complete data about breast cancer and nursing role

1. BREAST CANCER
BY- MS. TRUPTI SANDESH
TAMBE
2ND YEAR P.B. BSC. NURSING

2. What is cancer?
Cancer is an abnormal growth of cells
which tend to proliferate in an uncontrolled
way and, in some cases, to metasize (spread).

3. Breast Cancer

7. Definition
“Breast cancer is an uncontrolled growth of breast cells”
OR
“Breast cancer refers to a malignant tumour that has
developed from cells in the breast”

8. Incidence And Statistics
• For india, for the year 2012:
• 144,937 women were newly detected with breast cancer.
• 70,218 women died of breast cancer
• So roughly, in india, for every 2 women newly diagnosed
with breast cancer, one lady is dying of it.
• Cancer of breast with estimated 1.5 lakh( over 10 percent of
all cancers) new cases during 2016.

9. Aetiology
1.Age
2.Ethnicity
3.Ovarian and hormonal function
4.Benign breast disease
5.Family history
6.Environmental and dietary
factors

10. Risk factors

11. MODIFIABLE
• Alcohol Use
• Radiation Exposure
• Smoking
• Obesity
• Exposure To Hormones
E.g. Pills, Combination Of
Oestrogen And

12. • Early Menarche
• Late Menopause
• Nulliparaty
• Gender And Age
• Breast Condition,
Density
• Family History And
Non modifiable

14. types of breast cancer

18. • Breast cancers are malignant tumours that
typically begin in the ductal lobular epithelial
cells of the breast.
• Spread via the lymphatic system to the
axillary lymph nodes.
• The tumour may then metastasize to distant
regions of the body, including lungs , liver ,
bone and brain.

19. • The findings of breast cancer in the axillary
lymph nodes is an indicator of the tumours
ability for potential distant spread and is not
Marely contiguous growth into the adjacent
regions of the breast.
• Most primary breast cancers are
adenocarcinoma located in the upper outer
quadrants of the breast.

20. Sign And
Symptoms
• Most cancer present as painless.
• Non tender, hard, irregularly shaped non motile
masses.
• About 60% of cancers are somewhat movable, 40%
have irregular. borders by palpation , and 40% can

21. • Even when no mass is present , other
physical findings such as nipple discharge ,
induration , and dimpling , can suggest
malignancy.
• Heat and erythema of the breast skin may
be related to inflammatory carcinoma.
• Oedema – due to invasive and obstruction

23. PRIMARY TUMOR (T)
• TX: PRIMARY TUMOR CANNOT BE ASSESSED.
• T0: NO EVIDENCE OF PRIMARY TUMOR.
• TIS: CARCINOMA IN SITU (DCIS, LCIS, OR PAGET
DISEASE OF THE NIPPLE WITH NO ASSOCIATED
TUMOR MASS)
• T1: TUMOR IS 2 CM (3/4 OF AN INCH) OR LESS ACROSS.
• T2: TUMOR IS MORE THAN 2 CM BUT NOT MORE THAN
5 CM(2INCHES) ACROSS.
• T3: TUMOR IS MORE THAN 5 CM ACROSS.
• T4: TUMOR OF ANY SIZE GROWING INTO THE CHEST

24. Near By Lymph Nodes (N)
• NX: NEARBY LYMPH NODES CANNOT BE ASSESSED
• N0: CANCER HAS NOT SPREAD TO NEARBY LYMPH NODES.
• N1: CANCER HAS SPREAD TO 1 TO 3 AXILLARY (UNDERARM) LYMPH
NODE
N1MI: MICROMETASTASIS IN 1 TO 3 LYMPH NODES UNDER THE
ARM.
N1A: CANCER HAS SPREAD TO 1 TO 3 LYMPH NODES UNDER THE
ARM
N1B: CANCER HAS SPREAD TO INTERNAL MAMMARY LYMPH
NODES
N1C: BOTH N1A AND N1B APPLY.

25. •N2: Cancer has spread to 4 to 9 lymph nodes
under the arm
N2A: Cancer has spread to 4 to 9 lymph
nodes under the arm
N2B: Cancer has spread to one or more
internal mammary lymph nodes

26. • N3: ANY OF THE FOLLOWING:
N3A: EITHER CANCER HAS SPREAD TO 10 OR MORE AXILLARY
LYMPH NODES
OR
CANCER HAS SPREAD TO THE LYMPH NODES UNDER THE
CLAVICLE
N3B: EITHER CANCER IS FOUND IN AT LEAST ONE AXILLARY
LYMPH NODE
OR
CANCER INVOLVES 4 OR MORE AXILLARY LYMPH NODES
N3C: CANCER HAS SPREAD TO THE LYMPH NODES ABOVE THE

27. METASTASIS (M):
• MX: PRESENCE OF DISTANT SPREAD (METASTASIS)
CANNOT BE ASSESSED.
• M0: NO DISTANT SPREAD IS FOUND ON X-RAYS OR BY
PHYSICAL EXAM.
• M1: SPREAD TO DISTANT ORGANS IS PRESENT. (THE
MOST COMMON SITES ARE BONE, LUNG, BRAIN, AND
LIVER).

28. Stages Of Breast
Cancer.

29.  Stage 0 – Abnormal cells in lining of the ducts or
sections of the breast.

30.  Stage 1 – Cancer in the breast tissues. Tumour less
than 1 inches.

31.  Stage 2 – Cancer in the breast tissues. Tumour less
than 2 inches across may also spread to axillary lymph
node.

32.  Stage 3 – Tumour larger than 2 inches spread to
axillary nodes ,possible dimpling ,
inflammation or change of skin colour.

33.  Stage 4 – Spread of cancer beyond the immediate
region of the breast.

34. DIAGNOSTIC EVALUATION
• History collection
• Physical examination-
- Breast self
examination
- Clinical examination
• Mammography
• Breast ultrasound
• Biopsy-
- Fine needle aspiration
- Image guided core
needle biopsy
- Open biopsy
• CAD(computed assisted
diagnosis)

35. History Collection
• Personal history
• Family, hereditary , genetic history
• Menstrual and menopausal history
• History of contraceptive methods, pills
• History of hormonal therapy

36. Physical Examination
a)Self breast examination – It is done by
patient herself.
b)Clinical breast examination – It is done by
the health personnel like doctors, nurses.

37. Mammography
• Mammography is x-ray of the
breast
• Women (asymptomatic )40
years of age and older should
have a mammogram every
year.
• Mammogram should be done

38. • Breast ultrasound is uses sound waves to make
image of breast tissue which hard to study with a
mammogram
• It shows whether a breast lump is filled with fluid (
a cyst) or if it is solid lump. A ultrasound does not
replace the need for mammogram , but it is often
Breast Ultrasound

39. BIOPSY
1. Fine needle aspiration cytology-(FNAC)
Performed on a outpatient bases .
purpose is to determine whether a solid lump is a cyst or
to confirm a clinically apparent diagnosis. If a mass turned out to
be cyst, the lump should disappear after the aspiration.

40. 2. Stereotactic needle guided biopsy :
stereotactic needle guided biopsy is used mainly to target
and identify non-palpable lesions in the breast that have been
detected with mammography

42. 3. Ultrasound core biopsy
ultrasound guided breast biopsy
is used when the lesion can be seen on
ultrasound . it is easier for the client
than a stereotactic biopsy because she
can lie on her back and does not have
her breast immobilized during the
practice.

43. 4.Open Biopsy
• Excisional or open biopsy may be chosen when the lesion is
determined in nature , when results of cytology , or histogic
analysis are insufficient or when the clinical or mammographic
findings suggest malignancy.

44. Computer Assisted Diagnosis
(CAD)
• CAD uses a software program to target lesions suspected to be
malignant. The specificity of the image is enhanced by on screen
evaluation , which improves detection.

45. Breast Self Examination
• Woman can use breast self examination to assess their breast.
When they perform breast self examination properly and
regularly , they can note any changes in their breasts and seek
further evaluation.
• Examination should be done every month and at end of
menses in all menstruating women.

46. Direction For Palpation

50. Medical Management Involve
1.Chemotherapy:
- As Adjuvant , postoperatively usually begins 4
weeks after surgery.
- Treatment are given every 3-4 weeks for 6-9
months.
- As Primary Treatment In Inflammatory Breast
Cancer

51. - Anti oestrogen such as tomoxifen are used as
adjuvant systemic therapy after surgery
- Hormonal agents may be used in advanced disease
to induce remissions that last for months to several
years.
- Herceptin is a monoclonal antibody directed against
Her-2/ oncogenes , may be effective for patients
who express this genes.

52. Possible Side Effects
• Hair loss
• Mouth sores
• Loss of appetite
• Nausea and vomiting
• Increased chance of infections (due to low white
blood cell counts)
• Easy bruising or bleeding (due to low blood platelet
counts)
• Fatigue (due to low red blood cell counts and other
reasons)

53. Long Term Side Effects
• Menstrual changes:
• Neuropathy
• Heart damage
• Hand-foot syndrome
• Chemo brain
• Increased risk of leukemia

54. • Drugs Commonly Used
• Cyclophosphamide (C)
• Doxorubicin (A)
• Epirubicin (E)
• Methotrexate (M)
• 5-fluorouracil (F)
• Taxanes (T) E.G. Docetaxel, Paclitaxel Etc
• Mitomycin (M)
• Mitoxantrone (M)

55. Radiation Therapy

56. •Aim –
•To minimize the locoregional recurrence after surgery
and possibly improve survival
•Indications –
•All patients undergoing BCT
•Tumour size > 5 cms
•>= 4 Axillary Nodes positive
•All LABC patients

57. External beam radiation
This is the most common type of radiation
therapy for women with breast cancer. The
radiation is focused from a machine outside the
body on the area affected by the cancer.
The extent of radiation depends on whether a
lumpectomy or mastectomy was done and
whether or not lymph nodes are involved

58. EXTERNAL BEAM RADIATION

59. 3D-CONFORMAL RADIO THERAPY
RADIATION IS GIVEN WITH SPECIAL MACHINES SO
THAT IT IS AIMED BETTER AT THE AREA WHERE
THE TUMOR WAS.
TREATMENT WAS GIVEN TWICE A DAY FOR FIVE
DAYS.

60. 3D-CONFORMAL RADIO THERAPY

61. POSSIBLE SIDE EFFECTS OF EXTERNAL
RADIATION
•The main side effects of EBRT are swelling and
heaviness.
•Sunburn like skin changes in the treated areas
and fatigue.

62. BRACHYTHERAPY
• Intra cavitary Brachytherapy:
This Method Of Brachytherapy Consists Of A Small
Balloon Attached To A Thin Tube. The Deflated Balloon
Is Inserted Into The Space Left By The Lumpectomy
And Is Filled With A Salt Water Solution. (This Can Be
Done At The Time Of Lumpectomy Or Within Several
Weeks Afterward.) The Balloon And Tube Are Left In
Place Throughout Treatment

63. INTRACAVITARY APPLICATOR

64. •Interstitial Brachytherapy:
In this approach, several small, hollow tubes called
catheters are inserted into the breast around the area
of the lumpectomy and are left in place for several
days. Radioactive pellets are inserted into the catheters
for short periods of time each day and then removed.

65. INTERSTITIAL

66. INTERSTITIAL

68. Surgical Management Involves-
• Breast Preserving Procedures:
- Lumpectomy + Radiation Therapy
• Mastectomy-
1. Radical Mastectomy
2. Modified Radical Mastectomy
3. Prophylactic Or Total Mastectomy
4. Axillary Dissection

73. Post Mastectomy Care
• Elevate affected side and distal joint higher than proximal joint.
• No bp, injection , venepuncture on affected side.
• Watch for sign and symptoms of oedema on affected arm.
• Lymphedema can occur any time after axillary node dissection.
• Flexion and extension of exercises of the hand in the recovery.
• Abduction and external rotation arm exercise after wound has
healed.

74. • Assess dressing for drainage.
• Assess wound drain for amount and colour.
• Provide privacy when client looks at incision.
• Care during chemotherapy
• Care during radiation therapy
• Psychological concerns

75. Post operative exercises

79. • Body image disturbance related to surgical intervention
• Anxiety related to unsolved issues regarding dying,
prognosis , hospitalization, surgical intervention ,
recovery.
• Fear related to serious threat to well being.
• Ineffective coping related to treatment , prognosis.
• Sexual dysfunction related to loss of body part ,
partner’s reaction to loss

80. • Chronic sorrow related to diagnosis of cancer , loss
of body integrity.
• risk for spiritual distress: risk factor – fear of
diagnosis of cancer.
• insomnia related to anxiety , pain
• Risk for infection : risk factor- inadequate immune
system
• social isolation related to hospitalization , lifestyle

81. • Impaired physical motility related to weakness, pain
• Chronic pain related to metastatic cancer.
• Ineffective role performance related change in
physical capacity , inability to resume prior role.
• Impaired skin integrity related to immunological
deficit , immobility.

82. Patient Care During Radiation
Therapy
1. Education
• Information about radiation treatment planning
• Symptom management during radiation therapy
• Skin reactions
• Fatigue
2. Psychosocial and family support

83. Patient Care During Chemotherapy
1. Symptom management during chemotherapy
2. Bone marrow depressions
3. Nausea and vomiting
4. Mucositis

84. 5. Neurotoxicity
6. Alopecia
7. Arthralgia and myalgia
8.Hemorrhagic cystitis
9. Behavioral symptoms

85. Palliative Care
1. Life style
2. Patient wish
3. Patient desire
4. Spiritual preparation

86. Rehabilitation
1) Exercise
2) Prosthesis
3) Daily Activities
4) House Hold Work
5) Office Work
 Physical

87. 1. Fear
2. Anxiety
3. Depression
4. Sexual
5. Body image
6. Problem of un employment
 Psychological

88. PROSTHESIS
• Silicone Breast Prostheses
• Non-silicone Breast Prostheses
• Partial Breast Prosthesis
• Attachable (Contact) Breast Prosthesis

90. Health Education
• Breast Self-examination
• Diet
• Treatment
• Pregnancy
• Follow-up

91. Thank You