Breast cancer is the most common invasive cancer in women and the second leading cause of cancer death. It begins in the cells of the breast, usually the ducts or lobules, and can be invasive or non-invasive. Risk factors include being female, increasing age, family history, genetic factors, lifestyle factors like obesity, alcohol use, and reproductive factors. Symptoms may include a breast lump or changes to the breast or nipple. Treatment involves surgery, radiation, chemotherapy, hormone therapy, and targeted therapy depending on the cancer type and stage. Prevention strategies incorporate maintaining a healthy weight, being physically active, limiting alcohol, and breastfeeding.

1. INTRODUCTION:
Breast cancer is the most common invasive cancer in women and the second leading cause of
cancer death in women after lung cancer.
Breast cancer is a disease in which abnormal breast cells grow out of control and form tumours.
If left unchecked, the tumours can spread throughout the body and become fatal. Breast cancer cells
begin inside the milk ducts and/or the milk-producing lobules of the breast.
DEFINITION:
 According to the American cancer society (ACS), it is a disease that generates due to the
spreading and uncontrollable growth of abnormal cells.
 Breast cancer is the cancer that starts in the cells of the breast commonly in inner lining of milk
ducts or lobules. It can start in one or both breasts.
INCIDENCE:
 Breast cancer caused 685 000 deaths globally in 2020.
 Roughly half of all breast cancers occur in women with no specific risk factors other than sex
and age.
 Breast cancer occurs in every country in the world.
 Approximately 0.5–1% of breast cancers occur in men.
CLASSSIFICATION OF BREAST CANCER:
Breast cancer can be invasive or non-invasive. Invasive breast cancer is cancer that spreads into
surrounding tissues and/or distant organs. Non-invasive breast cancer does not go beyond the milk ducts
or lobules in the breast. About 80% of breast cancer is invasive cancer, and about 20% is non-invasive
cancer. There are multiple types of breast cancers, which are classified based on how they look under a
microscope.
 Ductal carcinoma in situ (DCIS): This is a non-
invasive cancer (stage 0) that is located only in the duct and
has not spread outside the duct.
 Lobular carcinoma in situ (LCIS): It is an uncommon
condition in which abnormal cells form in the milk glands
(lobules) in the breast.

2.  Invasive or infiltrating ductal carcinoma: This is cancer
that has spread outside of the ducts. It is the most common
type of invasive breast cancer.
 Invasive lobular carcinoma: This is a type of breast
cancer that has spread outside of the lobules.
Other less common include:
 Paget disease of the nipple: This type of breast cancer begins in the ducts of the nipple, but as it
grows, it begins to affect the skin and areola of the nipple.
 Phyllodes tumor: This very rare type of breast cancer grows in the connective tissue of the
breast. Most of these tumors are benign, but some are cancerous.
 Angiosarcoma: This is cancer that grows on the blood vessels or lymph vessels in the breast.
STAGES:
 Stage 0: Known as ductal carcinoma in situ (DCIS), the cells are limited to within the ducts and
have not invaded surrounding tissues.
 Stage 1: At this stage, the tumor measures up to 2 centimeters (cm) across. It has not affected
any lymph nodes, or there are small groups of cancer cells in the lymph nodes.
 Stage 2: The tumor is 2 cm across, and it has started to spread to nearby nodes, or is 2–5 cm
across and has not spread to the lymph nodes.

3.  Stage 3: The tumor is up to 5 cm across, and it has spread to several lymph nodes or the tumor is
larger than 5 cm and has spread to a few lymph nodes.
 Stage 4: The cancer has spread to distant organs, most often the bones, liver, brain, or lungs.
CAUSES AND RISK FACTORS:
The exact cause is idiopathic.
Factors that are associated with an increased risk of breast cancer include:
 Being female: Women are much more likely than men are to develop breast cancer.
 Increasing age: The risk of breast cancer increases as a person advances his or her age..
 A personal history of breast conditions: A breast biopsy that found lobular carcinoma in situ
(LCIS) or atypical hyperplasia of the breast have an increased risk of breast cancer.
 A personal history of breast cancer: If a person had breast cancer in one breast, then have an
increased risk of developing cancer in the other breast.
 A family history of breast cancer: If the mother, sister or daughter was diagnosed with breast
cancer, particularly at a young age, the risk of breast cancer is increased. Still, the majority of
people diagnosed with breast cancer have no family history of the disease.
 Inherited genes that increase cancer risk: Certain gene mutations that increase the risk of breast
cancer can be passed from parents to children. The most well-known gene mutations are referred
to as BRCA1 and BRCA2. These genes can greatly increase the risk of breast cancer and other
cancers, but they don't make cancer inevitable.
 Radiation exposure: If a person received radiation treatments to the chest as a child or young
adult, the risk of breast cancer is increased.
 Obesity: Being obese increases the risk of breast cancer.
 Beginning the period at a younger age: Beginning the period before age 12 increases the risk of
breast cancer.
 Beginning menopause at an older age: If a women began menopause at an older age, it is more
likely to develop breast cancer.
 Having the first child at an older age: Women who give birth to their first child after age 30 may
have an increased risk of breast cancer.

4.  Having never been pregnant: Women who have never been pregnant have a greater risk of breast
cancer than do women who have had one or more pregnancies.
 Postmenopausal hormone therapy: Women who take hormone therapy medications that combine
estrogen and progesterone to treat the signs and symptoms of menopause have an increased risk
of breast cancer. The risk of breast cancer decreases when women stop taking these medications.
 Drinking alcohol: Drinking alcohol increases the risk of breast cancer.
PATHOPHYSIOLOGY:

5. CLINICAL MANIFESTATIONS:
Breast cancer can have combinations of symptoms, especially when it is more advanced. Most people
will not experience any symptoms when the cancer is still early.
Symptoms of breast cancer can include:
 a breast lump or thickening, often without pain
 change in size, shape or appearance of the breast
 dimpling, redness, pitting or other changes in the skin
 change in nipple appearance or the skin surrounding the nipple (areola)
 abnormal or bloody fluid from the nipple.
MANAGEMENT:
Treatment will depend on several factors, including:
 the type and stage of the cancer
 the person’s sensitivity to hormones
 the age, overall health, and preferences of the individual
The main treatment options include:
 surgery
 radiation therapy
 chemotherapy
 biological therapy, or targeted drug therapy
 hormone therapy
SURGICAL MANAGEMENT:
 If surgery is necessary, the type will depend on both the diagnosis and individual preference.
Types of surgery include:
A) Lumpectomy: This involves removing the tumor and a small amount of healthy tissue
around it. It can help prevent the spread of the cancer.
B) Mastectomy: A mastectomy is surgery to remove all breast tissue from a breast as a way to
treat or prevent breast cancer.

6. There are several types of mastectomy. They include:
 Total (simple) mastectomy: This involves the surgeon removing the entire breast but
leaving the muscles under the breast and the lymph nodes in place.
 Double mastectomy: This involves the surgeon removing both breasts, usually as a
preventive measure — if genetic features indicate a high risk of breast cancer, for
example.
 Radical mastectomy: This involves the surgeon removing the entire breast, the
underarm lymph nodes, and the chest wall muscles.
 Modified radical mastectomy: This involves the surgeon removing the entire breast and
underarm lymph nodes but leaving the chest wall muscles intact.
 Skin-sparing mastectomy: This involves the surgeon removing the breast tissue and
nipple but leaving the skin intact.
 Nipple-sparing mastectomy: This relatively new procedure involves leaving the skin,
nipple, and peripheral breast tissue intact.
C) Sentinel node biopsy: Sentinel lymph node biopsy (SLNB) is a procedure in which the
sentinel lymph node is identified, removed, and examined to determine whether cancer cells are
present. It is used in people who have already been diagnosed with cancer.
A negative SLNB result suggests that cancer has not yet spread to nearby lymph nodes or other
organs.
A positive SLNB result indicates that cancer is present in the sentinel lymph node and that it
may have spread to other nearby lymph nodes (called regional lymph nodes) and, possibly, other
organs.
D) Axillary lymph node dissection: Axillary lymph node dissection (ALND) is a procedure to
remove these lymph nodes. ALND happens after cancer cells are found during a sentinel lymph
node biopsy. ALND can remove lymph nodes located above, below or directly underneath a
muscle that runs along the side of the upper chest.
RADIATION THERAPY: Radiation involves targeting the tumor with controlled doses of radiation
that kill any remaining cancer cells.
CHEMOTHERAPY: A doctor may prescribe cytotoxic chemotherapy drugs to kill cancer cells if there
is a high risk of recurrence or spread.

7. Some of the chemotherapy drugs for breast cancer include:-
 Anthracyclines, such as doxorubicin (Adriamycin) and epirubicin (Ellence)
 Taxanes, such as paclitaxel (Taxol) and docetaxel (Taxotere)
 5-fluorouracil (5-FU) or capecitabine.
 Carboplatin (Paraplatin)
HORMONE BLOCKING THERAPY: Hormones can stimulate some breast cancer cells to grow.
Hormone therapy works by either lowering the amount of hormones in the body or by blocking them
from getting to breast cancer cells. Hormone therapy is also known as endocrine therapy.
Examples of hormone blocking therapy medications may include:
 tamoxifen
 aromatase inhibitors
 ovarian ablation or suppression
 Goserelin, which is a luteinizing hormone-releasing agonist drug that suppresses the ovaries
BIOLOGICAL TREATMENT: Targeted therapy, also called biologic therapy, uses the body's
immune system or hormonal system to fight breast cancer cells.
Targeted drugs can destroy specific types of breast cancer. Examples include:
 trastuzumab (Herceptin)
 lapatinib (Tykerb)
 bevacizumab (Avastin)
NURSING MANAGEMENT:
Preoperative nursing interventions:
 Monitor for adverse effects of radiation therapy such as fatigue, sore throat, dry cough, nausea,
anorexia.
 Monitor for adverse effects of chemotherapy; bone marrow aspiration, nausea and vomiting,
alopecia, weight gain or loss, stomatitis, anxiety and depression.
 Involve the patient in planning and treatment.
 Describe surgical procedures to alleviate fear.

8.  Prepare the patient for side effects of chemotherapy, and plan ahead for alopecia, fatigue.
 Help patient identity and use support persons or family or community.
 Provide psychological support to the patient throughout the diagnostic and treatment process.
 Administer antiemetic prophylactically, as directed for patients receiving chemotherapy.
 Administer IV fluids and hyper alimentation as indicated.
Nursing Diagnosis:
1. Ineffective tissue perfusion related to lymphedema
2. Acute pain related to surgery.
3. Disturbed body image related to breast changes or loss of body part.
4. Impaired skin integrity related to surgical incision and radiation.
5. Anticipatory grieving related to loss and possible or impending death.
6. Anxiety related to diagnosis of breast cancer.
7. Disturbed sleeping pattern related to pain and anxiety.
8. Fear related to disease process or prognosis.
9. Risk for infection related to surgical incision.
Expected outcome:
1. Maintain adequate tissue perfusion.
2. Experience minimal pain or discomfort during recovery.
3. Maintain a positive body image.
4. Maintain skin integrity.
5. The patient will be able to identify and express feelings in an appropriate manner without
inflicting harm to oneself or others.
6. Reduce the level of anxiety.
7. Increase the sleeping pattern.
8. Identify the sources of her fear and demonstrate behaviours that may reduce fears.
9. Remain free of infection.
Nursing Interventions:
1. Elevate the surgical site extremity to relieve pain and edema. Elevation of extremity decreases
tension on surgical incision and promote blood circulation.
2. Ice pack to be applied to decrease discomfort and swelling particularly to the armpit after a
lymph node dissection.
3. A small pillow positioned in the armpit also may decrease discomfort and to promote gravity
drainage of fluid.

9. 4. Teach her to use caution when moving the arm on the operated side, to avoid strenuous activity,
lifting heavy objects, and vigorous exercise until the stitches are removed.
5. Administer IV or IM opioid analgesics (vicodin) for the management of moderate pain.
6. Narcotics can also cause or worsen constipation so increase fluid intake, eat high fibre foods and
take small walks.
7. Instruct the patient about post mastectomy exercises such as wall hand climbing, rod or broom
stick lifting, rope turning and pulley tugging.
8. Instruct patient in potential problem of lymphedema who undergo axillary node dissection in
combination with radiation therapy to axilla.
9. Teach the patient about importance of hand washing especially before wound and drain care.
Discuss the postoperative drainage device and its management.
10. Encourage her to discuss her thoughts and feelings about her body changes.
11. Discuss medication and dietary changes that will minimize the effects of chemotherapy, request
a consultation with the dietician.
12. Provide a list of educational resources about chemotherapy and breast reconstruction.
13. Encourage regular diet as soon as patient can take fluids after recovering from anaesthesia.
Encourages 8-10 glasses of water and non-caffeinated beverages per day, plenty of fruits and
vegetables as well as lower fat foods.
14. Teach her about dietary and lifestyle changes that can help reduce the risk of breast cancer.
PREVENTIONS:
1. Keep Weight in Check
It’s easy to ignore because it gets said so often, but maintaining a healthy weight is important for
everyone. Being overweight can increase the risk of many different cancers, including breast cancer,
especially after menopause.
2. Be Physically Active
Exercise is as close to a silver bullet for good health as there is. Women who are exercise for at least
30 minutes a day have a lower risk of breast cancer. Regular exercise is also one of the best ways to help
keep weight in check.
3. Eating Fruits & Vegetables – and Limit Alcohol

10. A healthy diet can help lower the risk of breast cancer. Try to eat a lot of fruits and veggies and limit
alcohol. Even low levels of drinking can increase the risk of breast cancer. And with other risks of
alcohol, not drinking is the overall best choice for the health.
4. Don’t Smoke
On top of its many other health risks, smoking causes at least 15 different cancers – including breast
cancer.
5. Breastfeed, If Possible
Breastfeeding for a total of one year or more (combined for all children) lowers the risk of breast
cancer. It also has great health benefits for the child. For breastfeeding information or support, contact
your paediatrician, hospital or local health department.
6. Avoid Birth Control Pills, Particularly After Age 35
Birth control pills have both risks and benefits. The younger a woman is, the lower the risks are.
While women are taking birth control pills, they have a slightly increased risk of breast cancer. This risk
goes away quickly, though, after stopping the pill. The risk of stroke and heart attack is also increased
while on the pill – particularly if a woman smokes. But long-term use can also have important benefits,
like lowering the risk of ovarian, colon and uterine cancers. Birth control pills also prevent unwanted
pregnancy, so there’s also a lot in their favour.
7. Avoid Hormone Therapy for Menopause
Hormone therapy in menopause shouldn’t be taken long term to prevent chronic diseases. Studies
show its mixed effects on health, raising the risk of some diseases and lowering the risk of others.
Whether estrogen is taken by itself or it’s combined with progestin, hormones increase the risk of breast
cancer. If women do take hormone therapy during menopause, it should be for the shortest time
possible. The best person to talk to about the risks and benefits of hormone therapy for menopause is
your doctor.
COMPLICATIONS:
Breast pain
Hormonal changes
Fibroadenomas
Nipple discharge
Sore, cracked and itchy nipples
Inverted nipples

11. Lymphedema
Breast and nipple infections.
CONCLUSION:
Breast cancer is the most common type of tumor in women in most parts of the world. Although
stabilized in Western countries, its incidence is increasing in other continents. Prevention of breast
cancer is difficult because the causes are not well known.
BIBLIOGRAPHY:
1. Lewi’s. Medical-Surgical Nursing- Assessment and Management of clinical problems. 2nd
South
Asia Edition. New Delhi; RELX India Private Limited: 2017.
2. Brunner and Suddarth’s. Textbook of Medical-Surgical Nursing. 13th
Edition. New Delhi;
Wolters Kluwer (India) Pvt. Ltd: 2015.
3. Venkatesan B: Textbook of Medical Surgical Nursing. Vol-I. Bangalore; Eminess Medical
Publishers: 2019.
4.