FACTS & FIGURESFACTS & FIGURES

MOST FREQUENT SITES OF CANCERBREAST & UTERUS = WOMEN

MALE & FEMALE BENIGN LESIONSMORE FREQUENT THAN MALIGNANT

182,000 NEW CASES EACH YEAR:1/3 WILL DIE

Leading cause of CA death in Leading cause of CA death in women ages 40 to 55women ages 40 to 55

MORTALITY RATE MORTALITY RATE ::

SCREENINGSCREENING•DETECTION @ EARLIER AGEDETECTION @ EARLIER AGE•MORE EFFECTIVE TX’SMORE EFFECTIVE TX’S

FIBROCYSTIC BREAST CONDITIONFIBROCYSTIC BREAST CONDITION

AGES 20 – 50 YRS

CAUSE: FEMALE HORMONESa.MENTAL STRESSb.CAFFEINEc.NO SX USUALLYd.AFTER MENOPAUSE, HORMONESe.CYSTS IN SIZE, f. RISKS FOR BREAST CANCER

THEN

DANAZOL (DANOCRINE) ESTROGEN

FIBROADENOMAFIBROADENOMA

LATE TEENS – EARLY 20’S*NO MALIGNANT POTENTIAL*

USUALLY FIRM, ROUND, ENCAPSULATED

EASILY REMOVED WITH A SMALL INCISION

<1% PROVE TO BE MALIGNANTAFRICAN AMERICAN WOMEN

INTRADUCTAL INTRADUCTAL PAPILLOMAPAPILLOMA

•WART-LIKE *BENIGN TUMOR

EPITHELIAL CELLS

•GROWS IN COLLECTING DUCT OR IN AREA OF CYSTIC DZ

•BLEED & BLOOD COLLECTS

PAGETS DISEASEPAGETS DISEASE

> 45 YEARS – UNILATERAL

BEGINS AS MILD ECZEMACONDITION – SPREADS

*TRUE CARCINOMA

EARLY & TOTAL REMOVAL OF BREAST

DETECTION & DIAGNOSIS (CA)DETECTION & DIAGNOSIS (CA)

90% DISCOVERED BY BSEAVERAGE SIZE OF TUMOR = 2.5CM

INCIDENCE – NO CHILDREN

INCIDENCE – MULTIPLE PREGNANCYOR BIRTH BEFORE 34 YEARS

INCIDENCE - HYSTERECTOMY

EARLY DETECTION

•TUMORS - 2 CM OR < LYMPH NODES•85% - 90% SURVIVAL

•+ LYMPH NODES =25% - 35% SURVIVAL

STAGING

TNM SYSTEM ♦

T = PRIMARY TUMOR {TUMOR SIZE}

N = REGIONAL LYMPH NODES{#NODES INVOLVED}

M = DISTANT METASTASIS{METASTASES}

T = TUMOR

T0 = NO TUMOR CLINICALLY

TIS = CARCINOMA IN SITU[SITE OF ORIGIN]

T1, T2 , T3, T4 = ASCENDING DEGREESOF IN TUMOR SIZE AND

INVOLVEMENT

N = NODES

N0 = NO REGIONAL LYMPH NODEINVOLVEMENT ASSESSEDCLINICALLY

NX = REGIONAL LYMPH NODES CANNOT BE ASSESSED CLINICALLY

N1, N2, N3, N4 = ASCENDING DEGREE OF NODAL INVOLVEMENT

M = METASTASIS

M0 = NO EVIDENCE OF DISTANTMETASTASIS

M1, M2, M3, M4 = ASCENDINGDEGREE OF METASTATICINVOLVEMENT OF HOST

CLINICAL STAGES – CA OF BREAST

SIZE TUMOR LYMPH NODES METS

I SMALL - 0 II 2CM 5CM - OR + 0

III LG 5 CM + 0

IV ANY SIZE + OR - ++

STAGE I – CA CONFINED TO MAMMARYLOBULES; NO NODE INVOLVEMENT

STAGE II – EXTENSION OUTSIDE LOBULES, TETHERING TO SKIN,AXILLARY NODES MAYBE +

STAGE III – INFILTRATED SKIN,

PEAU D’ ORANGE, PENETRATION

STAGE IV – PEAU D’ ORANGE, FIXATION, METS

DIAGNOSIS

SELF-EXAMONLY 25% TO 35% WOMEN DO BSE

REASONS$ FACTORS, EDUCATION,NO PAIN, *FEAR*, MODEST,DEPRESSIONAGE

INSPECTION

SYMMETRY, ERYTHEMA, EDEMA,

PITTING, PEAU D’ ORANGE,

ULCERATION, RASHES

NIPPLE DISCHARGE, (7 DAYS)

DIMPLING/RETRACTION

DON’T FORGET MALE BREASTS

DON’T FORGET MALE BREASTS

1% IN MEN ♦60 –65 YRS

SIMILAR CHARACTERISTICS

POORER PROGNOSIS

MAMMOGRAMSMAMMOGRAMSCAN DETECT MASSES LESS THAN

1 CM

AGES 35 – 50 NEED BASELINEAMERICAN CA SOCIETY SAYS AGE 40

ULTRASOUNDULTRASOUND

SOUND WAVES ♦MRIMRI IMAGING OF SUSPICIOUS AREAS

BIOPSY

NEEDLE-ASPIRATION90% ACCURATE

INCISIONAL – REMOVES PIECE

EXCISIONAL – REMOVES ALL

BREAST CANCER

BEGINS IN AN ATYPICAL AREA

(SINGLE TRANSFORMED CELL)

PROGRESSES TO CARCINOMA IN SITU

INVASIVE STAGE

MOST OFTEN - OUTER QUADRANTAS GROWS, BECOMES ATTACHED TOCHEST WALL OR OVERLYING SKIN

BREAST CANCER

METASTASIS MOST OFTEN – • LUNGS,• BONES,• MEDIASTINAL LYMPH NODES,• LIVER

IF UNTREATED – DEATH –USUALLY OCCURS 2 – 3 YEARS

Breast Cancer-Nursing Diagnosis

Anxiety

Grieving ♦Acute pain

Disturbed sleep pattern

Disturbed body image

Sexual dysfunction

HIGH RISKS

WOMEN OVER 40 YEARS OF AGENATURAL MENOPAUSE AFTER 50FAMILIAL HISTORYEARLY MENARCHECHRONIC STRESSNO KIDS OR 1ST CHILD AFTER 30EXPOSURE OTHER CANCER

SINGLE MOST MAJOR RISK

----OLDER---FEMALE

CLINICAL MANIFESTATIONS

USUALLY OUTER QUADRANT

NO PAIN, LOCALIZED DISCOMFORT,BURNING, STINGING, ACHING,DIMPLING, ORANGE PEEL APPEARANCE,

ASYMMETRY, ELEVATION OF AFFECTED BREAST, NIPPLE RETRACTION,ULCERATION, MALNUTRITION,

GENERAL ILL HEALTH

4 ORGANS – BREAST METASTASIS

1. LUNGS & PLEURA

2. BONES

3. CNS (BRAIN)

4. LIVER

HORMONES

LUMPECTOMY

OOPHORECTOMY

ADRENALECTOMY

ANTIESTROGEN THERAPY

TAMOXIFEN

Breast Cancer-Interventions ♦Nonsurgical management

Hormonal therapy

Chemotherapy

Radiation

Surgical management

Breast-conserving surgery

1. Lumpectomy

2. Partial mastectomy

Modified radical mastectomy

Breast reconstruction

RADIATION THERAPYRADIATION THERAPY

• 5 – 6 WEEKS• 5 DAYS/WEEK M – F• WEEKEND RESTS

SIDE EFFECTS: FATIGUE, EDEMA,

TENDERNESS OF BREAST, SKIN CHANGES

SURGICAL PROCEDURES

1.SIMPLE EXCISION (LUMP)

2.SIMPLE MASTECTOMY (BREAST)

3.MODIFIED RADICAL MASTECTOMY ENTIRE BREAST, NIPPLE & AXILLARY LYMPH NODES

4.RADICAL MASTECTOMY – ENTIRE BREAST, AXILLARY LYMPH NODES, BOTH PECTORALIS MUSCLES

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CHEMOTHERAPY

• ANTIMETABOLITES (CELL CYCLE SPECIFIC)

• ALKYLATING AGENTS (DNA LADDER STRUCTURE)

• CORTICOSTERIODS (PREDNISONE)

BREAST RECONSTRUCTION

1.SILICONE IMPLANTATION

2.TISSUE EXPANSION

3.MYOCUTANEOUS FLAPTRAM

           

 

PSYCHOSOCIAL CARE

1)RECURRENCE OF DX

2)PERSONAL, SOCIAL, SEXUALMEANINGS

3)PHYSICAL EFFECTS & ADJUVANT TX

FACTORS INFLUENCING ADJUSTMENTS

1.PATIENTS PERSONALITY

2.PAST & PRESENT COPING MECHANISMS

3.QUALITY OF FAMILY, SEXUAL, SOCIAL

4.PSYCHOSOCIAL SUPPORTS

8-10 WEEKS POST-OP

PRE-OP TEACHING

• DETAILS OF SX – LOCATION & EXTENT

• BLOOD LOSS• RADIATION & SIDE EFFECTS• CHEMO• PHYSICAL ‘S

POST OP - TO WATCH FORINTEGUMENTARY

OXYGENATION

CIRCULATION

MUSCULOSKELETAL

EXERCISES

PSYCHOSOCIAL

POST-OP TEACHING

INFECTIONPNEUMONIAHEMORRHAGEEXERCISESPSYCHOSOCIALVASOCONSTRICTION

REACH TO RECOVERY

HAND AND ARM CARE FOLLOWING AHAND AND ARM CARE FOLLOWING AMASTECTOMY MASTECTOMY

•PROTECT HAND AND ARM ON OPERATED SIDE•APPLY HAND LOTION•USE A THIMBLE WHEN SEWING•WEAR A MEDIC ALERT TAG•NOTIFY MD IF ARM GET RED OR SWOLLEN

AVOID:CUTS, BRUISES, BURNSWORKING NEAR THORNY BUSHESDIGGING IN THE GARDENBLOOD DRAWINJECTIONSB/P TAKEN ON AFFECTED ARMCARRYING HEAVY PURSE

QUESTIONS