BREAST CANCE

cancer that starts in the breast, usually in the inner lining of the milk ducts or lobules is the second leading cause of cancer death in women, after lung cancer is the most common cancer among women in the United States, other than skin cancer

The American Cancer Society's most recent estimates for breast cancer in the United States are for 2011:

About 230,480 new cases of invasive breast cancer in women About 57,650 new cases of carcinoma in situ (CIS) will be found About 39,520 deaths from breast cancer (women)

Top 10 Causes of Cancer Deaths in the RP (2010)

10. Non-Hodgkins lymphoma 9. Prostate cancer 8. Ovarian cancer 7. Rectal cancer 6. Thyroid cancer 5. Colon cancer 4. Cervical cancer 3. Liver cancer 2. Lung cancer

Number 1 leading cause of Cancer Death in the RP

1.

Breast cancer
i. most common cancer in the country with 16 percent of a total of 50,000 cases resulting in death ii. the leading cause of cancer for Filipino women

Types of Breast Cancer

Ductal carcinoma in situ (DCIS) is ductal carcinoma in its earliest stage (Stage 0). Invasive ductal carcinoma . This cancer starts in the milk ducts of the breast. Then it breaks through the wall of the duct and invades the fatty tissue of the breast. Infiltrating (invasive) lobular carcinoma. This cancer begins in the lobules of the breast where breast milk is produced, but has spread to surrounding tissues or the rest of the body. Lobular carcinoma in situ (LCIS) is cancer that is only in the lobules of the breast. Inflammatory breast cancer (IBC): This uncommon type of invasive breast cancer accounts for about 1% to 3% of all breast

Risk factors for breast cancer:

Gender Increasing

or advance age Personal history of breast cancer Family history of breast cancer Genetic mutation

Hormonal factors
Early menarche Late menopause Nulliparity Late age at first full-term pregnancy Hormone therapy

Exposure to ionizing radiation History of benign proliferative breast disease Obesity Alcohol intake Race

Pathophysiology
1st

Proto-oncogenes are changed to oncogenes

Cancer cell grows and divides rapidly Alteration of the tumor suppression genes takes place

2nd

3rd

4th

DNA repair genes are altered and turned off

Clinical Manifestations:

Early Detection for Breast Cancer:

Breast Self Examination Clinical Breast Examination Early 20s 20s 30s every 3 years 40 years old and above annually

Diagnostic Examination
Mammography Magnetic Resonance Imaging Computed Tomography Scan Positron Emission Tomography Tumor Marker Identification Genetic Profiling

Diagnostic Examination: Staging DCIS, LCIS, PAGETS DISEASE OF THE NIPPLE STAGE 0
WITH NO INVASION STAGE I tumors 2cm or less with no involvement of axillary lymph node STAGE II A tumor smaller than two centimeters across with lymph node involvement or a tumor that is larger than two but less than five centimeters across without underarm lymph node involvement STAGE II B tumor that is greater than five centimeters across without underarm lymph nodes testing positive for cancer or a tumor that is larger than two but less than five centimeters across with lymph node involvement STAGE III A STAGE III B STAGE IV tumors are greater than 5cm, or tumors are accomplished by enlarged axillary lymph nodes fixed to one another or to adjacent tissue more advance lesions with satellite nodules, fixation to the skin or chest wall, ulceration, or edema, or with supraclavicular or intraclavicular involvement Tumors of any size, with distant metastases

STAGE I: Tumors are less than 2cm in diameter and confined to breast

STAGE II A: tumor smaller than two centimeters across with lymph node involvement or a tumor that is larger than two but less than five centimeters across without underarm lymph node involvement

STAGE II B: tumor that is greater than five centimeters across without underarm lymph nodes testing positive for cancer or a tumor that is larger than two but less than five centimeters across with lymph node

STAGE III A: Tumors are greater than 5cm, or tumors are accomplished b enlarged axillary lymph nodes fixed to one another or to adjacent tissue

STAGE III B: More advance lesions with satellite nodules, fixation to the skin or chest wall, ulceration, or edema, or with supraclavicular or intraclavicular involvement

STAGE III C:
there may be no sign of cancer in the breast or the tumor may be any size and may have spread to the chest wall and/or the skin of the breast. Also, cancer: has spread to lymph nodes above or below the collarbone; and may have spread to axillary lymph nodes or to lymph nodes near the breastbone.

 Stage

IIIC breast cancer is divided into operable and inoperable stage IIIC. In operable stage IIIC, the cancer:
is found in ten or more axillary lymph nodes; or is found in lymph nodes below the collarbone; or is found in axillary lymph nodes and in lymph nodes near the breastbone.
In

inoperable stage IIIC breast cancer, the cancer has spread to the lymph

STAGE IV: All tumors with distant metastases

Medical Management

Surgical Management
Modified Radical Mastectmoy Total Mastectomy Breast Conservation Treatment Sentinel Lymph Node Biopsy

Exercises recommended after surgery

Wall handclimbing Rope turning Rod or Broomstick lifting Pulley Tugging Ball Squeezing

Medical Management
Radiation Therapy Systemic Treatments

Chemotherapy Hormonal Therapy Targeted Therapy

Complications/S.E. of Chemotherapy
Fatigue Alopecia Immunosuppression Bone Marrow Depression Stomatitis

Nursing diagnoses

Potential Nursing Diagnosis

Risk for infection

Actual Nursing Diagnoses

Impaired Tissue Integrity Imbalanced nutrition: Less than body requirements

Risk for Infection

Nursing Management
Assess for evidence of infection Initiate measures to minimize infection

Imbalanced nutrition: Less than body requirements

Nursing Management
Suggest foods that are preferred by the patient Encourage adequate fluid intake Encourage on small frequent feeding Provide a quiet and calm environment Encourage nutritional supplements and high protein foods between meals Encourage frequent oral hygiene

Impaired Tissue Integrity: Alopecia

Nursing Management:
Discuss potential hair loss and regrowth with patient and family Prevent or minimize hair loss Prevent trauma to scalp
Suggest ways to cope with hair loss

Encourage to retain social contacts Explain that hair growth usually begins again once therapy is completed

Nursing Management
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. Realize that a diagnosis of breast cancer is a devastating emotional shock to the woman. Provide psychological support to the patient throughout the diagnostic and treatment process. Involve the patient in planning and treatment.

STAGE

Breast Cancer Treatment Guideline or Lumpectomy Tamoxifen 0 DCIS TM

I 0-2cm BCT or MRM Considere d for all invasive procedure s Regimen depends on tumor size and nodal status
PostOp and possibly PreOp

TUMOR

SURGERY

CHEMO

RADIATION

For lumpectomy

For BCT

II

2-5cm

BCT or MRM

For BCT

III

>5cm

MRM

To chest wall & possibly axilla after MRM To control progression or

IV

Metastatic

Possible To control lumpectomy or MRM progressio

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