BREAST CANCER

• Identify Breast Cancer

• Assessment
• Diagnostic/ Lab Exam
• Pathophysiology
• Nursing Diagnosis
• Nursing Care
• Medical/ Surgical Treatment
• Rehabilitation

Objectives:
• Breast cancer is when cells in the breast begin to grow
out of control.
• 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.

What is Breast Cancer?

• Breast cancers can start from different parts of the breast.
Most breast cancers begin in the ducts that carry milk to
the nipple (ductal cancers). Some start in the glands that
make breast milk (lobular cancers). There are also other
types of breast cancer that are less common.
• A small number of cancers start in other tissues in
the breast. These cancers are called sarcomas and
lymphomas and are not really thought of as breast
cancers.

Where breast cancer

start
• Ductal carcinoma in situ
• Lobular carcinoma in situ
• Invasive (or infiltrating) ductal
carcinoma
• Invasive (or infiltrating) lobular
carcinoma

Common types of Breast

Cancer
BREAST CANCER STAGES
STAGES DEFINITION
STAGE 0 Cancer cells remain inside the breast duct,
without invasion into normal adjacent breast
tissue.
STAGE 1 Cancer is 2 centimeters or less and is confined
to the breast (lymph nodes are clear).
STAGE No tumor can be found in the breast, but cancer
IIA cells are found in the axillary lymph nodes (the
lymph nodes under the arm) or the tumor
measures 2 centimeters or smaller and has
spread to the axillary lymph nodes or
the tumor is larger than 2 but no larger than 5
centimeters and has not spread to the axillary
lymph nodes
STAGE The tumor is larger than 2 but no larger than 5
IIB centimeters and has spread to the axillary
lymph nodes or the tumor is larger than 5
centimeters but has not spread to the axillary
lymph nodes.
STAGE No tumor is found in the breast. Cancer is
IIIA found in axillary lymph nodes that are sticking
together or to other structures, or cancer may
be found in lymph nodes near the breastbone or
the tumor is any size. Cancer has spread to the
axillary lymph nodes, which are sticking
together or to other structures, or cancer may
be found in lymph nodes near the breastbone
STAGE The tumor may be any size and has spread to
IIIB the chest wall and/or skin of the breast and
may have spread to axillary lymph nodes that
are clumped together or sticking to other
structures, or cancer may have spread to
lymph nodes near the breastbone.
Inflammatory breast cancer is considered at
least stage IIIB.
STAGE There may either be no sign of cancer in the
IIIC breast or a tumor may be any size and may
have spread to the chest wall and/or the skin
of the breast and the cancer has spread to
lymph nodes either above or below the
collarbone and
the cancer may have spread to axillary lymph
nodes or to lymph nodes near the breastbone.
STAGE IV The cancer has spread — or metastasized
— to other parts of the body.
Risk Factors:
• High Genetic Risk
• Female
• Age
• Early menarche
• Late menopause
• First pregnancy after age 30
• Early or prolonged use of oral contraceptives

Assessment
• High-fat and low-fiber diet
• Excessive alcohol intake
• Cigarette smoking
• Exposure to low-level radiation
• Hormone Replacement therapy
• Obesity

Assessment
Subjective Data
• Breast pain or soreness
Objective Data
• Physical Assessment Findings
 Skin Changes(peau d’orange)
 Dimpling
 Breast Tumors
 Increased vascularity
 Nipple retraction or ulceration
 Enlarged lymph nodes

Assessment
• BRCA1 and BRC2 gene test
 Consent form is required before conducting the test.
 Cannot be done within 3 months of a blood transfusion
 Test result are either positive or negative for presence of
the gene.

Diagnostic/Laboratory
Tests
• HER2 gene cell
 Pathology report from a biopsy may determine if cancer
cells contain the HER2 gene.
 If the result is positive, this gene may be responsible for
the rapidly cancerous growing cells.
 Additional chemotherapy may be needed postoperatively.

Diagnostic/Laboratory
Tests
• Mammogram
• Biopsy-definitive diagnosis
 An open biopsy is done by excising a small portion of the
mass for histologic exam.
 Fine needle aspiration is the removal of tissue or fluid
from the breast mass through a large-bone needle.

Diagnostic/Laboratory
Tests
• Acute pain
• Body image disturbance related to significance of loss of
part or all of the breast
• Anxiety
• Fear
• Imbalanced nutrition: Less than body requirements
• Impaired physical mobility

Nursing Diagnoses
• Impaired skin integrity
• Ineffective coping
• Ineffective role performance
• Risk for infection
• Risk for spiritual distress
• Bathing or hygiene self-care deficit
• Energy field disturbance

Nursing Diagnoses
• Always evaluate the patient’s feelings about her illness
and determine her level of knowledge and expectations.
• Administer analgesics for pain as needed.
• Perform comfort measures to promote relaxation and to
relieve anxiety.
• If immobility develops late in the disease, prevent
complications by frequently repositioning the patient,
using a convoluted foam mattress.

Nursing Care
• Provide skin care particularly in bony prominences.
• Provide measures to relive adverse effects of treatment.
• Instruct the patient or caregiver how to manage adverse
effects of treatment.
• Watch for treatment complications, such as nausea,
vomiting, anorexia, leucopenia, thrombocytopenia,
gastrointestinal ulceration, and bleeding.

Nursing Care
• Monitor patient’s weight and nutritional intake for
evidence of malnutrition.
• Inspect the skin for redness, irritation, and skin
breakdown if immobility occurs.
• In late disease, monitor the patient’s pain level and the
efficacy of administered analgesics and non-
pharmacologic measures.
• Assess the patient’s and family’s ability to cope,
especially if the cancer is terminal.

Nursing Care
• Surgical procedures includes:
 Lumpectomy (Breast Conserving)
 Wide excision or partial mastectomy
 Total mastectomy
 Modified radical mastectomy
 Radical mastectomy
 Reconstructive surgery
 Endocrine related surgeries to reduce endogenous
estrogen as a palliative measure.
 Bone marrow transplantation may be combined with
chemotherapy.

Medical Surgical
Treatment
REHABILITATION