Breast cancer

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breast cancer overview.. mgt, dx, tx and nsg dx... :)

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Breast cancer

  1. 1. Many of you might already know that cancer ranks 3rdamong the leading causes of mortality and morbidity in the Philippines. Infectious and cardiovascular diseases are the top two. Cancer prevention attitude here sucks, and a researcher has lamented that if this continues “it is estimated for every 1800 Filipinos, 1 will develop cancer annually.”<br />
  2. 2. In Asia, the Philippines has the highest reported incidence rate of breast cancer. From 43.2 in 1993-1995, the age standardized incidence rate (ASR) is now 47.7 per 100,000 females. And this, figure exceeds the rate reported for several western countries including Spain, Italy, and most Eastern-European countries.<br />
  3. 3. BREAST<br />CANCER<br />
  4. 4. Survival QUEST<br />By:<br />Mike Pendon<br />
  5. 5. Breast cancer is malignant abnormal cell growth in the breast.<br />
  6. 6. Breast cancer is a relatively common cancer among women in the US, and it is the leading cause of death in women between 45 and 64 years of age. <br />Breast cancer maybe discovered while in situ (localized), or it may be discovered as a malignant (spreading) neoplasm. <br />Breast cancer is usually an adenocarcinoma found in the milk ducts.<br />
  7. 7. Causes<br />Idiopathic; estrogen implicated by high incidence in women.<br />
  8. 8. Anatomy<br />
  9. 9. Types of Breast Cancer:<br />Ductal carcinoma (75%)<br />Lobular carcinoma (7%)<br />Paget’s Disease<br />Inflammatory carcinoma<br />
  10. 10. Two major groups of Breast cancer:<br />Noninvasive Carcinoma<br />DCIS – Ductal Carcinoma In Situ<br />Lobular Carcinoma In Situ<br />Invasive Carcinoma<br />Gain access to the supporting tissue between ducts, blood vessels, lymph, etc.<br />
  11. 11. Classification:<br />I n f l a m m a t o r y<br />M e d u l l a r y <br />M u c i n o u s <br />P a g e t ’ s d i s e a s e <br />P h y l l o d e s t u m o r <br />T u b u l a r <br />S a r c o m a s <br />L y m p h o m a s <br />
  12. 12. Risk factors<br />Age (over age 50)<br />1st Pregnancy after age 30<br />HRT<br />Menstruation before age 12<br />Menopause after age 50<br />Nulliparity<br />
  13. 13. Risk Factors<br />Endometrial or ovarian cancer<br />Estrogen therapy<br />Antihypertensives<br />Obesity<br />High fat diet<br />Fibrocystic disease<br />Exposure to low level ionizing radiation<br />Family history<br />1st pregnancy after age 31<br />Long menses<br />Never been pregnant<br />Unilateral breast cancer<br />Asian and Indian nationality<br />Multiple pregnancies<br />Pregnant before age 20<br />
  14. 14. Other Factors<br />Alcohol use<br />Family history<br />Genetic Link<br />History of breast biopsy<br />Obesity<br />History of breast cancer<br />Sedentary lifestyle<br />Race (Caucasian)<br />
  15. 15. Pathophysiology<br />1st<br />Proto-oncogens<br />Oncogens<br />Cell grow and divide faster than normal<br />
  16. 16. 2nd<br />Tumor suppressor genes are turned off<br />Cell grow and divide very quickly<br />Hyperplasia of breast tissue<br />
  17. 17. 3rd<br />DNA repair genes get turned off<br />Cells continue to grow and divide<br />Hyperplasia of breast tissue<br />Malignant<br />Breast Cancer<br />
  18. 18. Signs and Symptoms<br />A lump or mass in the breast<br />A change in symmetry or size of the breast.<br />A change in breast skin (thickening, scaly, dimpling)<br />Unusual drainage or discharge<br />A change in the nipple such as itching, burning, erosion or retraction.<br />Pain<br />Bone metastasis, pathologic bone fractures and hypercalcemia<br />Edema of the arm<br />
  19. 19. Staging of Breast Cancer<br />Stage 0<br />Pre-cancerous condition<br />DCIS<br />Paget’s disease<br />Stage I<br /><ul><li>Tumor is <2cm
  20. 20. No lymph node involvement</li></li></ul><li>Stage IIA<br /><ul><li><2cm and 1-3 axillary LN involved
  21. 21. <5cm and no axillary LN involved</li></ul>Stage IIB<br /><ul><li>>2cm and 1-3 axillary LN involved
  22. 22. >5cm and no axillary LN involved</li></li></ul><li>Stage III A<br /><ul><li><5cm 4-9 axillary LN
  23. 23. >5cm and 1-9 axillary LN</li></ul>Stage III B<br /><ul><li>Chest wall and skin
  24. 24. 9 axillary LN</li></ul>Stage III C<br /><ul><li>Tumor of any size
  25. 25. 10 or more axillary LN
  26. 26. 1 regional LN
  27. 27. E.g., Inflammatory Breast Cancer</li></li></ul><li>Stage IV<br /><ul><li>Tumor of any size
  28. 28. Have spread to nearby LN
  29. 29. Metastasis to bones, liver, lungs, brain and distant LN</li></li></ul><li>Diagnostic tests<br />Breast self examination<br />Mammography <br />Surgical biopsy/ fine needle aspiration<br />Ultrasonography<br />Bone scan/computed tomography scan<br />Hormonal receptor assay<br />
  30. 30. Diagnostic exams in Breast CA<br />Breast Self Examination<br />Starts from age 20. done after menstruation. Note for symmetry of the breast. Palpate the breast from periphery to the center in circular motion.<br />Mammogram<br />It involves x-ray examination of the breast, it is supported on flat, firm surface. It involves use of 2 x-ray films.<br />
  31. 31. Biopsy<br />It is the examination of affected tissue in detecting presence of cancer cells.<br />Nuclear Magnetic Resonance Imaging<br />This is viewing the structure of the breast using a high tech radiation imaging in detecting presence of mass or tumors.<br />
  32. 32. Treatment<br />In choosing the therapy,, the patient and practitioner should consider the stage of the disease, the woman’s age and menopausal status and the disfiguring effects of the surgery, treatment for breast cancer may include 1 or any combination of the following:<br />
  33. 33. Surgery<br />Simple or total mastectomy<br />Modified radical mastectomy<br />Radical mastectomy<br />Skin sparing mastectomy<br />Subcutaneous mastectomy<br />Partial mastectomy<br />lumpectomy<br />
  34. 34. Medical and Surgical Management:<br />Surgery including mastectomy (either simple, radical, or modified radical) and lumpectomy<br />Primary radiation therapy<br />Chemotherapy<br />Anti-estrogen therapy<br />Tamoxifen<br />Fulvestrant<br />Goserelin<br />Aromatase inhibitors<br />Peripheral stem cell therapy<br />Biological therapy<br />Drug therapy<br />
  35. 35. NursingConsideration<br />Pre-operative<br />Obtain informed consent<br />Provide good care for a breast care<br />Be sure to know what kind of surgery to be performed in order to prepare the patient<br />If mastectomy is scheduled:<br />Prevent pulmonary complications and thromboembolism<br />Place patient on the affected side<br />
  36. 36. Post-operative<br />inspect dressing anteriorly and posteriorly<br />Check circulatory status <br />MIO<br />Encourage coughing exercises and turning schedule every two hours<br />Provide psychological and emotional support<br />Explain to the patient that she may experience phantom breast syndrome<br />
  37. 37. Nursing<br />Deficient knowledge about the planned surgical treatments.<br />Anxiety related to the diagnosis of cancer<br />Fear related to specific treatments and body image changes<br />Risk for ineffective coping related to the diagnosis of breast cancer<br />Decisional conflict related to treatment options.<br />Disturbed body image related to loss or alteration of the breast<br />Diagnoses<br />
  38. 38. THE<br />end<br />

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