• Breast Cancer

OBJECTIVES

• Discuss breast cancer and its

management
Breast CA

•BREAST CANCER

• A cancer that starts in the cells

of the breast in women and
men
•A cancer that starts in the cells
of the breast in women and men
Introduction

Breast cancer starts when cells in the

breast begin to grow out of control.
These cells usually form a tumor that
can often be seen on an x-ray or felt
as a lump. The tumor is malignant
(cancer) if the cells can grow into
(invade) surrounding tissues or
spread (metastasize) to distant areas
of the body. Breast cancer occurs
almost entirely in women, but men
can get breast cancer.
BREAST ANATOMY
Anatomy & Physiology

1- The breasts are made of fat, glands, and

connective (fibrous) tissue
2- The breast has several lobes, which are
divided into lobules and end in the milk
glands
3- Tiny ducts run from the many tiny
glands, connect together, and end in the
nipple
These ducts are where 78% of breast
cancers occur. This is known as infiltrating
ductal cancer.
4- Cancer developing in the lobules is
termed infiltrating lobular cancer. About
10-15% of breast cancers are of this type.
Another type of breast cancer is
inflammatory breast cancer (Often
Misdiagnosed and dangerous)
Risk Factors

1- Personal or family history

2- Not having children
3- Having first child after
age 30
4- Radiation therapy to
chest/upper body
5- Overweight or obese
6- Age
7- Late menopause
8- Diets high in saturated fat
9- Sex
10- ERT
BREAST • NON MODIFIABLE RISK
FACTORS
• MODIFIABLE RISK
FACTORS
CANCER :
• Gender (More • Nulliparity
RISK common in women) • Use of birth control
FACTORS • Age (>50yrs)
• Genetic risk factors
pills
• Postmenopausal
(BRCA1 & BRCA2) hormone therapy
• Race (PHT)

• Personal history of • Use of alcohol

breast cancer • Being overweight
• Early menarche & or obese
late menopause
Signs & Symptoms
1- Early breast cancer has
little or no symptoms. It is
not painful.
2-Breast discharge,
especially if only from
one breast
3-Sunken nipple
4-Redness, changes in
texture, and puckering.
Usually caused by skin
disease but sometimes
can be associated with
breast cancer.
5-Lumps on or around
breast. Most lumps are
not cancerous
6-Other lumps around the
under arm or collarbone
which don’t go away
SIGNS & SYMPTOMS
• A lump or mass on the breast
• Change in symmetry or size of the breast
• Skin changes such as thickening or dimpling , scaly skin around
the nipple, an orange- peel-like appearance or ulcer
• Change in skin temperature or colour
• Pink or bloody spontaneous unilateral nipple discharge
• Nipple changes- inversion or retraction, scaling, ulceration
TYPES OF BREAST
CANCER

• DUCTAL CARCINOMA
• The most common type of breast cancer
• Forms in the lining of the milk ducts
• Can remain in the duct as non-invasive or
ductal carcinoma in situ OR
• Can break out of the ducts and referred to
as invasive ductal carcinoma
• LOBULAR
• Starts in the lobules of the breast where
milk is produced
• Can break out of the lobules, to become
INVASIVE LOBULAR CARCINOMA
 • CONNECTIVE TISSUE
• Breast cancer can arise from the
connective tissues- RARE!
BREAST CANCER • Referred to as a SARCOMA
TYPES..CONT’D • Examples include phylloid tumors and
angio-sarcomas
 • Includes information on the size
of the tumour, lymph nodes status
and the presence or absence of
metastatic disease
• The American Joint Committee
on Cancer (AJCC) staging
system, commonly called the
TNM staging system is used,
BREAST where:
CANCER • T- represents the tumour size
STAGING • N- represents the presence or
absence of disease in ipsilateral
axillary lymph nodes
• M- indicates the presence or
absence of distant metastatic
disease e.g. bones, lungs, etc.
BREAST CANCER STAGING
Tumour Description Regional lymph Description Metastases Description
Size(T) Nodes (N) (M)

TX Primary tumor cannot be NX Lymph node cannot MX Metastases cannot

assessed be assessed be assessed

T0 No evidence of primary N0 No cancer spread to M0 No distant

tumor regional lymph metastases
nodes

T1 Tumour 0.1cm to 2cm N1 1-3 positive axillary M1 Metastases to other

nodes organs

T2 Tumour 2.1cm to 5cm N2 4-9 positive axillary

nodes

T3 Tumour >5cm N3 10 or more positive

axillary nodes

T4 Tumour involves all breast’s

quadrants or there’s
evidence of the disease on
the chest wall
BREAST CANCER STAGING
Stages of breast Cancer
The stages 0-IV
Stage 0 is noninvasive breast cancer, that is, carcinoma in situ with no
affected lymph nodes or metastasis. This is the most favorable stage to
find breast cancer.
Stage I is breast cancer that is less than three quarters of an inch in
diameter & has not spread from the breast.
Stage II is breast cancer that is fairly small in size but has spread to lymph
nodes in the armpit OR cancer that is somewhat larger but has not spread
to the lymph nodes
Stage III is breast cancer of a larger size (greater than 2 inches in
diameter), with greater lymph node involvement, or of the inflammatory
type. Spreading to other areas around the breast.
◦ Stage IV is metastatic breast cancer: a tumor of any size or type that has
metastasized to another part of the body (ex. bones, lungs, liver, brain).
This is the least favorable stage to find breast cancer.
Metastasis

❑lymph nodes under the arm or above

the collarbone on the same side as the
cancer. Brain, Bones, liver
BREAST CANCER TREATMENT

• Surgery: breast lump or whole breast removal

• Chemotherapy: Use of drugs
• Radiotherapy : Use of deep penetrative x-rays
• Hormonal therapy
Treatment

❖Radiation
❖Chemotherapy
❖Vaccines
❖Surgery
❖Hormonal therapy
❖Tamoxifen is the most commonly prescribed hormone treatment.
27CASE PRESENTATION: BREAST CARCINOMA
HER-2/neu Vaccine
1- Targets HER-2/neu protein
2- Made from small protein pieces likely to trigger an immune response
3- Helps to increase white blood cell counts
4- Monthly shots for six months
5- No serious side effects
Trastuzumab
1- Type of biologic therapy
2-Breast cancer treatment drug
3-Monoclonal antibody therapy
4-Blocks HER-2/neu
5-Effective in metastatic HER-2/neu positive breast cancer
6-Little effect with HER-2/neu negative breast cancer
Trastuzumab is administered intravenously weekly or every 3 weeks.[29]
Surgery

1- Lumpectomy, removal of the cancerous tissue and a surrounding

area of normal tissue
2- Simple mastectomy, removes the entire breast but no other
structures
3- Modified radical mastectomy, removes the breast and the
underarm lymph nodes
4- Radical mastectomy, removal of the breast and the underlying
chest wall muscles, as well as the underarm contents. This surgery is
no longer done because current therapies are less disfiguring and
have fewer complications.
Patey Mastectomy (MRM)

Patey Mastectomy (MRM) This is the most acceptable and most widely
practised surgery. In this , the entire breast including nipple and areola
are removed with, pectoralis minor, followed by axillary block
dissection should include node clearance up to level III. o Level I:
Extends from axillary tail to the lateral border of the pectoralis minor.
oLevel II: Extends from lateral border of the pectoralis minor to medial
border of the pectoralis minor. oLevel III: Up to the apex of axilla.
 Nursing Care plans
• Acute Pain Care Plan
• Pain associated with breast cancer can
be caused by tissue damage from the
cancer. It can also be caused by the
treatment measures used to fight the
cancer.
• Nursing Diagnosis: Acute Pain
• Related to:
• Tumor advancement causing
inflammation and compression on
nerves and bones
• Chemotherapy
• Radiation
• Surgery

https://www.nursetogether.com/breast-cancer-nursing-diagnosis-care-plan/
Acute Pain care plan
cont.
• As evidenced by:
• Verbalization of pain
• Body language/guarding behavior
• Facial grimacing
• Changes in vital signs
• Agitation/restlessness
• Expected Outcomes:
• Patient will verbalize pain is reduced or
controlled
• Patient will demonstrate the ability to
perform ADLs due to improved comfort
 • Acute Pain Assessment
• 1. Assess pain appropriately.
Breast cancer can cause pain due to the tumor(s) or
from the cancer treatments. The nurse can assess
pain by asking the patient their pain level on a 0-10
scale or using a nonverbal pain scale if the patient is
unable to rate.
• 2. Assess pain with vital signs.
Elevated blood pressure, tachycardia, and
tachypnea are often seen along with complaints of
Acute Pain… pain. The nurse can assess if pain is controlled or
not by assessing for changes in vital signs. Of
course, pain is always subjective and the nurse will
treat for pain based on the patient’s report.
• 3. Examine the patient’s cultural norms regarding
pain expression.
Some cultures display pain openly, while others do
not. The nurse can address this by assessing for
pain often, using verbal and nonverbal pain scales,
and remaining understanding and nonjudgmental
towards the patient’s beliefs.
Acute Pain…

• Acute Pain Interventions

• 1. Administer pain medication as prescribed.
Patients being treated for breast cancer often require a combination of opioids and NSAIDs
along with antiemetics for nausea caused by chemotherapy to relieve pain and discomfort.
• 2. Evaluate the effectiveness of pain medication.
After pain medications are administered, evaluate the effectiveness regularly. The dosage
and type of medications may need to be adjusted by the physician if the patient’s pain is
not controlled.
• 3. Provide nonpharmacological pain management.
Participating in activities such as distraction, massage, hot/cold compresses, and
acupuncture may provide the patient with pain relief and relaxation.
• 4. Educate patients about side effects and treatment.
Inform the patient about what to expect regarding side effects of chemotherapy, radiation,
and other treatments which are often uncomfortable. Educate and encourage patients to
be honest about their pain and communicate regularly with their provider.
 Other e.g’s of nursing
diagnoses

• Fear/ Anxiety related to Crisis/ Threat of death/ Lack of

knowledge / Unfamiliarity with treatments / Change in
health status AEB Verbalization of fear or worry /
Distressed appearance: shaking, hand wringing,
restlessness / Insomnia / Shortness of breath or heart-
pounding sensation (acute panic) /Crying / Difficulty
concentrating / Lack of appetite
• Impaired Skin Integrity Related to: Effects of radiation /
Effects of chemotherapy / Surgical incisions / Lymphedema
following surgery or radiation / Alteration in nutritional
status / Immunocompromised status AEB Skin irritation:
redness, skin peeling, swelling / Damaged epidermal tissue