BREAST CANCER

By : Preethi Vithana

Content

• Anatomy of Breast• What is Breast Cancer• Risk Factors• Pathophysiology• Spreading of Breast Cancer• Investigation• Treatment• Nursing care• Preventive care

Introduction

• Most common female cancer

• Incidence high in the west

• 211,300 new cases yearly and rising

• 40,000 deaths yearly

• Incidence increasing 14 per 100000 in SL in 2000

Anatomy of Breast

The breast consist with;

• Lobules and ducts-lobules develop in pregnancy and puberty

-15 to 20 lobules, each has separate ducts

• Stroma -contains connective tissues and fat

• Lymph vessels

• Main blood supply by lateral thoracic artery

• Coopers ligament give support to the breast

Definition Breast cancer is an uncontrolled growth of breast cells.

It can be ductal carcinomas or lobular carcinomas.

Ductal Carcinoma Lobular Carcinoma

Two type of tumors

• Benign tumor -Benign tumors are

noncancerous

• Malignant tumor -Malignant tumors are cancerous Malignant Benign

Risk Factors• Genetic

BRACA 1

BRACA2

• Reproductive history

Increased estrogen exposure

–Early menarche

–Late menopause

–Nulliparity

• Female

• Family history

• Age

Other Risk Factors

• Obesity• Race• Alcohol • Birth control pills• Environmental

-Chemical -Radiation

-Heat

PathophysiologyEnvironmental factor

Inherited mutation;Genetic

Damage & failure of repair DNA

Mutation in genome

Activation of growth promoting oncogenes

Inactivation of tumor suppressor genes

Unregulated cell proliferation

Alteration in genes that regulate

apoptosis

Decreasedapoptosis

Colonial expansionTumor progression

Malignant neoplasm

Hormonal changes

Spreading of breast cancer

Breast cancer spreads in three different ways

• through the lymph system

• through the blood

• Local spread

Classification• Histopathology

This is based upon characteristics seen upon light microscopy of biopsy specimens

• GradeThis focuses on the appearance of the breast cancer cell comparing with normal breast tissues

• Stage TNM (tumor, node, metastasis) system

• Receptor statusAccording to estrogen progesterone receptor

• DNA-based

Staging• Primary Tumor

T1 = Tumor < 2 cm. in greatest dimensionT2 = Tumor > 2 cm. but < 5 cm.T3 = Tumor > 5 cm. in greatest dimensionT4 = Tumor of any size with direct extension to chest

wall or skin

• Regional Lymph NodesN0 = No palpable axillary nodesN1 = Metastases to movable axillary nodesN2 = Metastases to fixed, matted axillary nodes

• Distant MetastasesM0 = No distant metastasesM1 = Distant metastases including ipsilateral

supraclavicular nodes

Clinical Staging and prognosis

• Clinical Stage I T1 N0 M0

• Clinical Stage IIA T1 N1 M0 T2 N0 M0

• Clinical Stage IIB T2 N1 M0 T3 N0 M0

• Clinical Stage IIIA T1 N2 M0 T2 N2 M0 T3 N1 M0 T3 N2 M0

• Clinical Stage IIIB T4 any N M0

• Clinical Stage IV any T any N M1

• Staging prognosis for the 5 year survival rate

-stage I 93%

-stage II 72%

-stage III 41%

-stage IV 18%

Clinical Manifestations• Painless lump or thickening

• Thickening or swelling that

persist

• Axillary lymph node edema

• Pain or Invasive nipple

• Spontaneous discharge

• A breast that appears to have

enlarged

• Peud’orange appearance

Triple Assessment

• Clinical -Physical examination

-History

Investigations

• Imaging -Mammograms -MRI -Ultrasound

• Histology/cytologyFNAC (Fine needle aspiration cytology)

• HistologyCore biopsy

Treatments

• Surgical Treatments

-Lumpectomy

-Partial Mastectomy or Quadrantectomy

-Total Mastectomy

-Modified Radical Mastectomy

Lumpectomy

Quadrantectomy

Total Mastectomy

Modified Radical Mastectomy

• Radiation Therapy

• Chemotherapycyclosphosphamide, methotrexate, and fluorouracil

• Hormone blocking therapyTamoxifen or aromatase inhibitors Ex, Arimidex

Nursing Care and Interventions

• After surgery -wound care

• Long term complication -lymphedema, if present need to drainage fluid

• After radiotherapy -skin reactions occur leading to erythema, swelling and soreness of the breast. applied hydrocortisone

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 suppression, nausea and vomiting,

alopecia, weight gain or loss, fatigue, stomatitis, anxiety, and

depression.

• Provide psychological support to the patient throughout the diagnostic and treatment process.

• Involve the patient in planning and treatment.

• Describe surgical procedures to alleviate fear.

• Administer antiemetic prophylactically, as directed, for patients receiving chemotherapy.

• Administer I.V. fluids and hyperalimentation as indicated.

• Help patient identify and use support persons or family or community.

• Suggest to the patient the psychological interventions may be necessary for anxiety, depression, or sexual problems.

• Communicate feelings of comfort and decreased pain.

• Participate in her own care at the highest level possible within the limitations of her illness.

• Express positive feelings about self.

• Express increased sense of well-being.

• Use situational supports to reduce fear.

• Maintain optimal muscle strength and joint range of motion.

• Demonstrate adequate coping behaviors.

• Free from signs and symptoms of infection.

Preventive care• screening• physical activity• Limit alcohol• Breast-feed• Discontinue hormone

therapy• Avoid exposure to

environmental pollution• Breast self examination• Diet

References

• http://www.breastcancer.org/symptoms/diagnosis/staging.jsp• http://www.medicinenet.com/breast_cancer/article.htm• http://www.breastcancer.org/symptoms/testing/types/

physical_exam.jsp• http://www.singhealth.com.sg/PatientCare/

ConditionsAndTreatments/Pages/Breast-Cancer.aspx?gclid=CKnIi8_8vKwCFYka6wodoHXgow

• http://www.yapstuff.org/page/healthy_breasts.html?gclid=CL_C0Mz8vKwCFUN76wod-hSipg

Questions?

Thank You!!!