Breast cancer
is a cancer that starts in the breast, usually in the inner lining of the milk ducts or
lobules. There are different types of breast cancer, with different stages (spread),
aggressiveness, and genetic makeup. With best treatment, 10-year disease-free survival
is a that starts in the breast, usually in the inner lining of the milk ducts or lobules.
)Estimated ne New cases: 226,870 (female); 2,190 (male
Deaths: 39,510 (female); 41w cases and deaths from breast cancer in the United States
:in 2012
)0 (male
There are different types of breast cancer, with different stages (spread),
aggressiveness, and genetic makeup. With best treatment, 10-year disease-free survival
varies from 98% to 10%. Treatment includes surgery, drugs (hormone therapy and
chemotherapy), and radiation.varies from 98% to 10%. Treatment includes surgery,
.drugs (hormone therapy and chemotherapy), and radiation
1. Is the leading type of cancer in women.Most breast cancer begins in the lining of
the milk ducts, sometimes the lobule.
2. The cancer grows through the wall of the duct and into the fatty tissue.
3. Breast cancer metastasizes most commonly to auxiliary nodes, lung, bone,
liver, and the brain.
4. The most significant risk factors for breast cancer are gender (being a
woman) and age (growing older).
5. Other probable factors include nulliparity, first child after age 30, late
menopause, early menarche, long term estrogen replacement therapy, and
benign breast disease.
6. Controversial risk factors include oral contraceptive use, alcohol use,
obesity, and increased dietary fat intake.
7. About 90% of breast cancers are due not to heredity, but to genetic
abnormalities that happen as a result of the aging process and life in
general.
A woman’s risk of breast cancer approximately doubles if she has a first-degree relative
(mother, sister, daughter) who has been diagnosed with breast cancer. About 20-30% of
women diagnosed with breast cancer have a family history of breast cancer.
STAGES OF BREAST CANCER
STAGE
DEFINITION
Stage 0
Cancer cells remain inside the breast duct, without
invasion into normal adjacent breast tissue.
Stage I
Cancer is 2 centimeters or less and is confined to
the breast (lymph nodes are clear).
Stage IIA
No tumor can be found in the breast, but cancer
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 IIB
The tumor is larger than 2 but no larger than 5
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
IIIA
No tumor is found in the breast. Cancer is 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
IIIB
The tumor may be any size and has spread to 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
IIIC
There may either be no sign of cancer in the 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.
ASSESSMENT
1. A firm lump or thickness in breast, usually painless; 50% are located in the upper
outer quadrant of the breast.
2. Spontaneous nipple discharge; may be bloody, clear or serous.
3. Asymmetry of the breast may be noted as the woman changes positions;
compare one breast with the other.
4. Nipple retraction or scalliness, especially in Paget’s disease.
5. Enlargement of auxiliary or supraclavicular lymph nodes may indicate
metastasis.
DIAGNOSTIC EVALUATION
1. Mammography (most accurate method of detecting non-palpable lesions) shows
lesions and cancerous changes, such as microcalcification. Ultrasonography may
be used to distinguish cysts from solid masses.
2. Biopsy or aspiration confirms diagnosis and determines the type of breast
cancer.
3. Estrogen or progesterone receptor assays, proliferation or S phase study
(tumor aggressive), and other test of tumor cells determine appropriate
treatment and prognosis.
4. Blood testing detects metastasis; this includes liver function tests to detect
liver metastasis and calcium and alkaline phosphatase levels to detect bony
metastasis.
5. Chest x-rays, bone scans, or possible brain and chest CT scans detect
matastasis.
PHARMACOLOGIC INTERVENTIONS
1. Chemotherapy is the primary used as adjuvant treatment postoperatively ; usually
begins 4 weeks after surgery (very stressful for a patient who just finished major
surgery).
2.
3.
4.
5.
a. Treatments are given every 3 to 4 weeks for 6 to 9 months. Because
the drugs differ in their mechanisms of action, various combinations
are used to treat cancer.
b. Principal breast cancer drugs include cyclosphosphamide,
methotrexate, fluorouracil, doxorubicin, and paclitaxel.
c. Additional agents for advanced breast cancer include docetaxel,
vinorelbine, mitoxantrone, and fluorouracil.
d. Herceptin is a monoclonal antibody directed against Her-2/neu
oncogene; may be effective for patients who express this gene
Indications for chemotherapy include large tumors, positive lymph nodes,
premenopausal women, and poor prognostic factors.
Chemotheraphy is also used as primary treatment in inflammatory breast
cancer and as palliative treatment in metastatic disease or recurrence.
Anti-estrogens, such as tamoxifen, are used as adjuvant systemic therapy after
surgery.
Hormonal agents may be used in advanced disease to induce remissions that
last for months to several years.
SURGICAL INTERVENTIONS
1. Surgeries include lumpectomy (breast-preventing procedure), mastectomy
(breast removal), and mammoplasty (reconstructive surgery).
2. Endocrine related surgeries to reduce endogenous estrogen as a palliative
measure.
3. Bone marrow transplantation may be combined with chemotherapy.
NURSING INTERVENTIONS
1. Monitor for adverse effects of radiation therapy such as fatigue, sore throat, dry
cough, nausea, anorexia.
2. Monitor for adverse effects of chemotherapy; bone marrow suppression,
nausea and vomiting, alopecia, weight gain or loss, fatigue, stomatitis,
anxiety, and depression.
3. Realize that a diagnosis of breast cancer is a devastating emotional shock
to the woman. Provide psychological support to the patient throughout the
diagnostic and treatment process.
4. Involve the patient in planning and treatment.
5. Describe surgical procedures to alleviate fear.
6. Prepare the patient for the effects of chemotherapy, and plan ahead for
alopecia, fatigue.
7. Administer antiemetics prophylactically, as directed, for patients receiving
chemotherapy.
8. Administer I.V. fluids and hyperalimentation as indicated.
9. Help patient identify and use support persons or family or community.
10. Suggest to the patient the psychological interventions may be necessary for
anxiety, depression, or sexual problems.
11. Teach all women the recommended cancer-screening procedures.
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