This seminar presentation provides information about breast anatomy, breast cancer, risk factors, diagnosis, treatment and nursing interventions. The presentation covers the anatomy of the breast including lobes, ducts and lymph nodes. It defines breast cancer and describes types such as ductal carcinoma in situ, invasive ductal carcinoma and invasive lobular carcinoma. Stages of breast cancer and risk factors like age, family history and lifestyle factors are also outlined. Methods of diagnosis including mammography, ultrasound and biopsy are explained. Common treatments like surgery, chemotherapy and radiation are reviewed. Finally, nursing interventions related to risks like infection and body image are identified.

1. Seminar presentation
By:- Lemessa jira

2. 2

3. Presentation outline
• Breast anatomy
• breast cancer
• Epidemiology of breast cancer
• Types of breast cancer
• Stages of breast cancer
• Cause of breast cancer
• Risk factors
• Diagnosis and treatment
• Nursing interventions
3

4. Learning Objectives
• At the end of this session, you will be able to:
• Understand anatomy of breast
• Define breast cancer
• categorize types & stages of breast cancer
• List the causes of breast cancer
• Understand risk factors for breast cancer
• Describe the diagnosis and treatment options of
breast cancer
• Identify nursing interventions for breast
cancer
4cribe

5. Female Breast Anatomy
• Breasts consist mainly of
fatty tissue interspersed
with connective tissue
• There are also less
conspicuous parts
– lobes
– ducts
– lymph nodes
(American cancer society,
2016)
5

6. Normal Breast
Breast profile
A ducts
B lobules
C dilated section of duct to hold milk
D nipple
E fat
F pectoralis major muscle
G chest wall/rib cage
6
Enlargement
A normal duct cells
B basement membrane (duct wall)
C lumen (center of duct)
Illustration © Mary K. Bryson

7. Muscles
7
Breast has
no
muscle tissue
Muscles
underneath
the breasts
separating them
from the ribs

8. Breast Gland
8
• Each breast has 15 to 20
sections (lobes) arranged
like the petals of daisy
• Inside each lobe are many
smaller structures called
lobules
• At the end of each lobule
are tiny sacs (bulbs) that
can produce milk

9. Ducts
9
Areola
Lobes, lobules,
and bulbs are
Linked by a
network of thin
tubes (ducts)
Ducts carry
milk from bulbs
toward dark area
of skin in the
center of the
breast (areola)
Ducts join together
into larger ducts ending
at the nipple, where
milk is delivered

10. Blood Vessels
10
Oxygen, nutrients, and other
life-sustaining nourishment
are delivered to breast tissue
by the blood in the arteries
and capillaries.

11. Lymphatic System
11
• Lymph ducts: Drain fluid
that carries white blood
cells (that fight disease)
from the breast tissues
into lymph nodes under
the armpit and behind
the breastbone
• Lymph nodes: Filter
harmful bacteria and
play a key role in
fighting off infection
(Bahcall O, 2013)
A network of vessels
Lymph ductLymph node

12. What is Breast Cancer?
12

13. • Breast cancer starts when cells in the breast
begin to grow out of control. These cells
usually form a tumor that can often be seen on
an x-ray or felt as a lump
(American cancer society, 2016)
13

14. epidimiology
• In the US, around 1 in 8
women carry a lifetime risk of
invasive breast cancer.
(American cancer society, 2016)
14
Breast cancer is the common cancer in women
worldwide. It represents 16% of all cancers in
women. This rate is twice that of colorectal
cancer and cervical cancer and about three
times that of lung cancer.

15. Cont..
Somewhere in the world…
• A case of breast cancer is diagnosed
every 19 seconds
• A woman dies from breast cancer every 60
seconds
Over the next 25 years…
• Another 42 million new cases are
expected worldwide
• Another 13 million people worldwide will
die from breast cancer
(Globocan, 2012)
15

16. Types of breast cancers
• Ductal carcinoma in situ (DCIS)
- DCIS means that abnormal cells start in the
cells lining the ducts without invading through
the walls of the ducts into the tissue of the
breast. Because the cells haven’t invaded,
DCIS is also sometimes called a non-invasive
breast cancer.
16

17. Ductal Carcinoma in situ (DCIS)
17
Illustration © Mary K. Bryson
Ductal
cancer
cells
Normal
ductal
cellCarcinoma refers to any
cancer that begins in the
skin or other tissues that
cover internal organs

18. Cont…
• Invasive (or infiltrating) ductal carcinoma
(IDC)
- This is the most common breast cancer. It
starts in the cells lining a duct, and then
the abnormal cells break through the wall
of the duct and grow into (invade) the
tissue of the breast
18

19. Invasive Ductal Carcinoma (IDC –
80% of breast cancer)
19
• The cancer has spread to the
surrounding tissues
Illustration © Mary K. Bryson
Ductal cancer cells
breaking through
the wall

20. • Invasive (infiltrating) lobular carcinoma (ILC)
- This cancer starts in the cells lining the milk
glands (the lobules). The cells grow through
the wall of the lobules and then can spread to
nearby lymph nodes or other parts of the body.
20

21. Invasive Lobular Carcinoma (ILC)
21Illustration © Mary K. Bryson
Lobular cancer
cells breaking
through the wall

22. • Inflammatory breast cancer (IBC)
- This is a rare type of invasive breast
cancer. Often, there is no single lump or
tumor. Instead, IBC makes the skin of the
breast look red and feel warm.
(American cancer society, 2016)
22

23. Stages of breast cancer
• Stage 0—non-invasive carcinomas (LCIS or DCIS).
Cancer cells have not invaded the surrounding
breast tissue.
• Stage I—the tumor is no more than 2 cm in size
and cancer cells have not spread beyond the
breast.
23

24. • Stage II—either the tumor has spread to the
lymph nodes under the arms but the tumor is
less than 2 cm in size, or the tumor has not
spread to the lymph nodes under the arms but
is greater than 5 cm in size, or the tumor is
between 2 and 5 cm and may or may not have
spread to the nodes
24

25. Cont…
• Stage III—the tumor is greater than 5 cm in size
and has spread to the lymph nodes under the
arms.
• Stage IV—the cancer has spread to other parts
of the body (metastatic cancer).
(American Joint Committee on Cancer, 2010)
25

26. Causes of breast cancer
• The exact causes of breast cancer are not
well understood
• Breast cancer is usually caused by a genetic
abnormality. However, only 5-10% of cancers
are due to an abnormality inherited from
parents.
26

27. • The National Institute of Environmental
Health Sciences (NIEHS) added
estrogen to its list of known cancer-
causing agents.
(December 2015)
27

28. Risk Factors
• Non modifiable risk factors
 Gender: Breast cancer is much more common in
women than in men.
 Age: risk goes up with age.
80% of breast cancer occur in women older than age
50. in 30s, have one in 233 chance of developing
breast cancer. By age 35, chance is one in eight.
(Anderson GL, et al, 2012)
28

29. Cont…
• Genetic risk factors: Inherited changes
(mutations) in certain genes like BRCA1
and BRCA2 can increase the risk
• Around 45 percent of women who
inherit a harmful BRCA2 mutation will
develop breast cancer by age 70 years.
(Burstein HJ, et al, 2011)
29

30. Cont…
Menstrual periods
Breast radiation early in life
Family history
 Personal history of breast cancer
 Dense breast tissue
Race
Early menopause is protective
30

31. • Modifiable risk factor
Not having children or having them later in
life
Using hormone therapy after menopause
Being overweight or obese
Not breastfeeding
Alcohol
31

32. Compared to women who don't drink at all,
women who have three alcoholic drinks per
week have a 15% higher risk of breast cancer.
Experts estimate that the risk of breast
cancer goes up another 10% for each
additional drink women regularly have each
day
32

33. 33

34. Screening for breast cancer
• The term screening refers to tests and
exams used to find a disease like cancer in
people who do not have any symptoms. The
earlier breast cancer is found, the better
the chances that treatment will work. The
goal is to find cancers before they start to
cause symptoms
34

35. 35

36. 36

37. Signs and symptoms of breast cancer
• The most common symptom of breast cancer
is a new lump or mass. A lump that is
painless, hard, and has uneven edges is more
likely to be cancer.
• Swelling of all or part of the breast
• Skin irritation or dimpling
37

38. Cont…
• Breast pain
• Nipple pain or the nipple turning inward
• Redness, scaliness, or thickening of the
nipple or breast skin
• A nipple discharge other than breast milk
• Change in color or appearance of areola
38

39. Diagnosis of breast cancer
• Complete history
• Physical exam (including a breast exam)
39

40. Mammography
• Use a low-dose x-ray system to
examine breasts
• Digital mammography replaces x-
ray film by solid-state detectors
that convert x-rays into electrical
signals. These signals are used to
produce images that can be
displayed on a computer screen
(similar to digital cameras)
40

41. What Mammograms Show
Two of the most important mammographic
indicators of breat cancers
– Masses
– Microcalcifications: Tiny flecks of calcium – like
grains of salt – in the soft tissue of the breast
that can sometimes indicate an early cancer.
41

42. Detection of Malignant Masses
Malignant masses have a more spiculated
appearance
42
malignant
benign

43. Breast ultrasound
• An ultrasound uses sound waves to outline
a part of the body. The sound wave echoes
are picked up by a computer to create a
picture on a computer screen. For most
breast ultrasounds, a small, microphone-
like instrument is placed on the skin of the
breast after gel is applied.
43

44. Cont…
• This test is often used to look at an
area of concern found on a mammogram.
It can tell if something is a cyst or a
solid mass (tumor).
44

45. MRI of the breast
• MRI scans use magnets and radio waves
(instead of x-rays) to produce very
detailed, cross-sectional images of the
body. For a breast MRI, you have to lie
face down on a special platform inside a
narrow tube. The platform has openings
for each breast that allow the image to be
taken without pressing on the breast
45

46. Biopsy
• A biopsy is done when other tests show
that you might have breast cancer. The
only way to know for sure is for you to
have a biopsy. During this test, cells
from the area of concern are removed
so they can be studied in the lab.
46

47. 47

48. Types of treatment for breast cancer
• Surgery
• Radiation
• Chemotherapy
• Hormone therapy
• Targeted therapy
• Ovarian ablation or suppression
48

49. Surgery
• Surgery is usually the first type of treatment for
breast cancer. The type of surgery you undergo will
depend on the type of breast cancer you have.
There are two main types of breast cancer surgery:
• breast-conserving surgery – the cancerous lump
(tumour) is removed
• mastectomy – surgery to remove the whole breast
49

50. Chemotherapy
• Chemotherapy involves using anti-cancer
(cytotoxic) medication to kill the cancer
cells.
• It's usually used after surgery to destroy
any cancer cells that haven't been
removed. This is called adjuvant
chemotherapy.
50

51. Radiotherapy
• Radiotherapy uses controlled doses of
radiation to kill cancer cells. It's usually
given after surgery and chemotherapy to
kill any remaining cancer cells.
51

52. Hormone treatment
• Some breast cancers are stimulated to grow by
the hormones estrogen or progesterone, which
are found naturally in your body.
• These types of cancer are known as hormone
receptor-positive cancers. Hormone therapy
works by lowering the levels of hormones in
your body or by stopping their effects
52

53. Nursing process
DIAGNOSES
• Risk for infection, related to surgical incision
• Acute pain, related to surgery
• Disturbed body image, related to loss of breast
. Decisional conflict about treatment, related to
concerns about risks and benefits
. Fear, related to disease process/prognosis
53

54. Cont…
EXPECTED OUTCOMES
• Remain free of infection.
• Experience minimal pain or discomfort
during her recovery.
• Maintain a positive body image, regardless
of her decision about reconstruction.
54

55. Cont…
• Evaluate the treatment options in
relation to personal values and decide on
a course of action.
• Identify the sources of her fear and
demonstrate behaviors that may reduce
fears.
55

56. IMPLEMENTATION
• Teach her about hand washing and wound
care.
• Discuss the postoperative drainage device
and its management after she goes home.
• Assess her pain tolerance and administer
analgesics as prescribed
56

57. Cont…
• Encourage her to discuss her thoughts and
feelings about her body changes
• Encourage her to verbalize her fears about
her own prognosis and about her
daughters’ future risk of breast cancer;
assess the need/interest for referral to
psychological counseling.
57

58. Cont…
• Assess her interest in spiritual/religious
support and refer if appropriate.
• Teach her about dietary and lifestyle
changes that can help reduce the risk of
breast cancer for her daughters (low-fat,
high-fiber diet; regular exercise;
avoidance of obesity, alcohol, and oral
contraceptives).
58

59. References
• American Joint Committee on Cancer. Breast. In: AJCC Cancer Staging Manual, 7th ed. New
York: Springer; 2010: 347–369.
• American Cancer Society. Cancer Facts and Figures 2016. Atlanta, Ga: American Cancer
Society; 2016
• Anderson GL, Clebowski RT, Aragaki AK, et al. Conjugated equine oestrogen and breast cancer
incidence and mortality in postmenopausal women with hysterectomy: extended follow-up
of the Women’s Health Initiative randomised placebo-controlled trial. Lancet Oncol. 2012
May;13(5):476−486. Epub 2012 Mar 7.
• Bahcall O. Common variation and heritability estimates for breast, ovarian and prostate
cancers. Nature Genetics. Accessed at www.nature.com/icogs/primer/common-variationand-
heritability-estimates-for-breast-ovarian-and-prostate-cancers/ on May 30, 2013.
• Burstein HJ, Harris JR, Morrow M. Malignant tumors of the breast. In: DeVita VT, Lawrence
TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg's Cancer: Principles and Practice of
Oncology. 9th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2011:1401–1456.
59

60. 60