REVIEW OF
CHRONIC
CONDITION
BREAST CANCER
REVIEW OF CHRONIC CONDITION BREAST CANCER
PREDISPOSING FACTORS:
PRECIPITATING FACTORS
Gender
Diet
Genetics
Sedentary lifestyle
Age
Smoking
Early Menarche
Oral Contraceptives
Late Menopause
Nulliparity
Child Birth after 30 years old
Response to
carcinogens
Damage or
change in genetic
material
Genetic mutation
of the cellular
DNA
(P53, BRCA 1 &
BRCA 2 genes)
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REVIEW OF CHRONIC CONDITION BREAST CANCER
Activtion of growth
Inactivation of
Alterations in the
promoting
oncogenes
tumor suppressor
gene that control
apoptosis
genes
Unregulated proliferation and
differentiation of cancer cells
in the milk duct
Growth of malignant
tumor
Release of growth
factors
Angiogenesis
Malignant tumor
grows rapidly
Malignant tumors
tends to compress
blood and
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lymphatic vessels
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REVIEW OF CHRONIC CONDITION BREAST CANCER
Activation of
immunologic mechanism
Impairment of the
Immune response
Immunosuppression
Rapid multiplication
of cancer cells
Rapid metabolism
caused by cancer
cells
Normal cells deprived
of nutrients
Cancer cells begin to
spread locally via
lymphatic vessels
BREAST CANCER
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Malignant tumor
obstructs milk duct
Rupture of milk
duct
Inflammatory
response
WARNING SIGNS
C – Change in bladder and bowel habits
A – A sore that doesn’t heal
U – Unusual bleeding
T – Thickening or lumps
I – Indigestion or difficulty in swallowing
O – Obvious change in a dart or mole
N – Nagging/persistent cough/hoarseness
U – Unexplained anemia
S – Sudden or unexplained weight loss
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REVIEW OF CHRONIC CONDITION BREAST CANCER
CLINICAL MANIFESTATIONS OF BREAST CANCER
Swelling of all or part of a breast (even if no distinct lump is felt)
Skin irritation or dimpling
Breast or nipple pain
Nipple retraction (turning inward)
Redness, scaliness, or thickening of the nipple or breast skin
A nipple discharge other than breast milk
A change in the size, shape, or contour of the breast
Signs of inflammation (fever, pain, redness, warmth, swelling, etc)
BREAST CANCER
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SURGICAL MANAGEMENT
The main goal of surgery is to gain local control of the disease. With breast cancer being diagnosed today at earlier stages,
options for less invasive surgical procedures are available.
 MODIFIED RADICAL MASTECTOMY
It is performed to treat invasive breast cancer. The procedure involves removal of the entire breast tissue, including
the nipple-areola complex. In addition, a portion of axillary lymph nodes are also removed in axillary lymph node dissection
(ALND). If immediate breast reconstruction is desired, the patient is referred to plastic surgeon prior to mastectomy so that
she has the opportunity to explore all available resources. In modified radical mastectomy, the pectoralis major and
pectoralis minor muscles are left intact, unlike the radical mastectomy, in which muscles are removed.
 TOTAL MASTECTOMY
Like modified radical mastectomy, total mastectomy (ie., simple mastectomy) also involves removal of the breast and
nipple-areola complex but does not include ALND. Total mastectomyu may be performed in patients with non-invasive breast
cancer (eg, DCIS), which does not have a tendency to spread to the lymph nodes. It may also be performed prophylactically in
patients who are at high risk for breast cancer.
 BREAST CONSERVATION TREATMENT
The goal of breast conservation treatment (ie, lumpectomy, wide excision, partial or segmental mastectomy) is to
excise the tumor in the breast completely and obtain clear margins while achieving an acceptable cosmetic result. If the
procedure is being performed to treat a non invasive breast cancer, lymph node removal is not necessary. For invasive breast
cancer, lymph node removal is indicated.
 SENTINEL LYMPH NODE BIOPSY
Emerged as a less invasive alternative to ALND and is now considered a standard of care for the treatment of earlystage breast cancer.
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REVIEW OF CHRONIC CONDITION BREAST CANCER
The sentinel lymph node is the first node in the lymphatic basin that receives drainage from the primary tumor in the
breast is identified by injecting a radio isotope and/or blue dye into the breast.
In SLNB, the surgeon uses hand held probe to locate the sentinel lymph node, excises it, and sends it for pathologic
analysis, which is often performed during the surgery using frozen section analysis.
MEDICAL MANAGEMENT
 Radiation therapy
Radiation therapy uses high-powered beams of energy, such as X-rays, to kill cancer cells. Radiation therapy is typically done
using a large machine that aims the energy beams at your body (external beam radiation). But radiation can also be done by placing
radioactive material inside your body (brachytherapy).
External beam radiation is commonly used after lumpectomy for early-stage breast cancer.
Side effects of radiation therapy include fatigue and a red, sunburn-like rash where the radiation is aimed. Breast tissue may also
appear swollen or more firm.
 Chemotherapy
This uses drugs to kill cancer cells. If your cancer has a high risk of returning or spreading to another part of your body, doctors
may recommend chemotherapy to decrease the chance that the cancer will recur. This is known as adjuvant systemic
chemotherapy.
Chemotherapy is sometimes given before surgery in women with larger breast tumors. The goal is to shrink a tumor to a size that
makes it easier to remove with surgery.
Chemotherapy is also used in women whose cancer has already spread to other parts of the body. It may be recommended
trying to control the cancer and decrease any symptoms the cancer is causing.
The side effects depend on the drugs you receive. Common side effects include hair loss, nausea, vomiting, fatigue and an
increased risk of developing infection.
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REVIEW OF CHRONIC CONDITION BREAST CANCER
 Hormone therapy
Hormone therapy — perhaps more properly termed hormone-blocking therapy — is often used to treat breast cancers that are
sensitive to hormones.
Hormone therapy can be used after surgery or other treatments to decrease the chance of your cancer returning. If the cancer has
already spread, hormone therapy may shrink and control it.
Treatments that can be used in hormone therapy include:
Medications that block hormones from attaching to cancer cells.
Selective estrogen receptor modulator (SERM) medications include tamoxifen, raloxifene (Evista) and toremifene
(Fareston).
Medications that stop the body from making estrogen after menopause.
Aromatase inhibitors, include anastrozole (Arimidex), letrozole (Femara) and exemestane (Aromasin).
A drug that targets estrogen receptors for destruction.
Fulvestrant (Faslodex)
Surgery or medications to stop hormone production in the ovaries.
Systemic therapy may be given after (adjuvant therapy) or before (neoadjuvant therapy) local treatment. Adjuvant therapy is used
after local treatments to kill any cancer cells that may remain in the body but are undetectable. It is also used for people with
advanced disease.
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REVIEW OF CHRONIC CONDITION BREAST CANCER
NURSING MANGEMENT
Pre-operative Nursing Interventions
 Providing education and preparation about surgical treatments
 Reviewing treatment options by reinforcing information provided to the patient and answering any questions.
 The patient should be informed that she will go home with the drain(s) and that complete instructions about drain
care will be provided prior to discharge.
 Inform patient that she will often have decreased arm and shoulder mobility after an ALND and that she will be
shown range-of-motion exercises prior to discharge.
 Reducing fear and anxiety and improving coping ability
 Help the patient cope with physical as well as emotional effects of surgery.
 Provide patient with realistic expectations about the healing process and expected recovery can help alleviate fears.
 Maintain open communication and assure patient that she can contact the nurse anytime with questions or concerns.
 Promoting decision-making ability
 Patient can be eligible for more than one therapeutic approach; she may be presented with treatment options and
then asked to make a choice.
 Ensure the patient and family members that truly understand their options.
 Help the patient weigh the risks and benefits of each option.
Post-operative Nursing Interventions
 Relieving pain and discomfort
 All patients are discharged home with analgesic medication (eg, oxycodone and acetaminophen) and are encouraged
to take it as needed.
 Patients who report excruciating pain must be evaluated to rule out any potential complications such as infection or
hematoma.
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
Encourage use of alternative methods of pain management such bas taking warm showers and using distraction
methods (eg, guided imagery) may also be helpful.
 Managing postoperative sensations
 Patients should be reassured that this is a normal part of healing and that these sensations are not indicative of a
problem.
 Promoting positive body image
 The nurse first assesses the patient’s readiness and provides gentle encouragement.
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


Maintain the patient’s privacy while assisting her as she views the incision to allow her to express feelings safely to
the nurse.
Ask patient what she perceives, acknowledge her feelings, and allow her to express her emotions about the breast
removal.
Reassure patient that her feelings are normal response to breast cancer surgery.
 Promoting positive adjustment and coping
 Provide ongoing assessment of how patient is coping with her diagnosis of breast cancer and her surgical treatment.
 Assist the patient in identifying and mobilizing her support systems.
 Encourage patient to discuss issues and concerns with other patients who have had breast cancer.
 Provide her with information about plan of care
 Improving sexual function
 Encourage patient to openly discuss how she feels about herself and about possible reasons for decrease in libido
 Helpful suggestions for the patient may include varying time of the day for sexual activity (when patient is less tired),
assuming positions that are more comfortable, etc.
 Promoting home and community-based care
 Prior to discharge, the nurse assesses the patient’s readiness to assume self-care responsibilities and identify any
gaps of knowledge.
 The nurse reiterates symptoms the patient should report, such as infection, seroma, hematoma or arm swelling.
 The goals of exercise regimen are to increase circulation and muscle strength, prevent joint stiffness, and
contractures and restore full-range of motion.
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`Exercise after Breast Surgery
 Wall climbing
Stand facing the wall with feet apart and toes as close as possible. With elbows slightly bent, place the palms of the
hand on the wall at shoulder level. By flexing the fingers, work the hands up the wall until arms are fully extended.
The n reverse the process, working the hands down to the starting point.

Rope turning
Tie a light rope to a doorknob. Stand facing the door. Take free end of rope in the hand on the side of surgery, place
the other hand on the hip. With the rope-holding arm extended and held away from the body (nearly parallel with the
floor), turn the rope, making as wide swings as possible. Begin slowly at first, speed-up later.

Rod or broomstick lifting
Grasp a rod with both hand, held about 2 feet apart. Keeping the arms straight, raise the rod over the head. Bend
elbows to lower the rod behind the head. Reverse maneuver, raising the rod above the head, then return to starting
position.

Pulley tagging
Toss a light rope over a shower curtain rod or doorway curtain rod. Stand as nearly under the rope as possible. Grasp
an end in each hand. Extend the arms straight away from the body. Pull the left arm up by tugging down with the
right arm; then the right arm up and the left down in a see-sawing motion.
REFERENCES:
1.
2.
3.
4.
5.
6.
7.
LeMone, P., Burke, K., Bauldoff, G., (2011) Medical-Surgical Nursing: Critical Thinking in Patient Care. 5th
Edition.
Smeltzer & Bare (2010). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing. 12th Edition.
Porth, Carol Mattson (2010). Pathophysiology: Concepts of Altered Health States. 7th Edition
www.cancer.org
http://www.mayoclinic.org/diseases-conditions/breast-cancer/basics/prevention/con-20029275
http://www.webmd.com/breast-cancer/guide/breast-cancer-treatment
http://www.cancer.gov/cancertopics/pdq/treatment/breast/Patient/page1
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