Transcript Oncology Nursing Forum. 38(1)

Among all cancers, breast cancer has
been the 2nd leading cause of death in
women (right behind lung cancer)
 Causes about 40,000 deaths annually
 About 5-10% of women who develop this
cancer have a genetic predisposition
with the BRCA1 gene.
 Breast cancer also affects glands and
the lymphatic system
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About 80% of breast cancers arise in the
ductal tissue, while the other remaining 1015% occurs in the lobular tissue
 As with many cancers, breast cancer is
highly influenced by hormones- our female
sex hormones such as FSH, Estrogen,
Progesterone can stimulate the growth of a
tumor
 How does it become cancer? Cells of the
breast may undergo growth changes
during tissue renewal and differentiation
that can ultimately give rise to cancer.
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Those who study breast cancer and how it arises
understand that the developmental pathways of the
breast tissues (ducal and lobular) and its responses to
the hormones and growth factors that regulate tissue
development
The cellular abnormalities of why tumors occur is not
yet known, however researchers do know that tumors
originate in the breast tissue and begin to proliferate
abnormally as a direct result of genetic changes
within the breast and hormones.
Symptoms= tumor that may or may not be palpable
DCIS- Ductal carcinoma in situ= Abnormal
cells arise in the ductal tissue, where is can
progress through the lining of the milk ducts
and invade the fatty tissue of the breast. In
the normal process of tissue development
during puberty, ductal tissue develops in
response to estrogen.
 LCIS=lobular carcinoma in stiu= begins in
the lobules that produce milk and may
progress to infiltrating invasive lobular
carcinoma.
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What is BRAC?
› Breast and Ovarian Cancer gene
› BRAC 1 was the first gene identified; carries with
this mutation have a higher risk of developing
breast or ovarian cancer during their lifetime
› BRAC2 an inherited gene also significantly
increases risks
› Both BRCA1 and 2 have been shown to promote
the development of breast cancer as a result of
their growth-promoting effects on breast tissue.
A vast majority of cases are in the
ABSENCE of genetic predisposition
 Age- increases over 50
 First menstruation before the age of 12
 First childbirth after the age of 35
 Menopause after the age of 50
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Self breast examination
 Mammogram
 To determine malignancy:
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› Biopsy- removal of small amonut of tissue
from the breast
› Ultrasonography- uses sound waves to
explore tissue structure
› Mammogram-radiography of the soft tissue
of the breast
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Primary treatment= surgical removal of
tumor
Mastectomy
Radiation
Chemotherapy
Hormone therapy
Protein
Medications: Tamoxifen, Evista, a newer
class of antiestrogens called aromatase
inhibitors (AI)
Prognosis is all dependent on tumor size,
appearance, local invasiveness, and
lymph node involvement for possible
metastasis
 Individualized ;age, menopause etc. are
also taken into account for prognosis
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Medical
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Nursing
› Alternative treatments
› Patient education
› Consent
› Empathy
› Prescriptions
› Symptom
› Surgical interventions
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management
Support
Coordination of care
Medication
administration
Consult
Multidisciplinary care
Ineffective coping
 Risk for disturbed body image
 Pain
 Impaired self-esteem
 Risk for infection
 Depression
 Anxiety
 Social isolation
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Scenario
 HPI
 Signs and symptoms
 Gaps between clinical experience and
new research
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A nurse is caring for a patient who has just
found out she has stage 2 breast cancer. She
asks the nurse what could have caused this.
The nurse would reply
A. “You might have had trauma in the past
that lead to tissue damage”
B. “There is nothing you could have done to
prevent it, try not to worry”
C. Breast cancer can be caused by a number
of factors including hormones, age, childbirth,
onset of menses and menopause and even
genetics”
D. “ You just have bad genes”
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A nurse is explaining the process of an
ultrasonography to a patient. The nurse
knows the patient understands what the
procedure is when she says which of the
following?
A. “There will be a needle inserted into my
breast tissue”
B. “The use of sound waves will explore my
breast structure”
C.” My breast will be placed between a
table and compressed”
D. “I will need to be prepared for surgery”
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A nurse is treating a 55 year old women who
had of a left mastectomy 6 months ago. The
patient states she feels pressure under her arm.
Upon assessment the nurse notes +4 edema on
the left arm. What conclusion can the nurse
make based upon these assessment findings?
A. The patient is having a reaction to
anesthesia.
She is showing signs of sepsis
Her cancer has now spread to her lymph
nodes
The patient is now suffering from lymphedema
due to her mastectomy
Crawford, Sarah, PH.D., Alder, Richard, Ph.D., (2013).
Breast Cancer. Magill’s Medical Guide (Online Edition).
Retrieved from http://eds.a.ebscohost.com.ezproxy.li
b.usf.edu/eds/detail?sid=3e78d67e-132e-48d6-abfcee94a2e3a562%40sessionmgr4005&vid
=4&hid=4203&bdata=JnNpdGU9ZWRz
LWxpdmU%3d#db=ers&AN=86193952
 Korber, Susan F., Padula, Cynthia., Gray, Julie.,
Powell, Margot., (2011). A Breast Navigator Program:
Barriers, Enhancers, and Nursing Interventions.
Oncology Nursing Forum. 38(1), 1-49. Retrieved from
http://eds.a.ebscohost.com/eds/pdfviewer/pdfviewer
?sid=2a6b876d-566c-49f1-a96e891eb8a23870%40sessionmgr4004&vid=8&hid=4213
 http://www.youtube.com/watch?v=8Ik1i9YT374
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