Oncology Nursing Topic Breast-Cancer.ppt

Oncology Nursing

2. Breast Cancer
•One out of every seven women will
be diagnosed with breast cancer in
2007
•Fortunately, radical mastectomy
(surgical removal) is rarely needed
today with better treatment options
2
Breast cancer is second only to lung cancer
as a cause of cancer deaths in American
women

3. What exactly is Breast
Cancer?

4. What is Cancer?
Cancer involves the abnormal multiplication
and spread of cells in the body.
It is usually caused by mutations in somatic
cell genes that regulate cell growth.
Almost every tissue in the body can produce
cancer; some even generate many different
types of cancer.
However, cancer mostly occurs in cells that
divide and reproduce more than other cells.

5. Breast Cancer
Breast Cancer occurs
when a mutation
takes place in the
cells that line the
lobules that
manufacture milk or
more commonly in the
ducts that carry it to
the nipple.
The area around the
center of the breast
is where most
cancers occur.
It is fairly rare for
cancers to form in
the fat or non-
glandular tissues of
the breast.

6. How does someone get
Breast Cancer?

7. The causes of breast cancer are not
completely understood and are not set in
stone. But certain women are more
susceptible of developing one form of
cancer.
http://www.cancerbacup.org.uk/info/brest/brest-5.htm
http://www.photostogo.com/store/search.asp?SearchStr=cancer
This is a picture of
breast cancer cells.

8. Risk Factors that cause
Breast Cancer
Factors that Cannot
be Prevented
Gender
Aging
Genetic Risk Factors
(inherited)
Family History
Personal History
Race
Menstrual Cycle
Estrogen
Lifestyle Risks
Oral Contraceptive Use
Not Having Children
Hormone Replacement
Therapy
Not Breast Feeding
Alcohol Use
Obesity
High Fat Diets
Physical Inactivity
Smoking

9. Environmental Factors
Exposure to Estrogen
Radiation
Electromagnetic Fields
Xenoestrogens
Exposure to Chemicals
This is a Breast
Cancer Cell
http://www.cellsalive.com/stock4.htm

10. Exogenous Estrogen
•Hormonal replacement
therapy(HRT)
–30% increased risk with
long term use
•Oral Contraceptives(OC)
–risk slight
–risk returns to normal once
the use of OC’s has been
discontinued

11. Risk Factors for Breast Cancer
•Radiation exposure
•Breast disease
–Atpyical Hyperplasia
–Intraductal carcinoma in situ
–Intralobular carcinoma in situ
•Obesity
•Diet
–Fat
–Alcohol

12. Genetics
•BRCA-1
•BRCA-2
•P53, Rb-1
•Her-2/neu, c-erB2,
c-myc

13. BRCA 1 and BRCA 2
Both of these genes code for DNA repair.
If a woman has a mutation on either one of
these genes, the risk of her getting breast
cancer increases from 10% to 80% in her
lifetime.
Mutations in BRCA1 or BRCA2 account for 40-
50% of all cases of inherited breast cancer.
These genes are also associated with ovarian
cancer in women and prostate cancer in men.
These genes can be inherited either from the
mother or the father.

14. Signs and Symptoms
14
Most common:
lump or
thickening in
breast. Often
painless
Change in color
or appearance
of areola
Redness or pitting
of skin over the
breast, like the
skin of an orange
Discharge
or
bleeding
Change in size
or contours of
breast

15. Types of Breast Cancer

16. Ductal Carcinoma in situ
(DCIS)
16
Illustration © Mary K. Bryson
Ductal
cancer
cells
Norma
l
ductal
cell

17. Invasive Ductal Carcinoma
(IDC – 80% of breast cancer)
17
•The cancer has spread to the
surrounding tissues
•Carcinoma refers to any cancer
that begins in the skin or other
tissues that cover internal
organs
Illustration © Mary K. Bryson
Ductal cancer
cells breaking
through the
wall

18. Invasive Lobular Carcinoma
(ILC)
18
Illustration © Mary K. Bryson
Lobular cancer
cells breaking
through the
wall

19. Cancer Can also Invade
Lymph or Blood Vessels
19
Illustration © Mary K. Bryson
Cancer cells
invade
lymph duct
Cancer cells
invade
blood
vessel

20. Staging of Breast Cancer
•The American Joint Committee on
Cancer (AJCC) has designated staging
by TNM
•T= tumor size
•N = lymph node involvement
•M = metastasis

21. Stage 1
•Tumor < 2.0 cm in
greatest dimension
•No nodal
involvement (N0)
•No metastases (M0)

22. Stage II
•Tumor > 2.0 < 5 cm
or
•Ipsilateral axillary
lymph node (N1)
•No Metastasis (M0)

23. Stage III
•Tumor > 5 cm (T3)
•or ipsilateral axillary lymph nodes fixed
to each other or other structures (N2)
•involvement of ipsilateral internal
mammary nodes (N3)
•Inflammatory carcinoma (T4d)

24. Stage IV (Metastatic breast
cancer)
•Any T
•Any N
•Metastasis (M1)

25. How do you detect Breast
Cancer?

26. Breast Self Examination
•Opportunity for woman to
become familiar with her
breasts
•Monthly exam of the
breasts and underarm area
•May discover any changes
early
•Begin at age 20, continue
monthly

27. When to do BSE
•Menstruating women- 5 to 7 days after
the beginning of
their period
•Menopausal women -
same date each month
•Pregnant women –
same date each month
•Takes about 20 minutes
•Perform BSE at least
once a month
•Examine all breast tissue

28. Breast Exam
Breast exam. 
The doctor will
check both of your breasts,
feeling for any lumps or other
abnormalities. Your doctor
will likely check your breasts
in varying positions, such as
with your arms above your
head and at your side.

29. Mammogram
A Mammogram is a X-ray of
the breast that takes
pictures of the fat, fibrous
tissues, ducts, lobes, and
blood vessels.
When should a mammogram
be performed?
If a lump has been found
during self-examination or
by a physician
Younger women who have a
strong history of breast
cancer in their family
All women over forty
Women who have had
previous diagnosis of breast
cancer.
http://www.photostogo.com/store/search.asp?
SearchStr=cancer

30. Breast Ultrasoud
•Breast ultrasound. 
Ultrasound
uses sound waves to produce
images of structures deep within
the body. Your doctor may
recommend an ultrasound to help
determine whether a breast
abnormality is likely to be a fluid-
filled cyst or a solid mass, which
may be either benign or cancerous.
Breast ultrasound is helpful to
guide radiologic biopsy to get a
sample of breast tissue if a solid
mass is found.

31. Breast Biopsy
Open biopsy provides a
complete tissue specimen,
which can be sectioned to
allow more
accurate evaluation.
Breast biopsy is necessary to
confirm or rule out cancer. Needle
biopsy or fine-needle biopsy can
provide a core of tissue or a fluid
aspirate, but needle biopsy should
be restricted to fluid-filled cysts
and advanced malignant lesions.

32. Abnormal Results:
•Benign tumors may suggest fibrocystic disease, adenofibroma,
intraductal papilloma, mammary fat
 
necrosis, or plasma cell
mastitis.
•Malignant tumors may suggest adenocarcinoma,
cystosarcoma, intraductal and infiltrating carcinoma,
inflammatory carcinoma, medullary or circumscribed
carcinoma, colloid carcinoma, lobular carcinoma, sarcoma, or
Paget’s disease.
Nursing Interventions:
•If the patient has received a general or local anesthetic, monitor the
patient’s vital signs regularly. If she has received a general anesthetic, check
her vital signs every 15 minutes for 1 hour, every 30 minutes for 2 hours,
every hour for the next 4 hours, and then every 4 hours.
•Administer analgesics for pain, as ordered, and provide ice bags for comfort.
•Instruct the patient to wear a support bra at all times until healing is
complete.
•Observe for and report bleeding, tenderness, and redness at the biopsy site.
•Provide emotional support to the patient awaiting diagnosis.

33. Breast magnetic resonance
imaging (MRI).
•Breast magnetic resonance
imaging (MRI). 
An MRI
machine uses a magnet and
radio waves to create pictures of
the interior of your breast.
Before a breast MRI, you
receive an injection of dye. This
test may be ordered after a
breast biopsy confirms cancer,
but before surgery to give your
doctor an idea of the extent of
the cancer and to see if there's
any evidence of cancer in the
other breast.

34. Different Views
34
Top-to-Bottom
Side-to-Side
MRI - Cancer can have a unique
appearance – many small
irregular
white areas that turned out to be
cancer (used for diagnosis)

35. Treatments of Breast
Cancer
There is no “cure” for breast
cancer.

36. Treatment of Breast
Cancer
Chemotherapy
Radiation Therapy
Drugs
Surgery

37. Chemotherapy
Chemotherapy works by destroying cells that
are dividing and multiplying all the time.
Chemotherapy is used for treatment of breast
cancer because there is a possibility of the
cancer to spread to other parts of the body.
Chemotherapy works better for premenopausal
women.
Systemic chemotherapy can prevent the spread
of cancer.
Chemotherapy drugs are administered
intravenously.

38. Radiation
Radiation, at high energy levels, has the
ability to destroy what is in its path,
including normal and abnormal cells
Fortunately new technologies have found a
way to battle cancer with radiation.
Radiation usually destroys rapidly dividing
cancerous cells.
Normal cells have the ability to repair
themselves.

39. Drugs
Usually drugs used to battle cancer are
taken while receiving some other type of
treatment.
Most of the time as well, three or four
drugs are used at the same time, so
there is an overlapping effectiveness.
There are four drugs that are commonly
used to battle breast cancer.

40. Types of Drugs used to
Treat Breast Cancer
Alkylating Agents
Cytoxan
These types of drugs
usually damage the
programs that control the
growth in tumor cells.
Antimetabolites
Methotrexate & 5-
fluorouracil
This type of drug
interferes with the making
of nucleotides, which are
the substances that make
up DNA.
Natural Products
Vincristine (Oncovin and
vinblastine (Velban) come
from the periwinkle plant.
These drugs interfere
with cell structure as well
as cell division.
Hormones
Prednisone
Hormones affect the
growth of hormones and
usually enhances the
effects of other
cytotoxic drugs.

41. Surgical Management:
•Lumpectomy: Surgery to
remove a
 
tumor (lump)
and a small amount of
normal
 
tissue around it.
•Partial mastectomy:
Surgery to remove the
part of the breast that has
cancer and some normal
tissue around it. This
procedure is also called
a
 
segmental mastectomy.

42. •Total mastectomy :
Surgery to remove the
whole breast that has
cancer. This procedure is
also called a simple
mastectomy. Some of the
lymph nodes under the
arm may be removed for
biopsy at the same time
as the breast surgery or
after. This is done
through a separate
incision.
Surgical Management:

43. Surgical Management:
•Modified radical mastectomy:
Surgery to remove the whole
breast that has cancer, many of
the lymph nodes under the arm,
the lining over the chest
muscles, and sometimes, part
of the
 
chest wall muscles.
•Radical mastectomy: Surgery
to remove the breast that has
cancer, chest wall muscles
under the breast, and all of the
lymph nodes under the arm.
This procedure is sometimes
called a Halsted radical
mastectomy.

44. Psychological Impacts of
Breast Cancer

45. What do Patients Go
Through After Diagnosis?
Depression
Anxiety
Hostility
Fear
Changes in life
patterns due to
discomfort and pain
Marital/sexual
disruptions
Reduction of
activities
Panic
Guilt
Difficulty adapting
to illness
Overwhelmed
Disappointment

46. Preoperative Nursing Diagnoses:
Knowledge deficit about breast cancer and
treatment option.
Anxiety related to breast cancer diagnosis.
Fear related to specific treatments, body image
changes or possible death.
Risk for ineffective coping (individual or
family coping)related to the diagnosis of breast
cancer and related treatment options.
Decisional conflict related to treatment
options.

47. Nursing interventions:
1.Explain breast cancer and treatment options
 The patient confronting the diagnosis of breast cancer reacts with feelings of fear,
dread, and anxiety. The patient must be given time to absorb significance of diagnosis
and in any formation that will help her to evaluate available treatment options.
 The nurse caring for the patient with breast cancer should be knowledgeable enough to
inform her patient about the things she should learn .
 Methods to compensate for physical changes related to mastectomy are also discussed.
2. Reducing fear and anxiety and improving coping ability
 Fears and concerns are common and are discussed with the patient
 The nurse provides anticipatory teaching and counseling at each stage of the process
and identifies sensations that can be expected during additional diagnostic procedures.
 The nurse also discusses the implications of treatment course and lifestyle.
3. Promoting decision making ability
 Careful guidance and supportive counseling are the interventions the nurse can use to
help such patients.
 Encouraging one step of the treatment process at a time can be helpful.

48. Postoperative Nursing Diagnoses
 Pain related to surgical procedure
Impaired skin integrity related to surgical incision
Risk for infection related to surgical incision and
presence of surgical drain.
Body image disturbance related to loss or alteration of
the breast related to the surgical procedure
Self-care deficit related to partial immobility of upper
extremity on operative side.
Risk for sexual dysfunction related to loss of body
part, change in self-image , and fear of partners
responses.

49. Nursing Interventions
1. Relieving pain and discomfort
 Assess pain and discomfort
Moderately elevate the involved extremity to relieve pain because it
decreases tension on the surgical incision, promotes circulation, and
prevents venous congestion on the affected extremity.
Give intravenous or intramuscular opioid analgesics to manage pain.
 by the following day after surgery after the patient takes in food and
fluid and anesthesia has cleared sufficiently oral analgesics can be
effective in relieving pain.
 patient teaching before discharge is important in managing discomfort
after surgery.
Patients should be encourage to take analgesic like Acethaminophen
before exercise or at bedtime.
Take warm shower twice daily (2
nd
postoperative day) to alleviate
discomfort that comes from referred muscle pain.

50. 2. Maintaining skin integrity and preventing
infection
Maintain the patency of the surgical drain.
The dressing and drain should be inspected for bleeding and the
extent of drainage monitored regularly.
 initially, the fluid in the surgical drain appears bloody , but it
gradually change into serosanguinos and then serous fluid
during the next several days.
 the 2
nd
day the patient may shower and wash the incision and
drain site with soap and water to prevent infection.
 Dry dressing should be applied to the incision each day for 7
days.
 After incision is completely healed (usually 4-6 weeks) ,
lotions or creams may be applied to the area to increase skin
elasticity.

51. 3. Reducing stress and improving coping
skills
Privacy is a consideration when assisting the woman to view
her incision for the first time.
Allowing her to express what she perceives, acknowledging
her feelings and allowing her to express her emotions.
Patients support system is important and the patients spouse
or partner may need guidance, support and education as
well.
Answering questions and addressing the patients
concerns about treatment options that may follow
surgery.

52. 4. Promoting participation in care.
 ambulation is encourage when client is free of post anesthesia
nausea and can tolerate fluid.
Exercise are initiated on the 2
nd
day to increase circulation and
muscle strength, prevent joint stiffness, contractures, and restore
full range of motion.
 exercise is performed 3 times daily for 20 mins.
Showering before exercising loosens stiff muscle encourage self
care activities such as brushing, combing etc.
Heavy lifting is avoided
Driving may begin after the drain is removed and patient has full
ROM
 women are encourage to elevate the arm above the level of the
heart on a pillow for 45 minutes at a time.( 3 times daily)

53. 5. Managing postoperative sensation
 Common sensations are tightness, pulling,
burning, and tingling along the chest wall in the
axilla and along the inside aspect of the upper arm
are normal part of the healing process.
 Performing the exercises may decrease the
sensations.
Acetaminophen assist in managing this discomfort.

54. Prevention

55. Fat
Research shows that dietary fat should
be 20% or less in order to gain
meaningful protection against cancer.
Fat cells make estrogen, which promotes
breast cancer.
Diets high in fat are associated with the
increasing breast density in
mammograms, which makes interpretation
more difficult.

56. Fiber
Fiber provides protection against
breast cancer because it has a
mechanism that decreases the
amount of estrogen in the body.
The amount of fiber in the diet
affects the activities of intestinal
bacteria, which affects the amount
of reabsorbed estrogens.

57. Antioxidant Nutrients
Antioxidants are important in fighting
breast cancer because they can disarm
cancer-causing substances called free
radicals.
Vitamin C
Vitamin E
Beta-carotene
Vitamin A
Selenium

58. Other Preventative
Measures
Early Detection!!!!
Exercise
No Smoking!!
Good Diet

59. 10 Super Foods to Fight Breast Cancer
1. Crunchy Vegetables
Broccoli may not win cool points with kids, but we love the supreme cancer-fighting power it
wields. Grouped with cauliflower, brussel sprouts and mustard greens, all contain antioxidants and
help to covert unhealthy estrogens into healthy ones.
2. Cherries
Pretty and perfect for popping into your mouth as a treat, cherries contain an alcohol that fights many
kinds of cancer, including breast cancer. They also have a natural anti-inflammatory agent and
antioxidants.
3. Tomatoes
Whether diced, sliced, pureed, pasted or sundried, tomatoes are well-known for containing lycopene,
a powerful, cancer-fighting antioxidant and anti-inflammatory. It's no wonder this garden vegetable
is the most popular in the United States. Choose your variety (cherry, grape, heirlooms) and enjoy!
4. Garlic
Strong in smell but wonderful as a seasoning for soups and sauces, garlic contains a group of
compounds that work to kill bacteria and fungus, and stimulate the immune system. Research shows
that breast cancer cells die when exposed to garlic in test tubes.
5. Salmon
Studies show eating some fish twice a week is good for your health, especially if salmon is on the
menu. Rich with fish oil, this super food contains essential omega-3 fatty acids, which research
shows lowers the risk of breast cancer, reduces inflammation, improves blood flow characteristics,
and may improve response to chemotherapy.

60. 6. Turmeric
Very popular in East Indian dishes, this ginger-based herb, often ground into a yellow-orange
powder, is mainly used for adding flavor and color to foods. Think curry-based dishes. As a
health benefit, turmeric contains aromatic oils that demonstrate anti-inflammatory and anti-
cancer activity. It also protects against free radicals.
7. Soy
Vegetarians dig soy for its versatility and its usefulness as a protein source in place of red
meat. But there’s more to soy than meets the eye. Soy also contains phytochemicals that are
known to greatly reduce your risk of developing breast cancer.
8. Green Tea
There’s no doubt you’ve heard about the many health benefits of green tea – for weight loss,
age-fighting and skin protection, for example. Its potent antioxidants also discourage cancer
cells from growing. Studies show that people who regularly drink green tea reduce their risk of
many cancers, including breast cancer.
9. Flaxseed
This tiny wonder food contains cancer-fighting compounds that protect because of their ability
to reduce the chances of cancer cells spreading. Flaxseeds are packed with fiber and omega-3
fatty acids that fight inflammation in the body.
10. Berries
They’re yummy to eat, yes, but strawberries, blackberries and raspberries contain a common
and powerful cancer fighter called ellagic acid. Blueberries, raspberries and blackberries
especially contain an abundance of antioxidants that can help reduce the risk of a number of
cancers.

61. Prevention Table
This table shows the recommendations and benefits of these
recommendations by age to prevent breast cancer from occurring.
http://rex.nci.nih.gov/MAMMOG_WEB/PUBS_POSTERS/FACTS_BC.html
Recommendations for Women of Different Ages.

62. Prognosis
Breast cancer is the second most lethal cancer in women. (Lung cancer is the leading cancer
killer in women.) The good news is that early detection and new treatments have improved
survival rates. The 5-year survival rate for women diagnosed with cancer is 80%. About 88%
of women diagnosed with breast cancer will survive at least 10 years. Unfortunately, women in
lower social and economic groups still have significantly lower survival rates than women in
higher groups.
Several factors are used to determine the risk for recurrence and the likelihood of successful
treatment. They include:
Location of the tumor and how far it has spread
Whether the tumor is hormone receptor-positive or -negative
Tumor markers
Gene expression
Tumor size and shape
Rate of cell division
The good news is that women are living longer with breast cancer. Due to better treatment
options, breast cancer mortality rates declined by about 25% since 1990. However, survivors
must live with the uncertainties of possible recurrent cancer and some risk for complications
from the treatment itself.
Recurrences of cancer usually develop within 5 years of treatment. About 25% of recurrences
and half of new cancers in the opposite breast occur after 5 years.