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Breast Cancer
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Breast Cancer
R.M. is a 72-year-old female who went to her doctor complaining of "tightness" around a
lump in her right breast. R.M. has a history of high blood pressure and smoking (25 packs of
cigarettes a year). She comes from a family with a history of breast cancer, and one of her sisters
just had a lumpectomy and radiation treatment. Both her mother and aunt died of breast cancer in
their 60’s. R.M. has experienced "lumpy" breasts in the past, but this lump feels "different." She
claims she is unable to stop smoking due to the amount of stress in her life. Her husband just
divorced her, and she hasn't seen her two girls in over six months. She spends most of her time
watching television. R.M. is 5'9" and weighs 205 pounds; her blood pressure is 165/100, her
pulse is 76, her respirations are 20, and her temperature is 98.8°F. The nurse palpates a lump in
the upper outer quadrant of R.M.'s right breast. She had a bilateral mammography and a right
breast ultrasound.
According to Alkabban & Ferguson (2021), breast cancer is the most often diagnosed
cancers in women, accounting for more than one in ten new cancer diagnoses annually. It is the
second leading cause of cancer-related mortality among women worldwide. The majority of
breast cancer cases are detected by regular screening. This paper examines the types of breast
cancers alongside their pathologies, presentation, diagnosis, treatment, and emphasizes the
interprofessional team's involvement in R.M.’s care.
Breast Cancer Types and Risk Factors
Most breast cancers originate in the cells lining the ducts (ductal cancers). Some cancers
develop in the cells that line the lobules (lobular malignancies), whereas a tiny percentage arise
in other tissues. Non-invasive breast cancer cells that are restricted to the ducts and do not spread
to the surrounding fatty and connective tissues are referred to as ductal carcinoma in situ or
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lobular carcinoma in situ. Invasive breast cancer cells that infiltrate the surrounding fatty and
connective tissues of the breast after penetrating the duct and lobular walls are referred to as
invasive ductal carcinomas or invasive lobular carcinomas (Alkabban & Ferguson, 2021).
Cancer tumors can be invasive without metastasizing to lymph nodes or other organs.
In R.M.’s case, her risk factors for breast cancer are evident. The non-modifiable risk
factors include her sex, older age, and strong family history. The modifiable risk factors include
her physical activity level, smoking history, stress level, and possibly her weight and diet.
Radiation and Chemotherapy
The two fundamental objectives of therapy are to lower the likelihood of local recurrence
and the danger of metastatic dissemination. This can be done through surgical removal,
chemotherapy, and/or radiation therapy. R.M. should know that fighting cancer usually requires
a multidisciplinary approach or a mix of treatments. Radiotherapy is a local primary treatment
for breast cancer that is often performed after surgery and/or chemotherapy. It is conducted to
ensure that all malignant cells are eliminated, hence reducing the likelihood of breast cancer
recurrence (Łukasiewicz et al., 2021).
Chemotherapy is a systemic treatment option when treating breast cancer. It can be used
as neoadjuvant or adjuvant. Neoadjuvant therapies are performed before the primary treatment to
try and reduce the size of the tumor or kill any cancerous cells that have traveled, providing a
better chance for the primary treatment to be successful. Adjuvant treatment would be performed
after the primary treatment to kill any cancer cells that may have been left over (CTCA, 2019).
Special Considerations for the Older Adult
The physiology of an individual is dynamic and ever-changing, with structural,
functional, and molecular changes brought on by aging. When focusing on the special
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considerations of the older adult patient, a nurse must consider the physiologic changes that
every organ system experiences over time. Changes of the nervous system mostly cause
intellectual damages, the cardiac system causes low cardiac output and high blood pressures, the
respiratory system causes a decrease in arterial oxyhemoglobin, the GI system causes postponed
gastric emptying with a decrease in hepatic metabolism, and the renal system causes a decrease
in glomerular filtration rate (Alkabban & Ferguson, 2021). All of these alterations vary from
patient to patient and effect how pharmaceuticals are absorbed, metabolized, and excreted. When
all of these changes are combined, they result in a complicated physiological state. This distinct
physiology must be considered by the nurse while treating an elderly patient with cancer.
Chemotherapy Classifications
R.M. has been diagnosed with invasive lobular carcinoma with 6 out of 15 lymph nodes
testing positive for cancer. As stated earlier, there are different classifications of chemotherapy:
neoadjuvant and adjuvant chemotherapy. Neoadjuvant therapies are performed prior to the
primary treatment to try and cut the volume of the cancerous mass or it will kill any cancerous
cells that have traveled, providing a better chance for the primary treatment to be successful.
Adjuvant treatment would be performed after the primary treatment to kill any cancer cells that
may have been left over (CTCA, 2019). Currently, treatment includes a simultaneous application
of schemes 2–3 of the following drugs—carboplatin, cyclophosphamide, 5fluorouracil/capecitabine, taxanes (paclitaxel, docetaxel), and anthracyclines (doxorubicin,
epirubicin) (Łukasiewicz et al., 2021).
Nursing Management
Nurses consider special challenges while caring for older adult patients who have cancer.
Recognizing, evaluating, and managing normal physiological changes of the older adult in
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combination with cancer care are crucial and may be performed via the use of several geriatric
assessment methods by the nurse. Evaluating physical ability, functional grade, psychological
welfare, and socioeconomic dynamics will assist the nurse in creating a baseline functionality
and, therefore, an appropriate set of goals to attain throughout treatment. Considering R.M.’s
physical status, the nurse should evaluate her comorbidities, nutritional state, and medication
history. Within functional status, the nurse should evaluate R.M.’s frailty, ADL’s, instrumental
ADL’s, falls and balance test, gait speed, and strength. For R.M.’s psychological well-being, the
nurse should evaluate cognitive function and depression and anxiety. Lastly, the nurse should
evaluate R.M.’s socioeconomic status by assessing her social support system and her living
environment (Chang et al., 2017).
The Impact of Having Cancer
A cancer diagnosis can very well have a strong emotional impression on patients and
their families. Anxiety, fear, and hopelessness are common reactions throughout this lifechanging transtion. It is crucial for the nurse to acknowledge these changes to the patient and
provide assistance as needed.
Cancer may have a substantial influence on one's mental health and welfare. The
presence of depression and anxiety in a patient’s life can effect cancer treatment and cause a
more difficult and prolonged recovery. The experience of getting diagnosed, especially if it is
delayed, may be a substantial cause of grief and can have an influence on how patients accept
their diagnosis. Feelings of despair, lack of control, and uncertainty about life and death can all
be harmful to a person’s self-view and outlook on life.
On top of all the mental obstacles that R.M. may encounter throughout her cancer
journey, she will also experience a lot of physiologically. R.M. could experience infection, pain,
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bleeding, cosmetic issues, permanent scarring, or loss of sensation all related to surgical
complications (Alkabban & Ferguson, 2021). Chemotherapy can cause nausea/vomiting and
diarrhea, hair loss, memory loss, vaginal dryness, menopausal issues, and neuropathy (Alkabban
& Ferguson, 2021). Hormone therapy can cause hot flashes, vaginal dryness, and fatigue
(Alkabban & Ferguson, 2021). Radiation therapy can cause pain, skin changes, fatigue, nausea,
hair loss, heart and lung issues, and neuropathy (Alkabban & Ferguson, 2021).
Nursing Diagnosis
In terms of the physician’s duties related to R.M.’s care, they oversee the medication
treatment regimen. As for nursing, we would oversee the medication administration, and mental
and physical evaluation and well-being which includes treating her acute pain, providing mental
support, and evaluating her progress. A primary nursing diagnosis I would consider for R.M. is
inability to adapt to a change in health status. She states that she cannot quit smoking due to the
current high stressors happening such as her husband divorcing her and not having any
communication with her two daughters in over 6 months. This nursing diagnosis is related to her
chosen coping strategy of smoking and the high level of stressors that are already present in her
life. A possible outcome to this diagnosis would include the use of positive coping strategies and
the use of healthy behaviors that decrease stress. A nursing intervention that would assist R.M. in
this transitional phase would be to talk about the stressors in her life and use verbal and
nonverbal communication approaches like empathy, active listening, and confrontation to
encourage the client and family to express their emotions and reach a point where goals can be
set (Ackley et al., 2020). A second nursing intervention could entail the nurse’s assistance in
setting attainable goals and identifying personal skills and knowledge of coping with stressful
situations (Ackley et al., 2020).
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Conclusion
In this paper, I examined the case of R.M. and identified multiple breast cancer
pathologies alongside nursing management and implications throughout the patient’s care.
R.M.’s risk factors were identified as well as common mental and physical considerations that
the nurse must focus on when caring for an older adult who has been diagnosed with breast
cancer. I identified the classifications of breast cancer treatment options connected to radiation
and chemotherapy, then intertwined the nursing expectations of care to common psychological
and physical changes that R.M. may show as a result of the treatment regimen. Finally, I applied
my knowledge of assessing the whole patient by presenting a nursing diagnosis that was
accompanied by possible outcomes and helpful interventions that would benefit the patients
current and long-term status throughout the treatment of her breast cancer.
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References
Ackley, B. J., Ladwig, G. B., Makic, M. B. F., Martinez-Kratz, M. R., & Zanotti, M. (2020).
Nursing diagnosis handbook: an evidence-based guide to planning care. Twelfth edition.
St. Louis, Missouri: Elsevier.
Alkabban, F. & Ferguson, T. (2021). Breast cancer. StatPearls Publishing.
https://www.ncbi.nlm.nih.gov/books/NBK482286/
Cancer Treatment Centers of America CTCA. (2019). What’s the difference: adjuvant and
neoadjuvant therapies. Cancer Treatment Centers of America.
https://www.cancercenter.com/community/blog/2019/01/whats-the-difference-adjuvantand-neoadjuvant-therapies
Chang, S., Goldstein, N. E., & Dharmarajan, K. V. (2017). Managing an older adult with
cancer: considerations for radiation oncologists. BioMed Research International,
1695101. https://doi.org/10.1155/2017/1695101
Łukasiewicz, S., Czeczelewski, M., Forma, A., Baj, J., Sitarz, R., & Stanisławek, A. (2021).
Breast cancer-epidemiology, risk Factors, classification, prognostic markers, and current
treatment strategies-an updated review. Cancers, 13(17), 4287.
https://doi.org/10.3390/cancers13174287