CASE STUDY:

BREAST CANCER

Submitted by: Joanna Marie A. Cabildo

Submitted to: Ms. Gabriel

Introduction

Breast cancer is the most common malignancy in women and the

second leading cause of cancer death, exceeded only by lung cancer in 1985.
One woman in eight who lives to age 85 will develop breast cancer at some
time during her life.
Breast cancer (malignant breast neoplasm) is a cancer originating from
breast tissue, most commonly from the inner lining of milk ducts or the
lobules that supply the ducts with milk. Cancers originating from ducts are
known as ductal carcinomas; those originating from lobules are known as
lobular carcinomas. There are many different types of breast cancer, with
different stages (spread), aggressiveness, and genetic makeup; survival
varies greatly depending on those factors. Computerized models are
available to predict survival. With best treatment and dependent on staging,
10-year disease-free survival varies from 98% to 10%. Treatment includes
surgery, drugs (hormonal therapy and chemotherapy), and radiation.
Breast cancer is not just a woman's disease. The American Cancer
Society estimates that 1600 men develop the disease yearly and about 400
may die from the disease. Breast cancer risk is higher among those who have
a mother, aunt, sister, or grandmother who had breast cancer before age 50.
If only a mother or sister had breast cancer, your risk doubles. Having two
first-degree relatives who were diagnosed increases your risk up to five times
the average. Early signs of breast cancer include the following:
A lump which is usually single, firm and most often painless is detected.
-An area of the skin on the breast or underarm is swollen and has an unusual
appearance.
-Veins on the skin surface become more prominent on one breast.
-The affected breast nipple becomes inverted, develops a rash, changes in
skin texture, or has a discharge other than breast milk.
-A depression is found in an area of the breast surface.
At present there are over 2 million women living in the United States
who have been treated for breast cancer. About 41,000 women will die from
the disease. The chance of dying from breast cancer is about 1 in 33.
However, the rate of death from breast cancer is going down. This decline is
probably the result of early detection and improved treatment.

THEORETICAL FRAMEWORK

Jean Watson’s (1979-1985) Theory of Human Caring.

She emphasized that nursing is the application of the art and human science
through transpersonal caring transactions to help persons achieve mind-
body-soul harmony, which generates self-knowledge, self-control, self-care,
and self-healing. She included health promotion and treatment of illness in
nursing. She believed that a person is a valued being to be cared for,
respected, nurtured, understood and assisted; a fully functional integrated
self.

The Ten Carative factors, transpersonal caring relationship and the caring
occasion constitute the elements of Jean Watson’s Theory of Human Caring.
Her ten carative factors are viewed as the guide of a nurse in honoring the
human dimensions of nursing’s work and the inner life world. These carative
factors point to the aspects of nursing which affect the one caring and the
one being cared for thereby potentiating the therapeutic healing processes.
The ten

carative factors included in her work are the following:

(1) Formation of a humanistic-altruistic system of values.
(2) Instillation of faith-hope.
(3) Cultivation of sensitivity to one’s self and to others.
(4) Development of a helping-trusting, human caring relationship.
(5) Promotion and acceptance of the expression of positive and negative
feelings.
(6) Systematic use f a creative problem-solving caring process.
(7) Promotion of transpersonal-teaching learning.
(8) Provision of a supportive, protective and corrective mental, physical ,
societal and spiritual environment.
(9) Assistance with gratification of human needs.
(10) Allowance for existential-phenomenologicalspiritual forces (Watson,
1979).
I. Patient’s Profile
Name: Tabanquil, Adoracion
Age: 73
Gender: Female
Religion: Roman Catholic
Occupation: None
Address: Mayantoc, Tarlac
Date of Admission: July 25, 2010
Admitting Diagnosis: Invasive ductal CA L

II. History of Present Illness

Admitted for several times from e-ward per wheel chair accompanied
by husband, for 3rd cycle chemotherapy.

III. Past Medical History

( + ) History of stroke
( + ) HPN
( + ) DM type II
( + ) CVD
( + ) Pulmonary disease

IV. Physical Examination

-Patient is conscious, coherent, alert and not in cardiorespiaratory distress.
- Anecteric sclerae
- No scar, no lesion, no TPC
- Wheezes (-), rales (-), ronchi (-)

IV. Family History

( - ) HPN ( - ) Kidney disease
( - ) Acute MI ( - ) Cancer
( - ) DM ( - ) PTB
( - ) Stroke ( - ) Others

V. Personal Social History

Occupation: (present) – none
(previous) – Grade school teacher
( + ) Smoking (quit 20 years ago)
( - ) Alcohol use
( - ) Illicit drug use
DIAGNOSTIC PROCEDURES
(1) CHEST CT SCAN
Date of examination: July 25, 2010

CT scanning—sometimes called CAT scanning—is a noninvasive medical test

that helps physicians diagnose and treat medical conditions. CT scanning
combines special x-ray equipment with sophisticated computers to produce
multiple images or pictures of the inside of the body. CT of the chest is used
to:
• Further examine abnormalities found on conventional chest x-
rays.
• Help diagnose the cause of clinical signs or symptoms of disease
of the chest, such as cough, shortness of breath, chest pain, or fever.
• Detect and evaluate the extent of tumors that arise in the chest,
or tumors that have spread there from other parts of the body.
• Assess whether tumors are responding to treatment.
• help plan radiation therapy.

(2) GRAM STAIN -Gram staining is an empirical method of differentiating

bacterial species into two large groups (Gram-positive and Gram-negative)
based on the chemical and physical properties of their cell walls. The Gram
stain is almost always the first step in the identification of a bacterial
organism.

Date of Examination: July 29, 2010

Specimen: Pleural fluid
Result: No organism seen

(3) URIINALYSIS- analysis of the urine. It is performed by collecting a urine

sample from the patient in a specimen cup. Usually only small amounts (10-
15 ml's) may be required for urinalysis testing.

Date of examination: July 29, 2010

Color: Yellow
Transparency: Turbid
Ph: 7.5
Specific Gravity: 1.005

(4) HEMATOLOGY – the scientific study of blood and blood-forming tissues.

Date of examination: August 3, 2010

Normal Resul Interpretation

values t
Hemoglobi 120-160 145 Normal- adequate oxygen-carrying protein
n gm/L and deliver it to the body tissue
Hematocrit 0.37- 0.47 0.44 Normal- adequate proportion of total blood
volume made up of red blood cell.
Lymphocyt 0.20- 0.40 0.30 Normal- No presence of infection.
e
Eosinophil 0.01-0.05 0.07 Due to presence of Neoplastic disease.
Basophils 0.0-0.01 0.01 Normal
(5) Chest X-ray- The chest x-ray is the most commonly performed diagnostic
x-ray examination. An x-ray (radiograph) is a noninvasive medical test that
helps physicians diagnose and treat medical conditions. Imaging with x-rays
involves exposing a part of the body to a small dose of ionizing radiation to
produce pictures of the inside of the body.

Date of examination: August 05, 2010

Findings: Pleural effusion – Bilateral

SPECIAL PROCEDURES

(1) THORACENTESIS- is an invasive procedure to remove fluid or air from the

pleural space for diagnostic or therapeutic purposes.
*The most common causes of pleural effusions are cancer, congestive heart
failure, pneumonia, and recent surgery.

Date: August 04, 2010

(2) CLOSED TUBE THORACOSTOMY (CTT)

Date: August 11, 2010
 ANATOMY AND PHYSIOLOGY

Female Breast

The female breast is made up mainly of

• Lobules (milk producing glands)
• ducts (any tubes that carry the milk from the lobules to the nipple)
• stroma (fatty tissue and connective tissue surrounding the ducts and
lobules, blood vessels, and lymphatic vessels)

T h e L y m p h a t i c S y s t e m
 The lymph system is important to understand because it s one of the
ways in which breast cancers can spread. This system has several parts.
Lymph nodes are small, bean-shaped collections of immune system cells
(cells that are important in fighting infections) that are connected by
lymphatic vessels. Lymphatic vessels are like small veins, except that they
carry a clear fluid called lymph (instead of blood) away from the breast.
Lymph contains tissue fluid and waste products, as well as immune system
cells.
Breast cancer cells can enter lymphatic vessels and begin to grow in
lymph nodes. Most lymphatic vessels in the breast connect to lymph nodes
under the arm (axillary nodes).Some lymphatic vessels connect to lymph
nodes inside the chest (internal mammary nodes) and those either above or
below the collarbone (supraclavicular or infraclavicular nodes).
 PATHOPHYSIOLOGY OF BREAST CANCER

Predisposing
Precipitating
Age
Etiology -Exposure to radiation and
Gender
Unknown certain chemicals
Family history

Somatic mutations in the DNA

Activate oncogene / deactivate

tumor suppressor gene

Neoplasm formation in the breast

Primary tumor begins in the

breast

If treated: If not treated

-Surgery
-Chemotherapy
-Radiotherapy
Tumor becomes invasive

Cancer cell
destroyed
Progressed beyond the breast to
regional lymph node.
Compromise the functions of the
major
DEATH
Travel to other organs
organ system
 DISCHARGE PLAN

Medication:
* Give adequate instructions to the significant others about the importance of
the following medications and dietary regimens so that the patient’s
condition can remain stable as soon as possible.

Exercise:
* Encourage or teach the patient the proper breathing exercises.
* Allow the patient to verbalize her feelings.

Treatment:
* Chemotherapy
* Encourage the patient to have a strict compliance with regards to the
medication to attain therapeutic effects.

Health Teachings:
* Practice good general hygiene.
* Advise to have a clean, quiet, well ventilated room, conductive to rest and
relaxation.

OPD Check-up:
* Instruct the patient and family to return to their attending physician for
scheduled follow up visit

Diet:
* Low salt, low fat.
* DM diet @ 1000 Kcal /day
Spirituality:
* Encourage the patient to read the Bible and pray to God always, ask for
guidance and pray for the healing and restoration of health.