Transcript 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
• 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?