Breasr Cancer Report 2013

7/27/2019 Breasr Cancer Report 2013

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BREAST CANCER

Breast cancer is a malignant tumor that starts

in the cells of the breast.

A malignant tumor is a group of cancer cells

that can grow into (invade) surrounding

tissues or spread (metastasize) to distantareas of the body.


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The disease occurs almost entirely in women,

but men can get it, too.

One of every 13 Filipino women are expected todevelop breast cancer in her lifetime. (Philippine

Star, 2013)

Breast cancer is the most common cancer in thePhilippines, taking at least 16 percent of the

50,000 cases diagnosed. (Department of Health

and Philippine Cancer Society, 2010)

In men , less than 1% of all breast cancers.(Dr.

Aldine Basa, 2010)


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The Normal

Breast


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The Lymphatic

System of the Breast


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Pathogenesis of Breast Cancer

Normal cells in the body communicate with

each other and regulate each other's

proliferation (division).Cells proliferate toreplace worn-out cells.

When cancer occurs, cells escape the normalcontrols on their growth and proliferation.


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How do cells escape their normal

growth and proliferation?

By acquiring damage (mutations) to genes

that normally regulate cell proliferation.


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What are the genes that are being

damaged?

Tumor Suppressor Genes

they control the processes of cell growth and cell

death (called apoptosis).

Proto-oncogenes

responsible for promoting cell growth.


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What happens to the genes when

mutated?

Tumor Suppressor Genes (acquired/inherited)

this can lead to tumor formation or growth

Proto-oncogenes (acquired)

they become oncogenes and then can promote

tumor formation or growth.


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Two Categories of Breast Cancer

Noninvasive Breast Cancer

Ductal Carcinoma in Situlocated within the ductand have not invaded the surrounding fatty breasttissue.

Lobular Carcinoma in Situabnormal cells growinside the lobules of the breast, but have not spreadto the nearby tissue or beyond.

Invasive Breast Cancer

Infiltrating Ductal Carcinomaoriginates in themammary glands and grows in the epithelial cells

lining these ducts.


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Possible Outcomes of Metastasis of

Breast Cancer

70% of breast cancer patients suffer from

bone metastases.

10% suffer from brain metastases. 20% suffer from lung and liver metastases.


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Manifestation of Metastases

Metastatic breast cancer to the lung or pleura

causes

chronic cough,

dyspnea

abnormal chest X-ray

chest pain


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Metastatic disease to the bone causes

severe,

progressive pain

less commonly

pathological fracture

erythema over the affected bone

swelling


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Metastatic breast cancer to the brain causes

the following symptoms:

persistent,

progressively worsening headache,

visual changes,

seizures, nausea or vomiting,

vertigo,

behavioral and personality changes,

increased intracranial pressure.


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Metastatic disease to the liver causes

Jaundice

elevated liver enzymes

abdominal pain

loss of appetite

nausea

vomiting


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Gender

Simply being a woman is the main risk factor

for developing breast cancer.

Men can develop breast cancer, but thisdisease is about 100 times more common

among women than men.

This is likely because men have less of thefemale hormones estrogen and progesterone,

which can promote breast cancer cell growth


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Aging

Your risk of developing breast cancer

increases as you get older.

About 1 out of 8 invasive breast cancers arefound in women younger than 45, while

about 2 of 3 invasive breast cancers are

found in women age 55 or older.


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Race and Ethnicity

Overall, White women are slightly more likely todevelop breast cancer than are African-Americanwomen, but African-American women are more

likely to die of this cancer. However, in women under 45 years of age, breast

cancer is more common in African-American

women. Asian, Hispanic, and Native-American women

have a lower risk of developing and dying frombreast cancer.


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Dense Breast Tissue

Women with dense breasts is four to five

times more likely to get breast cancer than

women with less dense breasts.


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P lif i l i i h i I h


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Proliferative lesions with atypia: In these

conditions, there is an overgrowth of cells in

the ducts or lobules of the breast tissue, withsome of the cells no longer appearing normal.

They have a stronger effect on breast cancerrisk, raising it 3 1/2 to 5 times higher than

normal.


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Menstrual periods

Women who have had more menstrual cycles

because they started menstruating early

(before age 12) and/or went through

menopause later (after age 55) have a slightly

higher risk of breast cancer.

The increase in risk may be due to a longer

lifetime exposure to the hormones estrogen

and progesterone.


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Having children

Women who have had no children or who had

their first child after age 30 have a slightly

higher breast cancer risk.


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Hormone Therapy and Birth Control

Pills

Women using this therapeutic regimens can

increase the risk of developing breast cancer

due to the prolonged exposure of estrogen

and progesterone.


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Alcohol

Alcohol causes cancer cells' blood vessels to

grow which in turn fuels the growth of the

tumor, a process known as angiogenesis.


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Overweight and Obese

Most of a woman's estrogen comes from fat

tissue. Having more fat tissue especially after

menopause can increase your chance of

getting breast cancer by raising the estrogen

levels.


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Tobacco Smoking

For a long time, studies found no link between

cigarette smoking and breast cancer.

In 2009, the International Agency for Research on

Cancer concluded that there is limited evidence that

tobacco smoking causes breast cancer.

It is Suggestive but not Sufficient evidence

of a link at this point. (The 2006 US Surgeon

General's report, The Health Consequences of

Involuntary Exposure to Tobacco Smoke)


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Other possible signs and symptoms: Swelling of all or part of a breast (even if no distinct

lump is felt)

Skin irritation or dimpling Breast or nipple pain

Nipple retraction (turning inward)

Redness, scaliness, or thickening of the nipple or breastskin

Nipple discharge (other than breast milk)

Lymph nodes under the arm

.


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Early Cancer Detection Women age 40 and older should have a

mammogram every year and should continueto do so for as long as they are in good health.

Women in their 20s and 30s should have aclinical breast exam (CBE) as part of a periodic(regular) health exam by a health professionalpreferably every 3 years. Starting at age 40,women should have a CBE by a healthprofessional every year.


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Early Cancer Detection Breast self-examination (BSE) is an option for

women starting in their 20s. Women shouldbe told about the benefits and limitations ofBSE. Women should report any breast

changes to their health professional rightaway.

Women at high risk (greater than 20% lifetimerisk) should get an MRI and a mammogramevery year.


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Nursing Diagnosis

Deficient knowledge related to planned surgicaltreatments.

Anxiety related to the diagnosis of cancer

Fear related to specific treatments and bodyimage changes

Risk for ineffective coping related to the diagnosis

of breast cancer Decisional conflict related to treatment options.

Disturbed body image related to loss or alteration

of the breast


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Screening Procedures

Self-Breast Examination

Clinical Breast Examination

Mammogram


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Diagnostic exams in Breast CABiopsy

It is the examination of affected tissue in detectingpresence of cancer cells.

Nuclear Magnetic Resonance Imaging

This is viewing the structure of the breast using a high tech

radiation imaging in detecting presence of mass or tumors.

Ductogram

A type of X-ray that helps determine the cause of nipple

discharge. A ductogram can show if there is a mass inside

the duct at the nipple


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Treatment

Lumpectomy

Partial or segmental mastectomy

Simple mastectomy

Modified radical mastectomy Axillary lymph node dissection

Chemotherapy

Radiation Therapy


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Surgical Nursing Intervention

Pre-operative Obtain informed consent

Provide good care for a breast care

Be sure to know what kind of surgery to beperformed in order to prepare the patient

If mastectomy is scheduled:

Prevent pulmonary complications andthromboembolism

Place patient on the affected side


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Surgical Nursing Intervention

Post-operative Inspect dressing anteriorly and posteriorly

Check circulatory status

Encourage coughing exercises and turning scheduleevery two hours

Provide psychological and emotional support

Explain to the patient that she may experience phantom

breast syndrome


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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; bonemarrow suppression, nausea and vomiting, alopecia,

weight gain or loss, fatigue, stomatitis, anxiety, anddepression.

Realize that a diagnosis of breast cancer is a devastating

emotional shock to the woman. Provide psychologicalsupport to the patient throughout the diagnostic andtreatment process.

Involve the patient in planning and treatment.


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Nursing Interventions Describe surgical procedures to alleviate fear.

Prepare the patient for the effects of chemotherapy, and planahead for alopecia, fatigue.

Administer antiemetics prophylactically, as directed, forpatients receiving chemotherapy.

Administer I.V. fluids and hyperalimentation as indicated.

Help patient identify and use support persons or family orcommunity.

Suggest to the patient the psychological interventions may benecessary for anxiety, depression, or sexual problems.

Teach all women the recommended cancer-screeningprocedures.


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Medications

Trastuzumab (Herceptin) Pertuzumab (Perjeta)

Ado-trastuzumab emtansine

(KadcylaLapatinib (Tykerb)

Bevacizumab (Avastin)


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Documents

Breasr Cancer Report 2013