BREAST CANCER By : Preethi Vithana - PowerPoint Presentation

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BREAST CANCER

By : Preethi Vithana

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Content

Anatomy of BreastWhat is Breast CancerRisk FactorsPathophysiologySpreading of Breast CancerInvestigationTreatmentNursing carePreventive care

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Introduction

Most common female cancer Incidence high in the west211,300 new cases yearly and rising40,000 deaths yearlyIncidence increasing 14 per 100000 in SL in 2000

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Anatomy of Breast

The breast consist with;

Lobules and ducts

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lobules develop in pregnancy and puberty

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15 to 20 lobules, each has separate ducts

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Stroma -contains connective tissues and fatLymph vesselsMain blood supply by lateral thoracic arteryCoopers ligament give support to the breast

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Definition

Breast cancer is an uncontrolled growth of breast cells. It can be ductal carcinomas or lobular carcinomas.

Ductal

Carcinoma

Lobular Carcinoma

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Two type of tumors

Benign tumor -Benign tumors are noncancerous Malignant tumor -Malignant tumors are cancerous

Malignant Benign

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Risk Factors

Genetic BRACA 1 BRACA2Reproductive history Increased estrogen exposure Early menarcheLate menopauseNulliparityFemale Family history Age

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Other Risk Factors

ObesityRaceAlcohol Birth control pills Environmental -Chemical -Radiation -Heat

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Pathophysiology

Environmental 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 expansion

Tumor progression

Malignant neoplasm

Hormonal changes

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Spreading of breast cancer

Breast cancer spreads in three different waysthrough the lymph system through the blood Local spread

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Classification

Histopathology

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

Grade

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

Stage

TNM (tumor, node, metastasis) system

Receptor status

According to estrogen progesterone receptor

DNA-based

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Staging

Primary Tumor

T1 = Tumor < 2 cm. in greatest dimension

T2 = Tumor > 2 cm. but < 5 cm.

T3 = Tumor > 5 cm. in greatest dimension

T4 = Tumor of any size with direct extension to chest wall or

skin

Regional Lymph Nodes

N0 = No palpable axillary nodes

N1 = Metastases to movable axillary nodes

N2 = Metastases to fixed, matted axillary

nodes

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Distant Metastases

M0 = No distant metastases

M1 = Distant metastases including ipsilateral supraclavicular nodes

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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

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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

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Staging prognosis for the 5 year survival rate

-stage I 93%

-stage II 72%

-stage III 41%

-stage IV 18%

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Clinical Manifestations

Painless lump or thickeningThickening or swelling that persistAxillary lymph node edemaPain or Invasive nippleSpontaneous dischargeA breast that appears to have enlargedPeud’orange appearance

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Triple AssessmentClinical -Physical examination -History

Investigations

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Imaging

-Mammograms -MRI -Ultrasound

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Histology/cytology

FNAC (Fine needle aspiration cytology)

Histology

Core biopsy

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Treatments

Surgical Treatments

-Lumpectomy

-Partial Mastectomy or Quadrantectomy

-Total Mastectomy

-Modified Radical Mastectomy

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Lumpectomy

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Quadrantectomy

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Total Mastectomy

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Modified Radical Mastectomy

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Radiation Therapy Chemotherapycyclosphosphamide, methotrexate, and fluorouracil Hormone blocking therapyTamoxifen or aromatase inhibitors Ex, Arimidex

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Nursing Care and Interventions

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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

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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 pro

cess.

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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.

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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.

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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.

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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.

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Preventive care

screeningphysical activityLimit alcoholBreast-feedDiscontinue hormone therapyAvoid exposure to environmental pollution Breast self examinationDiet

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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

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Questions?

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Thank You!!!