANAGE COMPLICATIONS • Hematoma • Notify the surgeon • Apply bandage wrap (Ace wrap) and ICE pack

  22. Breast Cancer NURSING INTERVENTION : Post-OP MANAGE COMPLICATIONS Infection • Monitor temperature, redness, swelling and foul-odor • IV antibiotics • No procedure on affected extremity

  23. Breast Cancer NURSING INTERVENTION : Post-OP TEACH FOLLOW-UP care • Regular check-up • Monthly BSE on the other breast • Annual mammography

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