This document discusses breast cancer, including its definition, etiology, risk factors, stages, types, pathophysiology, clinical manifestations, diagnostic evaluation, and management. It notes that breast cancer is an uncontrolled growth of breast cells. Risk factors include family history and genetics. Staging looks at tumor size, lymph node involvement, and metastasis. Treatment includes surgery, chemotherapy, radiation, hormone therapy, and reconstruction. Side effects of treatment include nausea, fatigue, and hair loss. Nursing diagnoses relate to pain, anxiety, knowledge deficits, and coping issues.

1. PRESENTED BY:-
VIJAYARADDI VANDALI
PHD SCHOLAR, M. SC. (NSG), PGDHA,
DEPARTMENT OF NURSING .
KUST, SLEMANI,.

2. DEFINITION
Carcinoma of breast is an uncontrolled
growth of an a plastic cells in breast.
-Phipps

3. ETIOLOGY
 Genetic- alteration includes changes
or mutations in normal gens.
 Hormonal, steroid hormones
(produced buy ovaries) have an
important role in breast cancer.
Hormones i.e. estradiol and
progesterone, which can affect growth
factors for breast cancer.

4. Risk factors
 Female gender
 History of previous breast cancer-
 Age over 40 years
 Early menarche and menopause, or
both
 Reproductive history
 Family history
 Ionizing radiation Women.

5. Possible risk factor
 Diet
 Alcohol
 Obesity

6. Stages of cancer
T:- Primary tumor size
TX:- Primary tumor cannot be assessed.
T0:- No evidence of primary tumor.
Tis:- Carcinoma in situ, intraductal
carcinoma, lobular carcinoma in situ, or
piget’s disease of the nipple with node.

7. Contd..
 T1:- Tumor 1 cm or less in greatest
dimension.
 T2:- Tumor more than 2 cm but not
more than 5 cm in greatest dimension.
 T3:- Tumor more than 5 cm in greatest
dimension.
 T4:- Tumor of any size direct extension
to chest wall or skin.

8. N:- Regional lymph nodes
 NX:- Regional lymph nodes cannot be
assessed (e.g. previously removed)
 N0:- No regional lymph node metastasis.
 N1:- Metastasis to movable ipsilateral
axillary lymph nodes.
 N2:- Metastasis to ipsilateral axillary lymph
nodes fixed to one another or to other
structures.
 N3:- Metastasis to ipsilateral internal
mammary lymph nodes.

9. Contd..
 M:- Distant Metastasis
 MX:- presence of distal metastasis
cannot be assessed
 M0:- No distal metastasis
 M1:- Distant metastasis (includes
metastasis to ipsilateral supra clavicle
lymph nodes)

10. Types of breast cancer
Type Characteristics
Infiltrating ductual
carcinoma
- Solid mass, hard and firm
on palpation
Modularly carcinoma - Characterized by Prominent
lymphocyte Infiltrate,
frequently seen in younger
patients.
Mucinous or colloid
carcinoma
- Slow growing, mucus
producing

11. Invasive lobular carcinoma - Multicentricity common,
may involve both breasts
have ill defined margins.
Paget’s disease - Scaly, eczematous nipple
with burning, itching,
discharge, usual to palpate
mass beneath nipple
Inflammatory breast cancer - Diffuse edema, skin &
breast redness firmness of
underlying tissue,
tenderness pain, nipple
retraction.

12. Contd…..
Carcinoma in
situ
Proliferation of Malignant
cells with in ducts and
lobules, without invasion
into surrounding tissue,
ductual carcinoma in situ
appearing as clustered
micro calcifications on
mammography

13. PATHOPHYSIOLOGY
Breast cancers are malignant tumors
that typically begin in the ductual
lobular epithelial cells of the breast.
It spreads via the lymphatic system to
the axillary lymph nodes.
The tumor may then metastasize to
distant regions of the body, including
lungs, liver, bone & brain.

14. CONTD…
The finding of breast cancer is the
axillary lymph nodes are an indicator of
the tumors ability for potential distant
spread.
Most primary breast cancers are adeno
carcinomas located in the upper output
quadrant of the breast.

15. CLINICAL MANIFESTATIONS
 Breast cancer can occur anywhere in
the chest.
Complains of diffuse breast pain &
tenderness occurring at the time of
menstruation.
 Dimpling or organ – peel appearance
of the skin.

16. CONTD…
Nipple discharge, retraction and lesions
fixed to the chest wall.
 Metastasis to the skin by ulcerating
lesions.
 Lump that is – irregular, star shaped

17. DIAGNOSTIC EVALUATION
Obtain history from etiological factor
Physical examination
Monthly breast self examination (BSE)
 Mammography
Galctography
Ultrasonography
Fine needle aspiration
 Surgical biopsy

18. MANAGEMENT
Local treatment of breast cancer
Mastectomy
Radiation therapy
Chemotherapy

19. Breast consenting surgery

20. Chemotherapy
 A combination of
 Cyclophosphamide (C)
 5- Fluorouracil (F)
 Methotrexate (M)
Very recently doxorubicin has been
introduced in place of Adriamycin and
treatment time had been reduced to 6
months with 4 cycles in therapy.

21. CONTD…
 Preferred single agents:-
Doxorubicin
Epirubicin
Pegylated liposomal doxorubicin
Paclitaxel
 Docetaxel

22. CONTD…
Capecitabine
Vinorelbine
Gemcitabine
Albumin bound paclitaxel

23. Preferred combination
CAF/FAC :- Cyclophosphamide,
Doxorubicin, Fluorouracil.
FEC :- Fluorouracil, Epirubicin,
Cyclophosphamide.
AC :- Doxorubicin,
Cyclophosphamide.
EP :- Epirubicin,
Cyclophosphamide.

24. CONTD…
AT :- Doxorubicin, Docetaxel,
Doxorubicin, Paclitaxel
CMF :- Cyclophosphamide,
Methotrexate, Fluorouracil,
Docetaxel, Capecitabine.
GT :- Gemcitabine, Paclitaxel.

25. Other active agents
Cisplatin
Carboplatin
Etoposide (po)
Vinblastine
Fluorouracil continuous infection

26. Hormonal therapy
Hormonal therapy targets cells that
depend on estrogen for growth. To
counteract the menopausal effect,
antiestrogen drug research led to the
development of ER modulators
tamoxifen.

27. Contd…
Tamoxifen & raloxifenen are non
steroidal drugs that compete for the
estradiol- binding site on ER positive
cell, thus removing the stimulus
(estrogen) for tumors growth. A 5 year
course of tamoxifen has been the
hormonal therapy of choice for women
with ER positive breast tumor.

28. Reactions to chemotherapy
Nausea and vomiting
Stomatitis, Alopecia, Cellulites.
Menstrual abnormalities.
Weakness, malaise, fatigue.
Numbness, tingling
Hot flushes - due to hormonal
therapy
Lethargy

29. Reactions to raditional therapy
Skin reaction and fatigue.
Rare side effect is pneumonitis.

30. reconstruction of breast
Reconstruction with subcutaneous or
sub pectoral implant
Predicted or free myocutaneous flap

31. Nursing diagnosis
 Acute pain relate to inflammatory process
secondary to cancer process.
 Anxiety related to diagnosis of cancer.
 Knowledge deficit related to disease process
and treatment options.
 Ineffective coping by patient or family
related to diagnosis prognosis, financial
stress or inadequate support.