Breast cancer are common conditions that primarilyaffect women. When a women discovers a breast lump, her firstresponse is often fear, of breast cancer, of losing herbreast and perhaps of losing her life. Breast cancer also strikes men although rarely. Breast cancer is rarely seen in client under the ageof 40.
fibrocystic breast changes : term used to describe certainbenign changes in the breast, typically associated withpalpable nodularity, lumpiness, swelling, or pain lymphedema : chronic swelling of an extremity due tointerrupted lymphatic circulatin, typically from an axillarylymph node dissection mastitis : inflammation or infection of the breast paget’s disease : from of breast cancer begins in the ductalsystem and involves the nipple, areola, and surrounding skin gynecomastia : overdeveloped breast tissue typically seen inadolescent boys
Breast cancer is a malignant (cancerous)growth that begins in the tissue of thebreast. Cancer is a disease in which abnormalcells grow in an uncontrolled way.
1 . DUCTAL CARCINOMA IN SITU ( DCIS ) increase use of mammography as a screening tool hascontributed to the dramatic. characterized by the proliferation of malignant cellsinside the milk ducts without invasion into thesurrounding tissue. DCIS is frequently manifested on a mammogram withthe appearance of calcifications , and considered breastcancer stage 0. if untreated, increase likelihood that it will progress toinvasive cancer.
The most traditional treatment is total orsimple mastectomy ( removal of the breastcancer) . The trend today is toward less aggressivesurgery breast conservation treatment (limited surgery followed by radiation).
2. INVASIVE CANCER a) infiltrating ductal carcinoma accounts for 80% of all cases. tumors arise from the duct system and invade thesurrounding tissue. they often form a solid irregular mass in the breast. b) infiltrating lobular carcinoma accounts for 10% to 15% of breast cancer. tumors arise from the lobular epithelium andtypically occur as an area of ill-defined thickening inthe breast.
c) medullary carcinoma accounts for about 5% of breast cancer. diagnosed more often in women younger than 50 yearsof age.Tumors grow in a capsule inside a duct .They can become large . d) mucinous carcinoma accounts about 3% of breast cancer.Often presents in postmenopausal women 75 years of ageand older.Tumor is slow growing , prognosis is more favorable thanin many other types.
e) tubular ductal carcinoma accounts for 2 % of breast cancer.Axillary metastases are uncommon with thishistology.Prognosis is usually excellent. f) inflammation carcinoma unique symptomsCharacterized by diffuse edema and brawnyerythema of the skin, referred to as peau d’orange.Can spread to other parts of the body.
g) paget’s disease accounts for 1% of breast cancer.Symptoms include a scaly,erythematous , pruriticlession of the nipple.
1. FEMALE GENDER AGE First-degree relative. Such as mother, sister, ordaughter.2. MENSTRUAL HISTORY Early menarche – (under age 12) ( late menopause after age 50 )
3. RADIATION EXPOSURE Chest x-ray, fluoroscopic examination, particularlybefore age 30.4. LIFE STYLE High fat diet, alcohol intake greater than two drinkdaily. smoking obesityBreast trauma
Stage 0 – noninvasive carcinomas occupy theirlocations of origin without spreading beyond this point Stage I – the tumor is no larger than twocentimeters, and cancer cells are confined to the breast Stage II – a tumor has started to spread to the lymph nodes or, the tumor has exceeded five centimeters in size
Stage III – the tumor has exceeded five centimeters and has spread into the lymph nodes in a more extensive way than in stage II Stage IV – the cancer has metastasized and spread to other regions of the body
1. Breast mass or thickening. 2. unusual lump in the underarm or abovethe colarbone. 3. Abnormal nipple discharge. 4. Rash around the nipple area. 5. Change in nipple position. 6. Burning, stinging or pricking sensation.
PERCUTANEOUS BIOPSY1) percutaneous biopsy performed on an outpatientbasis to sample palpable and nonpalpable lesion.2) is a needle or core bopsy that obtains tissue bymaking small punture in the skin.a) fine-needle aspiration 1) noninvasive biopsy technique. 2) need a small gauge needle ( 25 or 22 gauge). 3) suction is applied to the syringe.
4) fluid is usually discarded. 5) less expensive than other diagnostic methodsand result are usually available quickly. b) core needle biopsy 1) similar to fine-needle aspiration (FNA). 2) but used large gauge needle (usually 14 gauge). 3) a local anesthetic is applied, and tisssue cores areremoved. 4) more definitive diagnosis then FNA.
c) stereotactic core biopsy 1) performed on nonpalpable lesions detected bymammography. 2) tissue are taken for pathologic examination. 3) quite accurate and often allows the patient toavoid a surgical biopsy.
1. Chemotherapy * The most common chemotherapy agents actby killing cells that divide rapidly, one of themain properties of most cancer cells. Thismeans that chemotherapy also harms cells thatdivide rapidly under normal circumstances
2. Radiation Therapy * is a highly targeted, highly effective way todestroy cancer cells in the breast that may stickaround after surgery. Radiation can reduce therisk of breast cancer recurrence by about 70%. * Despite what many people fear, radiationtherapy is relatively easy to tolerate and its sideeffects are limited to the treated area.
3. Breast lumps * Less than one-fourth of all breast lumps are found to becancerous, but benign breast disease can be difficult todistinguish from cancer. Consequently, all breast lumpsshould be checked by a health care professional.
4. Mammography * Mammography is a low-powered x-ray technique thatcaptures a picture of the internal structure of the breast. * Additional angles and magnified views are taken ofsuspicious areas. A mammogram may help in the diagnosisof breast problems, including cancer.
5. CT scan * a thin X-ray beam is rotated around the area of thebody to be visualized. Using very complicatedmathematical processes called algorithms, the computer isable to generate a 3-D image of a section through the body. * CT scans are very detailed and provide excellentinformation for the physician.
6. Open biopsy of the breast * An open biopsy can be performed under local orgeneral anesthesia and will leave a small scar. Prior tosurgery, a radiologist often first marks the lump with awire, making it easier for the surgeon to find.
SURGICAL1)LUMPECTOMYA lumpectomy is surgery to remove a small area of breast tissue that iscancerous.This surgery is carried out only in early breast cancer, if the area of tissueto be removed is relatively small. Women who choose a lumpectomy will requireradiation therapy to destroy any cancer cells that may remain in the area. 2) MASECTOMYA mastectomy is the surgical removal of the entire breast that is done in order toremove a malignant tumour in cases of invasive breast cancer, with or withoutremoving the lymph nodes in the armpit. Sometimes, if more tissue needs to beremoved, a lumpectomy may be disfiguring and a mastectomy may be recommendedinstead.
CHEMOTHERAPHYi. Chemotheraphy tratment uses medicine to weaken and destroy cancer cells in the body, including cells at the original cancer site and any cancer cells that may have spread to another part of the body.ii. Chemotheraphy is used to treat :a) Early stage -invasive breast cancer to get rid of any cancer cells that may be left behind after surgery and to reduce the risk of the cancer coming back.b) Advanced stage-breast cancer to destroy or damage the cancer cells as much as possible.iii. Some cases, chemotherapy is given before surgery to shrink the cancer.
RADIATION THERAPHYi. Radiation theraphy is also called radio theraphy is a highly targeted, highly effective way to destroy cancer cells in the breast that may stick around after surgery.ii. Radiation therapy is relatively easy to tolerate and its side effects are limited to the treated area. radiation theraphy chemotheraphy
MEDICALTamoxifen or aromatase inhibitor is recomanded for estrogen receptor-positive (ER+) breast cancer. Its stop estrogen from fueling ER+ breastcancer.i. TAMOXIFENa) Medicine that blocks the effect of estrogen on breast cancer cells and normal breast cells. But this medicine may also increase other risks, such as for endometrial cancer, stroke and blood clots in veins and in the lungs.
ii. Aromatase Inhibitorsa) Letrozole (Femara)b) Anastrozole (arimidex)c) Exemestane (aromasin) are medicine that stop estrogen production in postmenopausal women.iii. Trastuzumab ( Herceptin )a) Is recommended after surgery and chemotherapy for HER2/neu breast cancer. This medicine is a monoclonal antibody that targets the HER-2 protein. It helps chemotherapy work better.iv. Serotonin antagonists, corticosteroids and phenothiazinesa) Treatment of breast cancer can cause nausea and vomitting. Doctor will be prescribe this medicine to help relieve and prevent nausea and vomitting.
Destruction of the breast.Destruction of the chest wall surrounding of thebreast.MastitisNipple dischargeChest painMost women will have aches or pains from time totime in the treated breast even years after treatment.Hair loss after radiation therapy and chemotherapy.
the breast plays a significant role in a woman’ssexuality and self –identity.A breast disoder, wether benign or malignant, cancause great anxiety and fear of potentialdisfigurement, loss of sexual attractiveness, and evendeath.Must have expertise in the assessment andmanagement of not only the physical symptom but alsothe psychosocial symptoms with breast disoders.
Madam Asiah age 35 years old admitted to the ward at9 a.m she complaint of generalized abdominal pain 1/7more on right sided region to the back. B/P :110/62,Temperature : 38.5,Pulse : 65,Rate : 14. Doctorhas her’s Bilateral Breast Cancer stage iv and suggestfor the operation.
1. Nursing Diagnosis :Imbalanced nutrition ,less than body requirement related to nausea and vomiting.Goal :Patient experiences less nausea and vomiting associated with chemotherapy, weight loss is minimized.
Intervension :i. Assess the patient previous experiences and expectation of nausea and vomiting, including cause and intervension.ii. Adjust diet before and after drug administration according to patient preference and tolerance.iii. Prevent unpleast sight,odor and sound in environment.iv. Ensure adequate fluid hydration,before during and after drug administration ,assess intake and output.v. Provide pain relief measure, if necessary.vi. Assess other contribution factor to nausea and vomiting such as other symptom, radiation therapy, medication.
2. Nursing Diagnosis :Disturbed body image and situation low self- esteemrelated to change in appearance, function and role.Goal :Improved body image and self-esteem.
Intervension :i. Assess patient feeling about body image and level of self- esteem.ii. Encouraged continued participation in activities and decision making.iii. Assist patient in self- care when fatigue,nausea,vomiting to prevent independence.iv. Assist patient in selecting and using cosmetic,hair pieces and clothing that increase sense of attractiveness.v. Individualize care for the patient.
3. Nursing Diagnosis :Chronic PainGoal :Relief of pain and discomfort.
Intervension :i. Assess pain and discomfort characteristic use pain scale.ii. Assess other factor contributing to patient pain : fear,fatigue.anger.iii. Administer analgesic to promote optimum pain relief.iv. Assess patient behavioral responses to pain and pain experiences.v. Teach patient new strategies to relieve pain and discomfort.
WAD PALIATIF CARE UNIT (PCU) HTAABRUNNER & SUDDARTH’S,Medical –Sergical Nursing,TwelthhEdition.http ://www.webmd.com/breast-cancer/tc/breast-cancer-medications.