prepared by: AMIEL S.

MANAHAN

also called as 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

Worldwide, breast cancer comprises 22.9% of all non-melanoma skin cancers in women In 2008, breast cancer caused 458,503 deaths worldwide (13.7% of cancer deaths in women) Breast cancer is more than 100 times more common in women than breast cancer in men, although males tend to have poorer outcomes due to delays in diagnosis

Breast cancer incidence in Asia has been highest in the Philippines. This percentage continues to increase annually by 5%. Researchers have not actually pointed out the main reason why Filipinos have the highest breast cancer incidence rate in Asia. According to the Philippine Breast Cancer Network, cancer was cited as the 3rd leading causes of death in the Cordillera and National Capital Region. However, they say that this can be partly caused by the lifestyle of Filipinos. The consumption of alcohol and the kind of food eaten matters in the development of breast cancer. Breast cancer awareness should not only be for women, but likewise, for men too.

Breast cancer may be one of the oldest known forms of cancerous tumors in humans The discovered oldest in description Egypt and of cancer back was to

dates

approximately 1600 BC. The Edwin Smith Papyrus describes 8 cases of tumors or ulcers of the breast that were treated by cauterization The writing says about the disease, "There is no treatment.

For centuries, physicians described similar cases in their practices, with the same

conclusion. It was not until doctors achieved greater understanding of the circulatory system in the 17th century that they could establish a link between breast cancer and the lymph nodes in the armpit

The French surgeon Jean Louis Petit (1674 1750) and later the Scottish surgeon Benjamin Bell (17491806) were the first to remove the lymph nodes, breast tissue, and underlying chest muscle. Their successful work was carried on by William Stewart Halsted who started performing mastectomies in 1882.

The Halsted radical mastectomy often involved removing both breasts, associated lymph nodes, and the underlying chest muscles. This often led to longterm pain and disability, but was seen as necessary in order to prevent the cancer from recurring Radical mastectomies remained the standard until the 1970s, when a new understanding

of metastasis led to perceiving cancer as a systemic illness as well as a localized one, and more sparing procedures effective. were developed that proved equally

Prominent women who died of breast cancer include Empress Theodora, wife of

Justinian; Anne of Austria, mother of Louis XIV of France; Mary Washington, mother of George, and Rachel Carson, the environmentalist.

The

first

case-controlled

study

on

breast cancer epidemiology was done by Janet Lane-Claypon, who published a comparative study in 1926 of 500 breast cancer cases and 500 control patients of the same background and lifestyle for the British Ministry of Health

Pathophysiology of Breast Cancer

abnormal cells formed by mutation of DNA

cell grows and proliferates

metastasis occurs when abnormal cells invade other tissue, through lymph and blood

cancer development linked to immune system failure

Understanding Breast Cancer Stages

Breast Cancer stages is based on four characteristics: the size of the cancer whether the cancer is invasive or noninvasive whether cancer is in the lymph nodes whether the cancer has spread to other parts of the body beyond the breast

You also may see or hear certain words used to describe the stage of the breast cancer: Local: The cancer is confined within the breast. Regional: The lymph nodes, primarily those in the armpit, are involved. Distant: The cancer is found in other parts of the body as well.

STAGE 0 used to describe non-invasive breast cancers, such as DCIS (ductal carcinoma in situ). In stage 0, there is no evidence of cancer cells or noncancerous abnormal cells

breaking out of the part of the breast in which they started, or getting through to or invading neighboring normal tissue.

STAGE I

this describes invasive breast cancer (cancer cells are breaking through to or invading normal surrounding breast tissue) in which: the tumor measures up to 2 cm and no lymph nodes are involved Microscopic invasion is possible in stage I breast cancer. In microscopic invasion, the cancer cells have just started to invade the tissue outside the lining of the duct or lobule, but the invading cancer cells can't measure more than 1 mm

STAGE II

Stage II is divided into subcategories known as IIA and IIB.

Stage IIA describes invasive breast cancer in which:

no tumor can be found in the breast, but cancer cells are found in the lymph nodes under the arm (axillary) the tumor measures 2 cm or smaller and has spread to the axillary lymph nodes the tumor is larger than 2 cm but not larger than 5 cm and has not spread to the axillary lymph nodes

Stage IIB describes invasive breast cancer in which:

the tumor is larger than 2 cm but no larger than 5 cm and has spread to the axillary lymph nodes the tumor is larger than 5 cm but has not spread to the axillary lymph nodes

Stage III Stage III is divided into subcategories known as : Stage IIIA Stage IIIB and Stage IIIC.

Stage IIIA describes invasive breast cancer in which either: no tumor is found, but cancer is found in axillary lymph nodes, which are clumped together or sticking to other structures cancer may have spread to lymph nodes near the breastbone the cancer is any size and has spread to axillary lymph nodes, which are clumped together or sticking to other structures

Stage IIIB describes invasive breast cancer in which: the cancer may be any size and has spread to the chest wall and/or skin of the breast may have spread to axillary lymph nodes, which are clumped together or sticking to other structures cancer may have spread to lymph nodes near the breastbone

Inflammatory breast cancer is considered at least stage IIIB. Typical features of inflammatory breast cancer include: reddening of a large portion of the breast skin the breast feels warm and may be swollen cancer cells have spread to the lymph nodes and may be found in the skin

Stage IIIC describes invasive breast cancer in which:

there may be no sign of cancer in the breast or, if there is a tumor, it may be any size and may have spread to the chest wall and/or the skin of the breast the cancer has spread to lymph nodes above or below the collarbone the cancer may have spread to axillary lymph nodes or to lymph nodes near the breastbone

Stage IV describes invasive breast cancer that has spread beyond the breast and nearby lymph nodes to other organs of the body, such as the lungs, distant lymph nodes, skin, bones, liver, or brain. you may hear the words advanced and metastatic used to describe stage IV breast cancer. Cancer may be stage IV at first diagnosis or it can be a recurrence of a previous breast cancer that has spread to other parts of the body

TNM staging system TNM (Tumor, Node, Metastasis) is another staging system researchers use to provide more details about how the cancer looks and behaves. Your doctor might mention the TNM classification for your case, but he or she is much more likely to use the numerical staging system. Sometimes clinical trials require TNM information from participants, so talk to your doctor if you are considering participation in a clinical trial.

The TNM system is based on three characteristics: size (T stands for tumor) lymph node involvement (N stands for node) whether the cancer has

metastasized (M stands for metastasis), or moved beyond the breast to other parts of the body.

The T (size) category describes the original (primary) tumor:

TX means the tumor can't be measured or found. T0 means there isn't any evidence of the primary

tumor.
Tis means the cancer is "in situ" (the tumor has not

started growing into healthy breast tissue).

T1, T2, T3, T4: These numbers are based on the size of

the tumor and the extent to which it has grown into neighboring breast tissue. The higher the T number, the larger the tumor and/or the more it may have grown into the breast tissue.

The N (lymph node involvement) category describes whether or not the cancer has reached nearby lymph nodes: NX means the nearby lymph nodes can't be measured or found. N0 means nearby lymph nodes do not contain cancer. N1, N2, N3: These numbers are based on the number of lymph nodes involved and how much cancer is found in them. The higher the N number, the greater the extent of the lymph node involvement.

The M (metastasis) category tells whether or not there is evidence that the cancer has traveled to other parts of the body:
MX means metastasis can't be measured or found. M0 means there is no distant metastasis. M1 means that distant metastasis is present.

Once the pathologist knows your T, N, and M characteristics, he or she can use them to assign a stage to the cancer. For example, a T1 N0 M0 breast cancer would mean that the primary breast tumor is less than 2 centimeters across (T1), has not involved the lymph nodes (N0), and has not spread to distant parts of the body (M0). This cancer would be grouped as stage I

You can control: Weight Exercise Alcohol consumption Exposure to estrogen Recent oral contraceptive use Stress and Anxiety Diet Smoking Stress & Anxiety

You cannot control: Gender Age Family History of breast cancer Race Radiation therapy to the chest Breast cellular changes Exposure to estrogen Pregnancy and breastfeeding DES (diethylstilbestrol)Exposure

Signs and Symptoms

Ann Kulze, M.D. is the author of Dr. Ann's 10-Step Diet (Top Ten Wellness and Fitness, October 2004), a primary care physician, spokesperson for Ruby Tuesday's Restaurant and mother of four. Dr. Ann designed these ten steps to show you how YOU can prevent breast cancer in your life.

1. Maintain a healthy body weight (BMI less than 25) throughout your life. 2. Minimize or avoid alcohol. 3. Consume as many fruits and vegetables as possible. 4. Exercise regularly the rest of your life. 5. Do your fats right! 6. Do your carbs right! . 7. Consume whole food soy products regularly, such as tofu, tempeh, edamame, roasted soy nuts, soy milk and miso. .

8. Minimize exposure to pharmacologic estrogens and xeno-estrogens. 9. Take your supplements daily. 10. Maintain a positive mental outlook.

Diagnostic Procedures

Treatment for Breast Cancer

Breast cancer is usually treated with surgery and then possibly with chemotherapy or radiation, or both. Hormone positive cancers are treated with long term hormone blocking therapy. Treatments are given with increasing aggressiveness according to the prognosis and risk of recurrence. Stage 1 cancers (and DCIS) have an excellent prognosis and are generally treated with lumpectomy and sometimes radiation. HER2+ cancers should be treated with the trastuzumab (Herceptin) regime. Chemotherapy is uncommon for other types of stage 1 cancers.

Stage 2 and 3 cancers with a progressively poorer prognosis and greater risk of recurrence are generally treated with surgery (lumpectomy or mastectomy with or without lymph node removal), chemotherapy (plus trastuzumab for HER2+ following cancers) large and sometimes multiple radiation positive (particularly nodes or

cancers,

lumpectomy). Stage 4, metastatic cancer, (i.e. spread to distant sites) has poor prognosis and is managed by various combination of all treatments from surgery, radiation, chemotherapy and targeted therapies. 10 year survival rate is 5% without treatment and 10% with optimal treatment.

SURGERY Surgery involves the physical removal of the tumor, typically along with some of the surrounding, apparently healthy tissue. Standard surgeries include: Mastectomy: Removal of the whole breast. Quadrantectomy: Removal of one quarter of the breast. Lumpectomy: Removal of a small part of the breast. If the patient desires, then breast reconstruction surgery, a type of cosmetic surgery, may be performed to create an aesthetic appearance. In other cases, women use breast prostheses to simulate a breast under clothing, or choose a flat chest.

Medication Drugs used after and in addition to surgery are called adjuvant therapy. Chemotherapy prior to surgery is called neo-adjuvant

therapy. There are currently 3 main groups of medications used for adjuvant breast cancer treatment: Hormone blocking therapy Chemotherapy Monoclonal antibodies

One or all of these groups can be used.

Hormone Blocking Therapy: Some breast cancers require

estrogen to continue growing. They can be identified by the presence of estrogen receptors (ER+) and progesterone receptors (PR+) on their surface (sometimes referred to together as hormone receptors). These ER+ cancers can be treated with drugs that either block the receptors,

e.g. tamoxifen, or alternatively block the production of estrogen with an aromatase inhibitor,

e.g. anastrozole (Arimidex) or letrozole(Femara). Aromatase inhibitors, however, are only suitable for post-menopausal patients.

Chemotherapy: Predominately used for stage 2-4 disease,

being particularly beneficial in estrogen receptor-negative (ER-) disease. They are given in combinations, usually for 36 months. One of the most common treatments is cyclophosphamide plus doxorubicin (Adriamycin), known as AC. The mechanism of action of chemotherapy is to destroy fast growing an or fast replicating cancer cells either by causing DNA damage upon replication or other mechanisms; these drugs also damage fast-growing normal cells where they cause serious side effects. Damage to the heart muscle is the most dangerous complication of doxorubicin.

Sometimes a taxane drug, such as docetaxel, is added, and the regime is then known as CAT; taxane attacks the microtubules in cancer cells. Another common treatment, which produces equivalent results, is cyclophosphamide, methotrexate, and fluorouracil

(CMF). (Chemotherapy can literally refer to any drug, but it is usually used to refer to traditional non-hormone treatments for cancer.)

Monoclonal

antibodies:

relatively

recent

development in HER2+ breast cancer treatment. Approximately 15-20 percent of breast cancers have an amplification of the HER2/neu gene or over expression of its protein product. This receptor is normally stimulated by a growth factor which causes the cell to divide; in the absence of the growth factor, the cell will normally stop growing. Over expression of this receptor in breast cancer is associated with increased disease recurrence and worse prognosis.

Trastuzumab (Herceptin), a monoclonal antibody to HER2, has improved the 5 year disease free survival of stage 13 HER2+ breast cancers to about 87% (overall survival 95%). Trastuzumab, however, is expensive, and approx 2% of patients suffer significant heart damage; it is otherwise well tolerated, with far milder side effects than conventional chemotherapy.[Other monoclonal antibodies are also undergoing clinical trials. A recent analysis of a subset of the Nurses' Health Study data indicated that Aspirin may reduce

mortality from breast cancer.

Radiation

Radiotherapy is given after surgery to the region of the tumor bed and regional lymph nodes, to destroy microscopic tumor cells that may have escaped surgery. It may also have a beneficial effect on tumor microenvironment. Radiation therapy can be delivered as external beam radiotherapy or as brachytherapy (internal radiotherapy). Conventionally radiotherapy is given after the operation for breast cancer. Radiation can also be given at the time of operation on the breast cancer- intraoperatively.

The largest randomised trial to test this approach was the TAR-GIT-A Trial which found that targeted intraoperative radiotherapy was equally effective at 4-years as the usual several weeks' of whole breast external beam

radiotherapy. Radiation can reduce the risk of recurrence by 50-66% (1/2 - 2/3 reduction of risk) when delivered in the correct dose and is considered essential when breast cancer is treated by removing only the lump (Lumpectomy or Wide local excision)

NURSING MANAGEMENT for BREAST CANCER

Pre-operative Management:
Provide Education and Preparation about surgical treatments Reduce fear and Coping-Ability Anxiety and Improve

Promote decision-making

Post-operative Management:
Relieve Pain and Discomfort Manage post-operative Sensations Promote Positive Body Image Promote Positive Adjustment and Coping Improve Sexual Function
Monitor and Manage Potential Complications

Teach Patients self-care

THANK YOU.

QUIZ:
1. Another term for breast cancer
2. What does DES stands for?

3-7. What are the signs and symptoms of breast cancer? 8. Cancers that originate from the ducts are called _______________ 9. Cancers that originate from lobules are called___________ 10.-12. give at least 3 nursing management 13-15. give at least 3 ways on how to detect breast cancer