Breast Cancer.pptx

For 2nd year B.Sc Nursing students

1. BREAST CANCER Presented By: Mr. NANDISH.S Associate Professor Mandya Institute of Nursing Sciences

2. INTRODUCTION : Breast cancer is a type of cancer that originates in the cells of breast. It is the most common cancer among women worldwide and second leading cause of death after lung cancer. It can be benign or malignant. In 2022, there were 2.3 million women diagnosed with breast cancer globally, out of which 0.67 million failed to survive.

3. DEFINITION : It is a type of cancer that begins in the breast – American Cancer S ociety. Breast cancer is a disease in which abnormal breast cells grow out of control and form tumor – WHO. It is a cancer that forms in the tissues of breast – National C ancer Institute In India, the most common type of breast cancer is Ductal Carcinoma which begins in the lining of the milk ducts.

4. ETIOLOGY & RISK FACTORS : 1. Genetic factors BRCA 1 located on chromosome 17 & BRCA 2 located on chromosome 11 are tumor suppressor genes present in women. Women with Mutation on these TWO genes may cause 10 – 40% of all breast cancer. Having a close relative diagnosed with breast cancer increases one’s risk. (mother, sister or daughter)

5. 2. Hormonal & Reproductive factors : Early Menstruation / Late Menopause Beginning menstruation at an early age (before 12 years) or experiencing menopause at later age (after 55 years) increases the life time exposure to estrogen and progesterone which increase the risk of breast cancer. Nulliparity Women who have never given birth. Late pregnancy Women who have their first child after 30 years of age. Hormone Replacement Therapy Long term use of combined estrogen and progesterone therapy after menopause.

6. 3. Lifestyle Factors - Alcohol consumption : Regular consumption of alcohol even in moderate amounts. - Obesity : Being overweight or obese after menopause. - Physical Activity : Lack of regular physical activity.

7. 4. Environmental and other factors : Previous Exposure to Radiation Dietary factors : consumption of diet rich in saturated fat, insufficient fruits and vegetables. Environmental Toxins : exposure to few chemicals, even though their contribution is not fully understood.

8. Types of Breast Cancer : Ductal Carcinoma In Situ (DCIS): It is a non invasive type where abnormal cells are found in the lining of breast duct but have not spread outside the duct.

9. 2. Invasive Ductal Carcinoma (IDC) This is the most common type of breast cancer. It begins in the milk ducts and then invades nearby tissue in the breast.

10. 3. Invasive Lobular Carcinoma (ILC) It begins in the lobules (milk producing glands) of the breast. It spreads to nearby tissue.

11. 4.Triple Negative Breast Cancer (TNBC) : It is characterized by the absence of Estrogen receptors, Progesterone receptors, HER2 (Human Epidermal growth factor Receptor ) / Neu receptors. It tends to be more aggressive and difficult to treat.

12. 5. Luminal A Breast Cancer : They are typically estrogen receptor – positive, progesterone receptor positive and HER2 – Negative. 6. HER 2 – POSITIVE Breast caner : This cancer is positive for a protein called Human Epidermal growth factor Receptor 2 which promotes the growth of cancer. It is treated with targeted therapies.

13. 7. Inflammatory Breast Cancer : It is a rare and aggressive form of breast cancer. It presents with redness, swelling and warmth in the breast.

14. 8. Paget’s Disease : It is a rare form of breast cancer. It starts in the ducts of nipple and spreads to surface of nipple & areola. It presents with symptoms like itching, redness and flaking of nipple skin.

15. PATHOPHYSIOLOGY : Due to E tiology Permanent damage to DNA (Mutation) Activation of Growth I ncucer Oncogens Disrupted proliferation of cells Growth of colony Progression of tumor Clinical features

16. CLINICAL MANIFESTATIONS : T – Tenderness or Pain A – Axillary Lymphadenopathy (Swollen lymph nodes in the armpit) N – Nipple retraction or Inversion L – Lump or mass in the breast U – Ulceration or skin changes (redness, dimpling or puckering) M – Milky discharge (from nipple) P – Peau d’ orange (skin resembling the texture of an orange peel)

17. DIAGNOSTIC STUDIES : History collection Physical Examination / Clinical Breast Examination (CBE) Mammography : it is an X – Ray of the breast tissue. Breast Ultrasound : sound waves are used to produce images of breast tissue. It helps to determine whether lump is Solid or Fluid filled. Breast MRI : Magnetic fields and Radio waves are used to create detailed images of Breast. It is done to evaluate abnormalities found on mammogram. Biopsy : A small sample of tissue is removed from the suspicious area and examined under the microscope. …….continued

18. Genetic Testing : it is done to identify mutations in genes like BRCA1 & BRCA2. It helps to rule out the risk. Ductogram : it involves injecting a contrast dye into the milk ducts of the breast and taking X-Rays. Fine Needle Aspiration : a thin needle is used to extract cells from a suspicious area in the breast. Core Needle Biopsy : a larger needle is used to remove small tissue from the suspicious area (larger sample).

19. BREAST SELF EXAMINATION : (June 2012 & 2019, Aug 2021 & 2023) It is a simple and convenient way for females to monitor their breast health and detect any changes that may indicate potential issue. Choose a regular time : Perform the examination at the same time in each month, ideally a few days after the menstrual period ends. Steps : Inspect the mirror : Stand in front of a mirror with shoulders straight and hands placed on hips. Examine your breast for any changes in size, shape or symmetry. Look for changes in skin texture, like dimpling or redness.

20. 2. Raise the arms : Raise the arms overhead & check for the same changes in size, shape and symmetry. 3. Examine the breast : Lie down on the back with a pillow placed under right shoulder and at right arm behind the head. Use the ones own three middle fingers on the left hand to check your right breast. Move the fingers in small, circular motion covering the entire breast and armpit area. Apply light, medium and firm pressure to feel different layers of tissue.

21. 4 . Check for Lumps or Thickening : Pay attention to any lumps or thickening. Be aware of changes in texture or the development of new, painless lumps. 5. Repeat on the other side: Repeat the examination on left breast using right hand. 6. Check the Nipples : Examine the nipples for any signs of discharge, change in shape or inversion. 7. Stand or sit examination : Perform examination in standing or sitting position whichever is helpful. 8 . Report any changes.

22. TREATMENT: 1. SURGERY : LUMPECTOMY (BREAST – CONSERVING SURGERY) : It involves removing only the tumor and small margin of surrounding tissue. It is an option for early – stage breast cancer. Following lumpectomy, radiation therapy is recommended to destroy any remaining cancer cells.

23. MASTECTOMY : In this procedure, entire breast is removed. There are different types. Partial Mastectomy : it is also known as Lumpectomy or breast – conserving surgery. Total / Simple Mastectomy : removal of entire breast without removing the axillary lymph nodes. Modified Radical Mastectomy : Removal of the entire breast along with the Axillary lymph nodes. Radical Mastectomy : this is an older procedure, involving removal of entire breast, underlying chest muscles and the axillary lymph nodes. It is typically reserved for extensive cases.

24. SENTINEL LYMPH NODE BIOPSY (SLNP) : In this procedure, the surgeon identifies and remove the sentinel lymph nodes – the first lymph nodes that cancer cells are likely to spread to form primary tumor .

25. AXILLARY LYMPH NODE DISSECTION (ALND): If cancer is found in the sentinel nodes, or if the surgeon suspects higher risk of lymph node involvement, a more extensive removal of axillary lymph nodes may be performed.

26. RECONSTRUCTIVE SURGERY : After the mastectomy, some women to choose to undergo breast reconstruction to restore the appearance of breast. It can be done by using implants or patient’s own tissue.

27. PROPHYLACTIC MASTECTOMY : In case of high genetic risk or strong family history of breast cancer, some women may choose to undergo prophylactic mastectomy to reduce the risk of developing breast cancer.

28. 2. RADIATION THERAPY External Beam Radiation : H igh energy rays are targeted at the affected breast to kill cancer cells & reduce the risk of recurrence. It is used oftenly after lumpectomy. Internal Radiation (Brachytherapy) : radioactive material is placed directly into or near the tumor . 3. CHEMOTHERAPY : Use of drugs to kill or slow the growth of cancer cells. It may be administered before or after the surgery.

29. 4. HORMONE THERAPY : For Hormone Receptor – Positive breast cancers, hormones may be used to block the effects of estrogen or progesterone. 5. TARGETED THERAPY : Drugs that target specific molecules involved in cancer growth. Ex : Herceptin (targets HER2 positive breast cancers)

30. 6. IMMUNOTHERAPY : It stimulates the body’s immune system to recognize & attack cancer cells. 7. LYMPH NODE DISSECTION : Removal of lymph nodes to determine the extent of spread of cancer. 8. GENETIC COUNSELLING : For individuals with a family history of breast cancer, genetic counselling and testing may be recommended.

31. Nursing Management : Acute pain related to tumor advancement causing inflammation and compression of nerves as manifested by facial grimacing. Impaired skin integrity related to surgical intervention and effects of chemotherapy as manifested by damaged skin. Anxiety related to crisis and threat to death as manifested by distressed appearance. Ineffective therapeutic regimen management related to lack of knowledge on treatment modalities.

32. THANK YOU