Interventions for Interventions for Clients with Clients with Breast

CancerCancer

Benign Breast Disorders

• Fibroadenoma, most common cause of breast masses during adolescence; may occur in clients in their 30s • Solid, slowly enlarging, benign mass; round, firm, easily movable, nontender, and clearly delineated from the surrounding tissue • Usually located in the upper outer quadrant of the breast

Fibrocystic Breast Disease

• Physiologic nodularity of the breast, most

common breast problem of women between 20

and 30 years of age • Stage 1: premenstrual fullness and

tenderness, symptoms occur on menstrual cycle • Stage 2: multiple nodular areas in both

breasts (Continued)

Fibrocystic Breast Disease (Continued)

• Stage 3: microscopic or macroscopic cysts

associated with pain, tenderness, or burning

occurring in women between 35 and 55 years of

age

Collaborative Management

• Symptomatic management • Hormonal manipulation • Drug therapy: vitamins C, E, and B

complex • Diuretics • Avoidance of caffeine • Mild analgesics (Continued)

Collaborative Management (Continued)

• Limited salt intake before menses • Well-padded supportive bra • Local application of heat or ice for

pain relief

Ductal Ectasia

• Benign breast problem of women approaching menopause caused by dilation and thickening of the collecting ducts in the subareolar area • Mass that is hard with irregular borders, tender • Greenish brown nipple discharge, enlarged axillary nodes and edema over the site of the mass

Intraductal Papilloma

• Occurs most often in women 40 to 55 years of

age • Benign process in the epithelial

lining of the duct, forming an outgrowth of tissue (Continued)

Intraductal Papilloma (Continued)

• Trauma and erosion within the duct, resulting in

bloody or serous nipple discharge • Diagnosis aimed first at ruling out

breast cancer

Gynecomastia

• Benign condition of breast enlargement in men • Can be a result of primary cancer such as lung cancer • Causes include: – Drugs – Aging – Obesity – Underlying disease causing estrogen excess – Androgen deficiency – Breast cancer

Breast Cancer

• Types of breast cancer • Complications include: – Invasion of lymph channels

causing skin edema – Metastasis to lymph nodes – Bone, lungs, brain, and liver

—sites of metastatic disease from breast

cancer – Ulceration of overlying skin

Breast Cancer in Men

• Of all breast cancers, only 1% occurs in men.

• Breast cancer in men usually presents as a hard, nonpainful subareolar mass.

• Breast cancer in men is often a widely spread disease because it is usually detected at a later stage than in women.

Mammography

• Baseline screening mammography yearly at age

40 is recommended. • Barriers to mammography

compliance can involve factors such as fear. • Increase compliance through

education.

Breast Self-Examination

• The goal of screening for breast cancer is early

detection because breast self-examination

cannot prevent breast cancer. • Early detection reduces

mortality rate. • Teach breast self-examination.

Breast Care

• Clinical breast examination • Cancer surveillance • Prophylactic mastectomy • Chemoprevention

Pathologic Examination

• Key to diagnosis of breast cancer • Presence or absence of estrogen

receptors or progesterone receptors • S-phase index, or growth rate • DNA ploidy • Histologic or nuclear grade • HER2/neu gene expression

Potential for Metastasis

• For clients with late-stage breast cancer, nonsurgical treatment may be the only alternative; tumor may be removed with

local anesthetic, follow-up treatment with

hormonal therapy, chemotherapy, and sometimes radiation. (Continued)

Potential for Metastasis (Continued)

• For breast cancer at a stage for which surgery is

the main treatment, follow-up with adjuvant

radiation, chemotherapy, hormone therapy, or

targeted therapy is commonly prescribed.

Surgical Management

• Mass should be removed to reduce risk for local recurrence; but controversy exists concerning the best treatment. • Axillary lymph nodes (dissection or removal) • Sentinel lymph node biopsy • Preoperative care • Operative procedure

Postoperative Care

• Avoidance of using the affected arm for blood

pressure measurement, giving injections, or

drawing blood • Monitoring of vital signs • Care of drainage tubes • Comfort measures • Mobility and diet • Breast reconstruction

Adjuvanat Therapy

• To decrease the risk of recurrence, adjuvant therapy consists of:

– Radiation therapy – Chemotherapy – Hormonal therapy – Stem cell transplantation – Targeted therapy