This document provides information about breast cancer, including: 1) Breast cancer is the most common cancer among women in the Philippines and its incidence rate is higher there than in some Western countries. 2) The document discusses the types, causes, risk factors, stages, signs and symptoms, diagnostic tests, and treatment options for breast cancer. 3) Nursing considerations for breast cancer include preparing patients for surgery, post-operative care like dressing changes and turning schedules, and providing psychological support.

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.”

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.

3. BREAST CANCER

4. Survival QUEST By: Mike Pendon

5. Breast cancer is malignant abnormal cell growth in the breast.

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. Breast cancer maybe discovered while in situ (localized), or it may be discovered as a malignant (spreading) neoplasm. Breast cancer is usually an adenocarcinoma found in the milk ducts.

7. Causes Idiopathic; estrogen implicated by high incidence in women.

8. Anatomy

9. Types of Breast Cancer: Ductal carcinoma (75%) Lobular carcinoma (7%) Paget’s Disease Inflammatory carcinoma

10. Two major groups of Breast cancer: Noninvasive Carcinoma DCIS – Ductal Carcinoma In Situ Lobular Carcinoma In Situ Invasive Carcinoma Gain access to the supporting tissue between ducts, blood vessels, lymph, etc.

11. Classification: I n f l a m m a t o r y M e d u l l a r y M u c i n o u s P a g e t ’ s d i s e a s e P h y l l o d e s t u m o r T u b u l a r S a r c o m a s L y m p h o m a s

12. Risk factors Age (over age 50) 1st Pregnancy after age 30 HRT Menstruation before age 12 Menopause after age 50 Nulliparity

13. Risk Factors Endometrial or ovarian cancer Estrogen therapy Antihypertensives Obesity High fat diet Fibrocystic disease Exposure to low level ionizing radiation Family history 1st pregnancy after age 31 Long menses Never been pregnant Unilateral breast cancer Asian and Indian nationality Multiple pregnancies Pregnant before age 20

14. Other Factors Alcohol use Family history Genetic Link History of breast biopsy Obesity History of breast cancer Sedentary lifestyle Race (Caucasian)

15. Pathophysiology 1st Proto-oncogens Oncogens Cell grow and divide faster than normal

16. 2nd Tumor suppressor genes are turned off Cell grow and divide very quickly Hyperplasia of breast tissue

17. 3rd DNA repair genes get turned off Cells continue to grow and divide Hyperplasia of breast tissue Malignant Breast Cancer

18. Signs and Symptoms A lump or mass in the breast A change in symmetry or size of the breast. A change in breast skin (thickening, scaly, dimpling) Unusual drainage or discharge A change in the nipple such as itching, burning, erosion or retraction. Pain Bone metastasis, pathologic bone fractures and hypercalcemia Edema of the arm

25. 10 or more axillary LN

26. 1 regional LN

28. Have spread to nearby LN

30. Diagnostic exams in Breast CA Breast Self Examination Starts from age 20. done after menstruation. Note for symmetry of the breast. Palpate the breast from periphery to the center in circular motion. Mammogram It involves x-ray examination of the breast, it is supported on flat, firm surface. It involves use of 2 x-ray films.

31. Biopsy It is the examination of affected tissue in detecting presence of cancer cells. Nuclear Magnetic Resonance Imaging This is viewing the structure of the breast using a high tech radiation imaging in detecting presence of mass or tumors.

32. Treatment 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:

33. Surgery Simple or total mastectomy Modified radical mastectomy Radical mastectomy Skin sparing mastectomy Subcutaneous mastectomy Partial mastectomy lumpectomy

34. Medical and Surgical Management: Surgery including mastectomy (either simple, radical, or modified radical) and lumpectomy Primary radiation therapy Chemotherapy Anti-estrogen therapy Tamoxifen Fulvestrant Goserelin Aromatase inhibitors Peripheral stem cell therapy Biological therapy Drug therapy

35. NursingConsideration Pre-operative Obtain informed consent Provide good care for a breast care Be sure to know what kind of surgery to be performed in order to prepare the patient If mastectomy is scheduled: Prevent pulmonary complications and thromboembolism Place patient on the affected side

36. Post-operative inspect dressing anteriorly and posteriorly Check circulatory status MIO Encourage coughing exercises and turning schedule every two hours Provide psychological and emotional support Explain to the patient that she may experience phantom breast syndrome

37. Nursing Deficient knowledge about the planned surgical treatments. Anxiety related to the diagnosis of cancer Fear related to specific treatments and body image changes Risk for ineffective coping related to the diagnosis of breast cancer Decisional conflict related to treatment options. Disturbed body image related to loss or alteration of the breast Diagnoses

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