BREAST CANCER ( PRE AND POST OPERATIVE

CARE )

INTRODUCTION Breast cancer are common conditions that primarily affect women. When a women discovers a breast lump, her first response is often fear, of breast cancer, of losing her breast and perhaps of losing her life. Breast cancer also strikes men although rarely. Breast cancer is rarely seen in client under the age of 40.

TERMINOLOGIES fibrocystic breast changes : term used to describe certain benign changes in the breast, typically associated with palpable nodularity, lumpiness, swelling, or pain lymphedema : chronic swelling of an extremity due to interrupted lymphatic circulatin, typically from an axillary lymph node dissection mastitis : inflammation or infection of the breast paget’s disease : from of breast cancer begins in the ductal system and involves the nipple, areola, and \surrounding skin gynecomastia : overdeveloped breast tissue typically seen in adolescent boys

DEFINITION Breast cancer is a malignant (cancerous) growth that begins in the tissue of the breast. Cancer is a disease in which abnormal cells grow in an uncontrolled way.

TYPES OF BREAST CANCER 1 . DUCTAL CARCINOMA IN SITU ( DCIS ) increase use of mammography as a screening tool has contributed to the dramatic. characterized by the proliferation of malignant cells inside the milk ducts without invasion into the surrounding tissue. DCIS is frequently manifested on a mammogram with the appearance of calcifications , and considered breast cancer stage 0. if untreated, increase likelihood that it will progress to invasive cancer.

Cont… The most traditional treatment is total or simple mastectomy ( removal of the breast cancer) . The trend today is toward less aggressive surgery breast conservation treatment ( limited surgery followed by radiation).

CONT… 2. INVASIVE CANCER a) infiltrating ductal carcinoma accounts for 80% of all cases. tumors arise from the duct system and invade the surrounding tissue. they often form a solid irregular mass in the breast. b) infiltrating lobular carcinoma accounts for 10% to 15% of breast cancer. tumors arise from the lobular epithelium and typically occur as an area of ill-defined thickening in the breast.

Cont… c) medullary carcinoma accounts for about 5% of breast cancer. diagnosed more often in women younger than 50 years of age.Tumors grow in a capsule inside a duct .They can become large . d) mucinous carcinoma accounts about 3% of breast cancer.Often presents in postmenopausal women 75 years of age and older.Tumor is slow growing , prognosis is more favorable than in many other types.

Cont… e) tubular ductal carcinoma accounts for 2 % of breast cancer.Axillary metastases are uncommon with this histology.Prognosis is usually excellent. f) inflammation carcinoma unique symptomsCharacterized by diffuse edema and brawny erythema of the skin, referred to as peau d’orange.Can spread to other parts of the body.

cont… g) paget’s disease accounts for 1% of breast cancer.Symptoms include a scaly,erythematous , pruritic lession of the nipple.

ETIOLOGY 1. FEMALE GENDER AGE First-degree relative. Such as mother, sister, or daughter.

2. MENSTRUAL HISTORY Early menarche – (under age 12) ( late menopause after age 50 )

Cont….. 3. RADIATION EXPOSURE Chest x-ray, fluoroscopic examination, particularly before age 30. 4. LIFE STYLE High fat diet, alcohol intake greater than two drink daily. smoking obesityBreast trauma

PHATOPHYSIOLOGY Stage 0 – noninvasive carcinomas occupy

their locations of origin without spreading beyond this point

Stage I – the tumor is no larger than two centimeters, and cancer cells are confined to

the breast

Stage II – a tumor has started to spread to the lymph nodes or, the tumor has exceeded

five centimeters in size

Stage III – the tumor has exceeded five centimeters and has spread into the lymph nodes in a more extensive way than in stage

II

Stage IV – the cancer has metastasized and spread to other regions of the body

CLINICAL MANIFESTATION 1. Breast mass or thickening. 2. unusual lump in the underarm or above the colarbone. 3. Abnormal nipple discharge. 4. Rash around the nipple area. 5. Change in nipple position. 6. Burning, stinging or pricking sensation.

INVESTIGATION / TEST PERCUTANEOUS BIOPSY 1) percutaneous biopsy performed on an outpatient basis to sample palpable and nonpalpable lesion. 2) is a needle or core bopsy that obtains tissue by making small punture in the skin. a) fine-needle aspiration 1) noninvasive biopsy technique. 2) need a small gauge needle ( 25 or 22

gauge). 3) suction is applied to the syringe.

Cont… 4) fluid is usually discarded. 5) less expensive than other diagnostic methods and result are usually available quickly. b) core needle biopsy 1) similar to fine-needle aspiration (FNA). 2) but used large gauge needle (usually 14 gauge). 3) a local anesthetic is applied, and tisssue cores are removed. 4) more definitive diagnosis then FNA.

Cont… c) stereotactic core biopsy 1) performed on nonpalpable lesions detected by mammography. 2) tissue are taken for pathologic examination. 3) quite accurate and often allows the patient to avoid a surgical biopsy.

IMAGING

1. Chemotherapy

* The most common chemotherapy agents act by killing cells that divide rapidly, one of the main properties of most cancer cells. This means that chemotherapy also harms cells that divide rapidly under normal circumstances

2. Radiation Therapy

* is a highly targeted, highly effective way to destroy cancer cells in the breast that may stick around after surgery. Radiation can reduce the risk of breast cancer recurrence by about 70%. * Despite what many people fear, radiation therapy is relatively easy to tolerate and its side effects are limited to the treated area.

3. Breast lumps

* Less than one-fourth of all breast lumps are found to be cancerous, but benign breast disease can be difficult to distinguish from cancer. Consequently, all breast lumps should be checked by a health care professional.

4. Mammography

* Mammography is a low-powered x-ray technique that captures a picture of the internal structure of the breast. * Additional angles and magnified views are taken of suspicious areas. A mammogram may help in the diagnosis of breast problems, including cancer.

5. CT scan

* a thin X-ray beam is rotated around the area of the body to be visualized. Using very complicated mathematical processes called algorithms, the computer is able to generate a 3-D image of a section through the body. * CT scans are very detailed and provide excellent information for the physician.

6. Open biopsy of the breast

* An open biopsy can be performed under local or general anesthesia and will leave a small scar. Prior to surgery, a radiologist often first marks the lump with a wire, making it easier for the surgeon to find.

TREATMENT SURGICAL

1)LUMPECTOMYA lumpectomy is surgery to remove a small area of breast tissue that is cancerous.This surgery is carried out only in early breast cancer, if the area of tissue to be removed is relatively small. Women who choose a lumpectomy will require radiation therapy to destroy any cancer cells that may remain in the area.

2) MASECTOMYA mastectomy is the surgical removal of the entire breast that is done in order to remove a malignant tumour in cases of invasive breast cancer, with or without removing the lymph nodes in the armpit. Sometimes, if more tissue needs to be removed, a lumpectomy may be disfiguring and a mastectomy may be recommended instead.

CHEMOTHERAPHY

i. Chemotheraphy tratment uses medicine to weaken and destroy cancer cells in the body, including cells at the original cancer site and any cancer cells that may have spread to another part of the body.

ii. Chemotheraphy is used to treat :

a) Early stage -invasive breast cancer to get rid of any cancer cells that may be left behind after surgery and to reduce the risk of the cancer coming back.

b) Advanced stage-breast cancer to destroy or damage the cancer cells as much as possible.

iii. Some cases, chemotherapy is given before surgery to shrink the cancer.

RADIATION THERAPHY

i. Radiation theraphy is also called radio theraphy is a highly targeted, highly effective way to destroy cancer cells in the breast that may stick around after surgery. 

ii. Radiation therapy is relatively easy to tolerate and its side effects are limited to the treated area.

radiation theraphy chemotheraphy

.

MEDICALTamoxifen or aromatase inhibitor is recomanded for estrogen receptor- positive (ER+) breast cancer. Its stop estrogen from fueling ER+ breast cancer.

i. TAMOXIFEN

a) Medicine that blocks the effect of estrogen on breast cancer cells and normal breast cells. But this medicine may also increase other risks, such as for endometrial cancer, stroke and blood clots in veins and in the lungs.

ii. Aromatase Inhibitors

a) Letrozole (Femara)

b) Anastrozole (arimidex)

c) Exemestane (aromasin) are medicine that stop estrogen production in postmenopausal women.

iii. Trastuzumab ( Herceptin )

a) Is recommended after surgery and chemotherapy for HER2/neu breast cancer. This medicine is a monoclonal antibody that targets the HER-2 protein. It helps chemotherapy work better.

iv. Serotonin antagonists, corticosteroids and phenothiazines

a) Treatment of breast cancer can cause nausea and vomitting. Doctor will be prescribe this medicine to help relieve and prevent nausea and vomitting.

COMPLICATIONSDestruction of the breast.Destruction of the chest wall surrounding of the breast.MastitisNipple dischargeChest painMost women will have aches or pains from time to time in the treated breast even years after treatment.Hair loss after radiation therapy and chemotherapy.

PREOPERATIVE CARE

POSTOPERATIVE CARE

SUMMARY the breast plays a significant role in a woman’s sexuality and self –identity.A breast disoder, wether benign or malignant, can cause great anxiety and fear of potential disfigurement, loss of sexual attractiveness, and even death. Must have expertise in the assessment and management of not only the physical symptom but also the psychosocial symptoms with breast disoders.

SCENARIO OF CASEMadam Asiah age 35 years old admitted to the ward at 9 a.m she complaint of generalized abdominal pain 1/7 more on right sided region to the back. B/P : 110/62,Temperature : 38.5,Pulse : 65,Rate : 14. Doctor has her’s Bilateral Breast Cancer stage iv and suggest for the operation.

NURSING CARE PLAN1. Nursing Diagnosis :Imbalanced nutrition ,less than body

requirement related to nausea and vomiting.

Goal :Patient experiences less nausea and vomiting

associated with chemotherapy, weight loss is minimized.

Intervension :

i. Assess the patient previous experiences and expectation of nausea and vomiting, including cause and intervension.

ii. Adjust diet before and after drug administration according to patient preference and tolerance.

iii. Prevent unpleast sight,odor and sound in environment.

iv. Ensure adequate fluid hydration,before during and after drug administration ,assess intake and output.

v. Provide pain relief measure, if necessary.vi. Assess other contribution factor to nausea and

vomiting such as other symptom, radiation therapy, medication.

2. Nursing Diagnosis :Disturbed body image and situation low self- esteem related to change in appearance, function and role.

Goal :Improved body image and self-esteem.

Intervension :i. Assess patient feeling about body image

and level of self- esteem.ii. Encouraged continued participation in

activities and decision making.iii. Assist patient in self- care when

fatigue,nausea,vomiting to prevent independence.

iv. Assist patient in selecting and using cosmetic,hair pieces and clothing that increase sense of attractiveness.

v. Individualize care for the patient.

3. Nursing Diagnosis :Chronic Pain

Goal :Relief of pain and discomfort.

Intervension :i. Assess pain and discomfort characteristic

use pain scale.ii. Assess other factor contributing to

patient pain : fear,fatigue.anger.iii. Administer analgesic to promote optimum

pain relief.iv. Assess patient behavioral responses to

pain and pain experiences.v. Teach patient new strategies to relieve

pain and discomfort.

REFERENCESWAD PALIATIF CARE UNIT (PCU) HTAA

BRUNNER & SUDDARTH’S,Medical –Sergical Nursing,Twelthh Edition.

http ://www.webmd.com/breast-cancer/tc/breast-cancer-medications.