The document provides information on breast cancer, including its epidemiology, risk factors, classification, clinical features, diagnosis, and management. It states that breast cancer is the second most common cancer worldwide and the most common cancer among women in Nepal. Risk factors include family history, genetic mutations, reproductive factors, and breast density. Diagnosis involves history, physical exam, imaging like mammography, and biopsy. Treatment options are also discussed.
Ovarian cancer usually happens in women over age 50, but it can also affect younger women. Its cause is unknown. Ovarian cancer is hard to detect early.
The sooner ovarian cancer is found and treated, the better your chance for recovery. But ovarian cancer is hard to detect early. Many times, women with ovarian cancer have no symptoms or just mild symptoms until the disease is in an advanced stage and hard to treat.
Ovarian cancer usually happens in women over age 50, but it can also affect younger women. Its cause is unknown. Ovarian cancer is hard to detect early.
The sooner ovarian cancer is found and treated, the better your chance for recovery. But ovarian cancer is hard to detect early. Many times, women with ovarian cancer have no symptoms or just mild symptoms until the disease is in an advanced stage and hard to treat.
It contains details about breast carcinoma-pathology,investigations and diagnosis,NACT,surgery and adjuvant therapy. Hope you will find it helpful.....
A Topic Where Every Woman Must Know. Early warning signs of breast cancer.knip xin
PLEASE LIKE AND COMMENT FOR ANY CONSTRUCTIVE CRITICISM. This power point presentation was made to raise awareness about breast cancer. Slides include definition of breast cancer, signs and symptoms, diagnostic exam, stages of breast cancer and treatment.
Dr. Jennifer Mueller, gynecologic cancer surgeon at Memorial Sloan Kettering Cancer Center, will share research updates on uterine/endometrial cancer and other new developments in treatment and surgery.
Breast cancer is known as the cancer that grow up in the cells of breasts. Breast cancer is the most typical cancer detected in the women. We are celebrating October month as the breast cancer awareness month. It helps the women to get more information about the breast cancer. DDRC SRL diagnostics center in Kerala provides free mammography campaigns for the women in Kerala in this breast cancer awareness month.
It contains details about breast carcinoma-pathology,investigations and diagnosis,NACT,surgery and adjuvant therapy. Hope you will find it helpful.....
A Topic Where Every Woman Must Know. Early warning signs of breast cancer.knip xin
PLEASE LIKE AND COMMENT FOR ANY CONSTRUCTIVE CRITICISM. This power point presentation was made to raise awareness about breast cancer. Slides include definition of breast cancer, signs and symptoms, diagnostic exam, stages of breast cancer and treatment.
Dr. Jennifer Mueller, gynecologic cancer surgeon at Memorial Sloan Kettering Cancer Center, will share research updates on uterine/endometrial cancer and other new developments in treatment and surgery.
Breast cancer is known as the cancer that grow up in the cells of breasts. Breast cancer is the most typical cancer detected in the women. We are celebrating October month as the breast cancer awareness month. It helps the women to get more information about the breast cancer. DDRC SRL diagnostics center in Kerala provides free mammography campaigns for the women in Kerala in this breast cancer awareness month.
Breast Carcinoma.
Breast cancer is a malignant (cancerous) tumor that starts in the cells of the breast and spread to other tissues.
The most common form of cancer among women
It is estimated that each year more than 83,000 cases of breast cancer are reported in Pakistan. Nearly 40,000 women die, just due to this deadly disease
Carcinoma of the breast occurs commonly in the western world,accounting for 3–5% of all deaths in women. In developing countries it accounts for 1–3% of death
The most common form of cancer among women
The second most common cause of cancer related mortality
1 of 8 women (12.2%)
Carcinoma breast and its management (1).pptxDr Sajad Nazir
This ppt is about carcinoma breast, its types,presentation, diagnosis, examination,management and recent trends in it.
Sentinel lymph node indications, axillary lymph node management.
Indications for chemotherapy and radiotherapy.
This is mainly for post graduates...
Kindly read anatomy of breast before proceeding for cancer breast and its management
breast cancer
cancer
epidemiology
community medicine
awareness of breast cancer
سرطان الثدي
وبائيات سرطان الثدي
epidemiology of breast cancer
prevention of breast cancer
risk factors of breast cancer
epidemiology of breast cancer in iraq
sign and symptoms of breast cancer
location of breast cancer
Timberland Medical Centre is a private hospital that has been in operation since 1994. We are strategically located at the 3rd Mile roundabout on Jalan Rock, Kuching, Sarawak, East Malaysia. Our hospital is 10 minutes from the Kuching International Airport and 15 minutes from the Central Bus Terminal. We continually seek to improve and upgrade our services and facilities, as we strive to provide the best medical care for our patients and customers.
This presentation is by Dr. Wong Kwong Hieng (General Surgeon at Timberland Medical Clinic) and covers what is breast cancer, and the breast cancer treatment available in Kuching, Sarawak, East Malaysia.
For more information, visit https://www.timberlandmedical.com
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Couples presenting to the infertility clinic- Do they really have infertility...
Breast cancer ppt
1. UNIT 2 ONCOLOGY NURSING
2.2 MALIGNANCIES
BREAST CANCER
Prepared by:
Barsha Silwal
Roll no: 4
BNS third year
2. OBJECTIVES
Introduce breast cancer
State the epidemiology of breast cancer
State the risk factor for breast cancer.
Describe the etiopathogenesis of breast cancer
List the classification of carcinoma of breast
Explain the common type of breast cancer
State the clinical features of breast cancer
Describe the complications and prognosis of breast
cancer
Explain the diagnostic evaluation of breast cancer
Explain the management of breast cancer
4. CONT’D
Histologically ducts are composed
of
Inner layer of cuboidal to low
columnar epithelial cells
surrounded by a discontinuous
layer of myoepithelial cells,
enclosed by a basement
membrane.
Inner layer of epithelial cells
within the TDLU that gives rise to
the common forms of breast
cancer.
5. BREAST CANCER
Malignant growth of breast tissue
Breast cancer are common condition that
primarily affect women.
Breast cancer rarely seen in a client under the
age of 40
Cancer of the male breast is rare and
comprises 0.2% of malignant tumours
6. CONT’D
Ratio between male-female breast cancer is
1:150.
Clinically, the breast cancer usually presents
as a solitary,painless, palpable lump which is
detected quite often by self-examination.
Higher the age, more are the chances of
breast lump turning out to be malignant.
7. EPIDEMIOLOGY
The incidence of breast cancer is highest in the
perimenopausal women.
Cancer is a leading cause of death worldwide, accounting
for an estimated 9.6 million deaths in 2018.
Breast cancer is second most common type of cancer
and fifth leading cause of cancer death worldwide.
- WHO fact sheet, 2018
8. CONT’D
The most common cancers are:
1. Lung (2.09 million cases)
2. Breast (2.09 million cases)
3. Colorectal (1.80 million cases)
The most common causes of cancer death are :
1. Lung (1.76 million deaths)
2. Colorectal (862 000 deaths)
3. Stomach (783 000 deaths)
4. Liver (782 000 deaths)
5. Breast (627 000 deaths)
9. IN NEPAL
Most common cancer in Nepalese women,
second only to carcinoma of cervix.
Total number of breast cancer : 1, 716
Total mortality from cancer : 7, 400
Total mortality from breast cancer : 11.6 % (
858)
-WHO – Cancer Country Profiles, 2014
10. RISK FACTORS
Major increase
Mutation in BRCA1 , BRCA 2 , Li-Fraumeni syndrome
Increasing age
Family history of breast or ovarian cancer in first-degree
relatives
Benign breast disease with atypical hyperplasia
Exposure to ionizing radiation
Prior diagnosis of breast cancer
11. CONT’D
Moderate increase
Early menarche ( menstruation starts at an early age (11
or younger).
Late menopause (menopause after age 55)
Nulliparity or delayed first full-term pregnancy(above age
30)
High socioeconomic status
Alcohol intake
Obesity (postmenopausal women only)
12. CONT’D
Unfavorable mammographic parenchymal pattern
Diagnosis of soft-tissue sarcoma in son or daughter
prior diagnosis of uterine, ovarian, or colon cancer
Benign breast disease with hyperplasia but
without atypia
Oral contraceptives (for longer than 10 years)
Postmenopausal hormone replacement therapy : use
of combined HRT for 5 years or longer have a higher
risk for breast cancer. (CCS)
13. QUESTIONABLE INCREASE
Interrupted first pregnancy
Psychosomatic factors
High-fat diet
Complex fibroadenoma
Exposure to low-frequency electromagnetic
fields
14. DECREASE
Full-term pregnancy before age 20
Multiple pregnancies
Ovariectomy before age 45
Regular exercise, especially during
adolescence and early adulthood
Breast feeding
17. HORMONAL FACTORS
Hormone-dependent disease
Excess endogenous oestrogen or
prolonged use of exogenously oestrogen
Some evidences in support of relationship
of increased risk with oestrogen excess are
as follows:
prolonged reproductive life
Hormone replacement therapy (HRT
18. GENETIC FACTORS
About 10% breast cancers have been
found to have inherited mutations
most important of which is mutated
breast cancer (BRCA) susceptibility gene
in inherited breast cancer
19. PATHOGENESIS
Breast epithelium possesses oestrogen and
progesterone receptors
Breast cancer cells secrete many growth
factors which are oestrogen-dependent
Interplay of high circulating levels of
oestrogen, oestrogen receptors and growth
factors bring about progression of breast
cancer.
20. CONT’D
a) BRCA 1 gene
located on chromosome 17
DNA repair gene
Implicated in both breast and ovarian
BRCA1 deletion is seen in about two-third
of women with inherited breast cancer
21. CONT’D
BRCA 2 gene
Located on chromosome 13
Another DNA repair gene
Higher incidence of inherited cancer of the
breast (one-third cases) and ovary in
females, and prostate in men.
22. CONT’D
Mutation in p53
Tumour suppressor gene on chromosome
17
Acquired defect accounts for 40% cases of
sporadic breast cancer
But rarely in women with family history of
breast cancer
23. CLASSIFICATION
BASED ON TISSUE TYPES
A. Non-Invasive (In Situ) Carcinoma
1. Intraductal carcinoma
2. Lobular carcinoma in situ
B. Invasive Carcinoma
1. Infiltrating (invasive) duct carcinoma-NOS :80%
2. Infiltrating (invasive) lobular carcinoma: 10%
3. Tubular (cribriform) carcinoma :6%
4. Medullary carcinoma : 2%
5. Colloid (mutinous) carcinoma : 2%
6. Other types
C. Paget's Disease Of The Nipple
24. BASED ON HORMONE RECEPTOR AND
GENETIC STATUS
Estrogen and Progesterone Receptor Status
• Estrogen receptor positive
• Estrogen receptor negative
• Progesterone receptor positive
• Progesterone receptor negative
HER-2 Genetic Status
• HER-2 positive
• HER-2 negative
26. NON - INVASIVE BREAST CANCER
Twenty % of breast cancers are noninvasive
A. Ductal carcinoma in situ (DCIS)
o Unilateral
o May progress to invasive breast cancer if left untreated
o begins with atypical hyperplasia of ductal epithelium
followed by filling of duct with tumor cells.
o Clinically it produces palpable mass in 30-75% cases
and presence of nipple discharge in 30 %, patient.
27. B. LOBULAR CARCINOMA IN SITU (LCIS)
Women with LCIS are more likely to develop
invasive breast cancer than without LCIS
Develop invasive cancer of ipsilateral breast in
about 25% in 10 years
Developing contralateral breast cancer (30%).
Hormone therapy as a preventive measure to
reduce breast cancer risk
28. INVASIVE (INFILTRATING) DUCTAL CARCINOMA
Most common type
Starts in the milk ducts and then breaks
through the walls of the duct, invading the
surrounding tissue
More frequently in the left breast, often in
upper outer quadrant.
Retraction of the nipple and attachment to
underlying chest wall may be present.
29. INVASIVE (INFILTRATING) LOBULAR
CARCINOMA
Carcinoma begins in the lobules (milk-producing
glands)
Break out of the lobule and potential to metastasize to
other areas of the body
Usually presents as a subtle thickening
frequently bilateral and within same breast, it may
have multicentric origin
Generally not detected by mammography.
30. INFLAMMATORY BREAST CANCER
Aggressive and fast-growing breast cancer with a high
risk for metastasis
One to 3% of all breast cancers.
Term use for breast cancer in which there is redness,
edema, tenderness and rapid enlargement
Often mistaken for mastitis
Inflammatory changes do not improve with antibiotics
A breast mass may not be present and changes may
not show up on mammograms,
31. CONT’D
Breast looks red, feels
warm, and has a
thickened appearance ,
resembling an orange
peel (peau d'orange).
32. PAGET'S DISEASE
Paget’s disease of the nipple is an eczematiod lesion
of the nipple, often associated with an invasive or
non invasive ductal carcinoma
Rare breast malignancy
Starts in the breast ducts and spreads to the nipple
and areola.
One % of all breast cancers
Paget's disease with palpable mass have underlying
invasive (infiltrating) ductal carcinoma
No palpable breast mass are usually subsequently
found to have intraductal carcinoma
33. PHYLLODES TUMOR
A rare bulky breast tumor that develops in the
connective tissue ( stroma) of the breast
Can be classified into benign, borderline and
malignant
Most patient are between 30-70 years of age
About 20 % of phyllodes tumors are histologically
malignant and less than half of them may
metastasise.
34. TRIPLE-NEGATIVE BREAST CANCER:
Breast cancer tests negative for all three receptors
(estrogen, progesterone, and HER-2)
Incidence is higher in African Americans, Hispanics,
premenopausal women, and those with a BRCA1 mutation
More aggressive tumors with a poorer prognosis
Do not usually respond to Hormone therapy or therapy for
the human epidermal growth factor receptor 2 (HER-2)
Chemotherapy is most successful method of treatment
36. CONT’D
Palpable mass is usually painless,
nontender, hard irregular in shape
and non-mobile in 64 to 70% of
cases
But breast cancers can be tender,
soft, or rounded. They can even be
painful.
Nipple discharge and retraction,
edema with "peau d' orange" skin,
and dimpling, usually unilateral
and may be clear or bloody
38. DIAGNOSTIC EVALUATION
HEALTH HISTORY
PHYSICAL ASSESSMENT
RADIOLOGY AND IMAGING
LABORATORY TESTS
BIOPSY
TESTS TO DETECT METASTASIS
39. MAMMOGRAPHY
Imaging technique that reduce the breast cancer
mortality.
Detect non palpable mass and assist in diagnosis of
palpable mass.
Detect tumor before it is clinically palpable i.e less than
1cm.
Sensitivity is 75%.
Both screen film and digital mammography use x-rays
to obtain images. With digital mammography, a film
image is replaced with an electronic image similar to
digital photography.
41. CONT’D
The indications for a screening mammogram
ACS recommend mammogram every year
beginning at the age of forty (40 years).
Patients aged < 40 years who are asymptomatic
but are high-risk group.
Begin screening 10 years earlier than the age at
which the youngest family member developed
breast cancer but not before 25 years of age.
42. CONT’D
The indications for a diagnostic
mammogram
Patients with breast complaints and/or
symptoms.
When a lump is found on physical
examination.
Abnormal screening mammogram
43. CONT’D
a. Category 1 is a negative result (normal mammogram)
with nothing on which to comment.
b. Category 2 is a normal mammogram but there is a
benign finding on which to comment.
c. Category 3 is probably benign, but short interval
follow-up may be recommended to determine stability
of the finding.
d. Category 4 describes a suspicious abnormality and
biopsy should be considered.
e. Category 5 is highly suggestive of malignancy
requiring appropriate action.
f. Category 6 describes a known, biopsy-proven
malignancy requiring appropriate action.
44. NURSING CARE CONSIDERATIONS
Compression of the breast is used to reduce the amount
of the radiation absorbed by the breast tissue and
separate overlapping tissue.
Two views are taken routinely: craniocaudal and
mediolateral; other views are done as necessary.
Remind patients not to apply deodorant, cream, or
powder to breast, nipple, or underarm areas on
examination day.
45. CONT’D
Benefits overweight the exposure to low dose of
radiation. The radiation is equal to about 1 hour
exposure to sunlight.
Mammography is not routinely done if a woman
is pregnant.
The breasts of young women tend to be
extremely dense and are poorly suited to
mammography
46. LABORATORY TESTS
Tumor-Specific Tests:
Tests to evaluate the characteristics of a tumor and/or its
potential to regrow
1. Estrogen and progesterone receptors:
Positive tumor benefit from hormonal therapy.
Approximately 75% are estrogen receptor positive.
A negative result is associated with a less favorable
prognosis.
2. HER2—Human epidermal growth factor receptor
Demonstrated in 15% to 30% of breast cancers.
Associated with poorer survival, regardless of clinical
stage. May affect treatment decisions.
47. NIPPLE DISCHARGE CYTOLOGY
Secretions are smeared on a slide, fixed, and
submitted for cytologic examination.
High rate of false-negative test results with this
method
Wash nipple area with water and pat dry before
obtaining specimen if crusting of drainage is present.
48. BIOPSY
1. Percutaneous biopsy
a. Fine-Needle Aspiration (FNA)
b. Core Needle Biopsy:
c. Stereotactic Core Needle
2. Surgical biopsy
a. Incisional biopsy
b. Excisional biopsy
c. Wire Needle Localization.
49. 1. PERCUTANEOUS BIOPSY
Performed on an outpatient
basis to simple palpable and
nonpalpable lesions.
Less invasive than a surgical
biopsy
Percutaneous biopsy is a
needle or core biopsy that
obtains tissue by making a
small puncture in the skin.
50. A. FINE-NEEDLE ASPIRATION (FNA)
Noninvasive biopsy technique that is generally well tolerated
A small gauge needle (25- or 22-gauge) attached to a syringe
is inserted into the mass or area of nodularity.
Suction is applied to the syringe, and multiple passes are
made through the mass.
For nonpalpable masses, the same procedure can be
performed by a radiologist using ultrasound guidance
If no fluid is obtained, any cellular material obtained in the
hub of the needle is spread on a glass slide or placed in a
preservative and sent to the laboratory for analysis.
false-negative or false-positive results are possible
51. B. CORE NEEDLE BIOPSY
Similar to FNA, except that a larger gauge needle is
used (usually 14-gauge).
A local anesthetic is applied, and tissue cores are
removed via a spring-loaded device.
This procedure allows for a more definitive diagnosis
than FNA, because actual tissue, not just cells, is
removed.
It is often performed for relatively large tumors that are
close to the skin surface.
52. C. STEREOTACTIC CORE NEEDLE
An x-ray-guided method for
localizing and sampling
nonpalpable lesions detected on
mammography with 90% to 95%
sensitivity in detecting breast
cancer.
Outpatient procedure with the
patient lying prone on a special
table using an automated biopsy
gun with a vacuum system to draw
tissue into a sampling chamber and
rotate cutter to excise tissue.
53. 2. SURGICAL BIOPSY
Usually performed using
local anesthesia and IV
sedation.
After an incision is made,
the lesion excised and sent
to a laboratory for
pathologic examination.
54. A. EXCISIONAL BIOPSY
Standard procedure for complete pathological
assessment of a palpable breast mass.
The entire mass, plus a margin of surrounding tissue,
is removed.
Also called lumpectomy
55. B. INCISIONAL BIOPSY:
Surgically removes a portion of a mass.
To confirm a diagnosis and to conduct special studies
Complete excision of the area may not be possible or
immediately beneficial to the patient, depending on the clinical
situation.
Performed on women with locally advanced breast cancer or
on women with suspected cancer recurrence
Pathological information may be easily obtained from core
needle biopsy, and incisional biopsy is becoming less
common.
56. C. WIRE NEEDLE LOCALIZATION
Used to locate nonpalpable
masses or suspicious calcium
deposits detected on a
mammogram, ultrasound, or
MRI
Radiologist inserts a long,
thin wire through a needle,
which is then inserted into the
area of abnormality using x-
ray or ultra-sound
57. CONT’D
Wire remains in place after the needle is withdrawn to
ensure the precise location
Taken to the operating room, where the surgeon follows
the wire to the tip and excises the area
Excisional biopsy is then done removing the area
around the tip of the wire.
58. TESTS TO DETECT METASTASIS
Increased values on liver function tests may indicate
possible liver metastasis.
Increased calcium and alkaline phosphatase levels may
indicate possible bony metastasis.
Additional metastatic workup may include chest x-ray,
bone scan, computed tomography (CT) scan, and
positron emission tomography (PET) scan.
Biological markers (ie, CA15.3 and CA27.29) may be
used for monitoring patients with metastatic disease
59. PROGNOSIS
Two most important factors are
Tumor size
Spread to the lymph nodes under the arm (axilla)
Generally, the smaller the tumor, the better the
prognosis.
The 5-year survival rate can be as high as 98.1 % for
a stage I breast cancer and as low as 27.1% for a
stage IV breast cancer (National Cancer Institute,
2008).
60. CONT’D
Pathologic Factors Associated With Favorable Prognosis for
Breast Cancer
Noninvasive tumors or invasive tumors less than 1 cm
Negative axillary lymph nodes
Estrogen receptor (ER) and progesterone receptor (PR)
proteins
Well-differentiated tumors
Low expression of HER-2/neu oncogene (also known as
ERBB2)
No vascular or lymphatic invasion
Diploid tumors with low S-phase fraction
62. SURGERY
Primary treatment for breast cancer
The most common surgical options for operable
breast cancer are
(1) Breast conservation surgery (lumpectomy
[segmental mastectomy]) and
(2) Mastectomy with or without reconstruction
Breast cancer management.docx
63.
64. PHANTOM BREAST PAIN
Feeling pain in the breast after a mastectomy.
The brain continues to send signals to nerves in
the breast area that were cut during surgery,
even though the breast is no longer physically
there.
65. CHEMOTHERAPY
Used in the neoadjuvant and adjuvant setting
Usually given for 3 to 6 months.
However, when a patient has metastasis,
chemotherapy may be given for the rest of
the patient's life.
66. CONT’D
Most widely used adjuvant therapy
CMF : Cyclophosphamide , Methotrexate and
Fluorouracil
Also indicated in patient with high risk for
cardiac toxicity ( a potential side effect of
antracycline based regimens)
For higher risk patient
CAF : Cyclophosphamide, doxorubicin and
Fluorouracil
67. CONT’D
For larger, node –negative cancer and for
those with positive axillary lymph nodes
ACT :Doxorubicin, Cyclophosphamide and
Taxane
68. RADIATION THERAPY
o Adjuvant (additional) therapy that can be used after
surgery.
o Radiation therapy may be used for breast cancer to
(1) Prevent local breast cancer recurrences after breast-
conserving surgery;
(2) Prevent local and lymph node recurrences after
mastectomy; or
(3) Relieve pain caused by local, regional, or distant
spread of cancer.
69. CONT’D
External-beam radiation
The most common type
Typically begins about 6 weeks after breast conservation
If systemic chemotherapy is indicated, radiation therapy
usually begins after its completion
Each treatment lasts only a few minutes and is generally
given 5 days a week for 5 to 6 weeks
After completion of radiation to the entire breast, many
patients receive a "boost," a dose of radiation to the
lumpectomy site where the cancer cells were located
70. CONT’D
One approach is brachytherapy (Internal radiation)
Delivers partial breast radiation by placing a radioactive
source within the lumpectomy site
Lead to an improved quality of life
Administered over 4 to 5 days
Internal radiation therapy is primarily delivered using a
multicatheter method or balloon-catheter system.
71. CONT’D
In the multicatheter method (e.g., SAVI brachytherapy)
many very small catheters are placed in the breast at the
site of the tumor.
Small radioactive seeds are placed in the catheters. The
seeds are left in place just long enough to deliver the
radiation dose (e.g., 5 to 10 minutes).
Inserted only during treatment and then removed.
The radiation does not remain in the body between
treatments or after the final treatment is over.
73. PALLIATIVE RADIATION THERAPY
Reducing the primary tumor mass with
a resultant decrease in pain
Also used to treat symptomatic
metastatic lesions.
Radiation therapy often relieves pain
and is successful in controlling
recurrent or metastatic disease
74. HORMONE THERAPY
If the cells are estrogen receptor positive
Block the effect and source of estrogen thus promoting
tumor regression.
Chances of tumor regression are significantly greater in
women whose tumors have positive estrogen and
progesterone receptors.
Hormone therapy can
(1) Block estrogen receptors or
(2) Suppress estrogen synthesis by inhibiting aromatase,
an enzyme needed for estrogen synthesis.
76. IMMUNOTHERAPY AND TARGETED
THERAPY
Trastuzumab (Herceptin) is a monoclonal antibody
that binds specifically to the HER-2/neu protein,
Inactivates the HER-2/neu protein, thus slowing tumor
growth
Breast cancer management.docx
78. ASSESSMENT : SUBJECTIVE DATA
Breast Manifestations
1. Palpable lumps—date noted; affected by
menstruation; changes noted since detection.
2. Nipple discharge—date of onset, color, unilateral or
bilateral, spontaneous or provoked.
3. Pain or tenderness—localized or diffuse, cyclic or
constant, unilateral or bilateral.
4. Date of last mammogram and result.
5. Patient's practice of breast self-examination (BSE).
79. History General Information
1. Age.
2. Past medical-surgical history; injuries; bleeding tendencies.
3. Medications, including current or prior use of hormonal con-
traceptives and hormones, over-the-counter (OTC) products,
vitamins, and herbal supplements.
Gynecologic and Obstetric History
1. Menarche.
2. Date of last menses.
80. NURSING DIAGNOSIS
Preoperative Nursing Diagnoses
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 (individual or family) related
to the diagnosis of breast cancer and related treatment
options
Decisional conflict related to treatment options
81. POSTOPERATIVE NURSING DIAGNOSES
Pain and discomfort related to surgical procedure
Disturbed, sensory perception related to nerve irritaion in affected
arm, breast, or chest wall
Disturbed body image related to loss or alteration of the breast after
surgery.
Self-care deficit related to partial immobility of upper extremity on
operative side
Risk for sexual dysfunction related to loss of body part, change in
self-image, and fear of partner's responses
Deficient knowledge: drain management after breast surgery
Deficient knowledge: arm exercises to regain mobility of affected
extremity
Deficient knowledge: hand and arm care after ALND
82. NURSING INTERVENTIONS
PRE OPERATIVE CARE
1. The nature of the procedure is explained, along with expected post
operative care that includes drain care, location of incision, and
mobility of the arm.
2. Information is clarified about diagnosis and possibility of further
therapy.
3. Recognize the extreme anxiety and fear , that the patient, family, and
significant others experience.
a. Discuss patients concerns and usual coping mechanisms.
b. Explore support systems with patient.
c. Discuss concerns regarding body-image changes.
4. Determine how well the patient will tolerate surgery
83. NURSE SHOULD EXPLAIN ABOUT POTENTIAL
COMPLICATIONS
Infection.
Hematoma, seroma.
Lymphedema.
Paresthesia, pain of axilla and arm.
Impaired mobility of arm.
84. POSTOPERATIVE NURSING CARE
In addition to general operative care:
1. Dressing is removed and the wound is assessed for
erythema, hematoma (, edema, tenderness, odor, and
drainage.
a. Initial dressing may consist of gauze held in place by
elastic, tape, or clear occlusive dressing wrap.
b. Usually removed within 24 hours.
c. Incision may remain open to air or elastic wrap may be
replaced if patient prefers.
85. CONT’D
2. Suction drain from wound is maintained.
a. May have 100 to 200 mL serous to serosanguineous
drainage in the first 24 hours.
b. Report if grossly bloody or excessive in amount.
3. Arm on affected side is observed for edema, erythema,
and pain.
4. Patient teaching absout drain care, exercises,
surgical outcome, and BSE occurs.
5. Female relatives, especially sisters, daughters, and
mother who may need closer breast cancer
surveillance are discussed
86. IN ADDITION TO ROUTINE POSTOPERATIVE
INTERVENTIONS, PROVIDE THE FOLLOWING CARE.
Psychosocial Support
Mobilizing Affected Arm
Increasing Knowledge
Enhancing Body Image
Reducing Anxiety
Promoting Lymphatic Drainage
Maintaining Sexual Activity
Facilitating Family Coping
Patient Education and Health Maintenance
87.
88. EVALUATION: EXPECTED OUTCOMES
Moves affected arm within prescribed limits.
States care of incision, drains, follow-up guidelines.
No infection or complications in affected arm.
Expresses positive body image.
Exhibits minimal anxiety.
Reports satisfactory sexual activity and sexuality.
Maintains a functional support system.
89. REFERENCES
Brunner & S. (2011). Textbook of Medical- Surgical Nursing
(12thedi.). New Delhi, India,Vol II, Wolters Kluwer.
Sharma, S. K.(Ed.).(2017). Lippincott Manual of Medical
Surgical Nursing (10thedi.). New Delhi, India, Wolters
Kluwer.
Lewis, et al.,(2018). Medical Surgical Nursing: Assessment
and Management of Clinical Problems (3rdedi.). New Delhi,
Voll II, India, Elsevier.
Kufe; Pollock; Weichselbaum; Bast; Gansler; Holland;&
Feri (2003). Cancer Medicine : BC Deaker.
Devita V.T; Hellman.S; & Rosenberg.S.A; (2005);
CANCER Principle & Practice of Oncology; (5th edi);
Lippincott .
Editor's Notes
Each terminal duct and its ductules compose the terminal duct lobular unit (TDLU)
Li-Fraumeni syndrome ( mutation of tumor supressor gene):increases the risk of developing certain types of cancer, including breast cancer, osteosarcoma, soft tissue sarcoma and leukemia. Most people with Li-Fraumeni syndrome have inherited a mutation in the TP53 gene,
Atypical hyperplasia is a precancerous condition that affects cells in the breast. Atypical hyperplasia describes an accumulation of abnormal cells in the breast.
Atypical hyperplasia isn't cancer, but it can be a forerunner to the development of breast cancer. Over the course of your lifetime, if the atypical hyperplasia cells keep dividing and become more abnormal, this can transition into noninvasive breast cancer (carcinoma in situ) or invasive breast cancer.
Women who have received radiation therapy to the chest, neck and armpit area (called the mantle radiation field) have a higher risk of developing breast cancer.
This increased risk has been particularly noted in women who received treatment to these areas for Hodgkin lymphoma. The risk of developing breast cancer is higher if mantle radiation therapy for Hodgkin lymphoma was given before the age of 30. The risk is further increased if the radiation treatment was given during puberty. Breast cancer risk is greatly increased if chemotherapy is combined with radiation therapy to treat Hodgkin lymphoma before the age of 15 years. But the benefit of treating the cancer usually far outweighs the risk of developing a second cancer from radiation therapy treatment.
Risk for breast cancer went up by about 1% for every year that women took estrogen alone and about 8% for every year that they took combined HRT.
Fibroadenoma is the most common type of benign breast tumor, and most don’t increase your risk of breast cancer. Although women of any age can develop fibroadenomas, they usually occur in younger, premenopausal women.
Complex fibroadenoma is a sub type of fibroadenoma harboring one or more of the following features:
epithelial calcifications
papillary apocrine metaplasia
sclerosing adenosis and
cysts larger than 3 mm
Breast cancer is a hormone-dependent disease. There is sufficient evidence to suggest that excess endogenous oestrogen or exogenously administered oestrogen for prolonged duration is an important factor in the development of breast cancer. Evidences in support of relationship of increased risk with oestrogen excess are as follows:
Men who have mutated BRCA1 have increased risk of developing cancer of the prostate but not of male breast.
In BRCA1 as well as BRCA2, both copies of the genes (homozygous state) must be inactivated for development of breast cancer.
CHEK2 mutation also accounts for some cases of inherited breast cancer.
d) Other mutations seen less frequently in breast cancer include mutated form of
ataxia telangiectasia (AT) gene,
PTEN (phosphate and tensin) tumour suppressor gene.
DCIS is considered non-invasive or pre-invasive breast cancer. DCIS can’t spread outside the breast, but it still needs to be treated because it can sometimes go on to become invasive breast cancer (which can spread).
In most cases, a woman with DCIS can choose between breast-conserving surgery (BCS) and simple mastectomy. But sometimes a mastectomy might be a bett
for DCIS. Lumpectomy is sometimes called breast conserving treatment because most of breast is saved.
While screening mammograms are routinely administered to detect breast cancer in women who have no apparent symptoms, diagnostic mammograms are used after suspicious results on a screening mammogram or after some signs of breast canceralert the physician to check the tissue.
Standard views are bilateral craniocaudal (CC) and mediolateral oblique (MLO) views, which comprise routine screening mammography.
Additional view in diagnostic mamogram
Multiple samples are taken from different portions of the lesion. Allows harvesting of larger quantities of tissue with a single needle insertion. A tiny clip may be left in place at the end of the procedure to mark the area.
Depending on the clinical situation, a frozen section analysis of the specimen may be performed at the time of the biopsy by the pathologist, who does an immediate reading intraoperatively and provides a provisional diagnosis. This can help confirm a diagnosis in a patient who had no previous tissue analysis performed.
. Most women diagnosed with early stage breast cancer (tumors smaller than 5 cm) are candidates for either treatment choice as the overall survival rate with lumpectomy and radiation is the same as that with mastectomy. It is important to note that breast reconstruction is an option for any woman undergoing surgical treatment for breast cancer.
Radiation therapy is used to decrease the chance of a local recurrence in the breast by eradicating residual microscopic cancer cells. Breast conservation treatment followed by radiation therapy for stages I and II breast cancer results n a survival rate equal to that of a modified radical mastectomy (NCCN, 2009).