FACTS & FIGURES MOST FREQUENT SITES OF CANCER BREAST & UTERUS = WOMEN MALE & FEMALE BENIGN LESIONS MORE FREQUENT THAN MALIGNANT 182,000 NEW CASES EACH YEAR: 1/3 WILL DIE

Leading cause of CA death in women ages 40 to 55 MORTALITY RATE  :  SCREENING  SCREENING EARLIER EARLIER AGE MORE EFFECTIVE TX’SMORE EFFECTIVE TX’S

FIBROCYSTIC BREAST CONDITION AGES 20 – 50 YRS CAUSE: FEMALE HORMONES a.MENTAL STRESS b.CAFFEINE c.NO SX USUALLY d.AFTER MENOPAUSE, HORMONES e.CYSTS IN SIZE, f.RISKS FOR BREAST CANCER THEN DANAZOL (DANOCRINE) ESTROGEN

FIBROADENOMA LATE TEENS – EARLY 20’S *NO MALIGNANT POTENTIAL* USUALLY FIRM, ROUND, ENCAPSULATED EASILY REMOVED WITH A SMALL INCISION <1% PROVE TO BE MALIGNANT AFRICAN AMERICAN WOMEN

INTRADUCTAL PAPILLOMA WART-LIKE *BENIGN TUMOR EPITHELIAL CELLS GROWS IN COLLECTING DUCT OR IN AREA OF CYSTIC DZ BLEED & BLOOD COLLECTS

PAGETS DISEASE > 45 YEARS – UNILATERAL BEGINS AS MILD ECZEMA CONDITION – SPREADS *TRUE CARCINOMA EARLY & TOTAL REMOVAL OF BREAST

DETECTION & DIAGNOSIS (CA) 90% DISCOVERED BY BSE AVERAGE SIZE OF TUMOR = 2.5CM INCIDENCE – NO CHILDREN INCIDENCE – MULTIPLE PREGNANCY OR BIRTH BEFORE 34 YEARS INCIDENCE - HYSTERECTOMY EARLY DETECTION

TUMORS - 2 CM OR <  LYMPH NODES 85% - 90% SURVIVAL + LYMPH NODES = 25% - 35% SURVIVAL

STAGING TNM SYSTEM ♦ T = PRIMARY TUMOR {TUMOR SIZE} N = REGIONAL LYMPH NODES {#NODES INVOLVED} M = DISTANT METASTASIS {METASTASES}

T = TUMOR T0 = NO TUMOR CLINICALLY TIS = CARCINOMA IN SITU [SITE OF ORIGIN] T1, T2, T3, T4 = ASCENDING DEGREES OF  IN TUMOR SIZE AND INVOLVEMENT

N = NODES N0 = NO REGIONAL LYMPH NODE INVOLVEMENT ASSESSED CLINICALLY NX = REGIONAL LYMPH NODES CANNOT BE ASSESSED CLINICALLY N1, N2, N3, N4 = ASCENDING DEGREE OF NODAL INVOLVEMENT

M = METASTASIS M0 = NO EVIDENCE OF DISTANT METASTASIS M1, M2, M3, M4 = ASCENDING DEGREE OF METASTATIC INVOLVEMENT OF HOST

CLINICAL STAGES – CA OF BREAST SIZE TUMOR LYMPH NODES METS ISMALL- 0 II  2CM  5CM - OR + 0 IIILG  5 CM+ 0 IVANY SIZE + OR - ++

STAGE I – CA CONFINED TO MAMMARY LOBULES; NO NODE INVOLVEMENT STAGE II – EXTENSION OUTSIDE LOBULES, TETHERING TO SKIN, AXILLARY NODES MAYBE + STAGE III – INFILTRATED SKIN, PEAU D’ ORANGE, PENETRATION STAGE IV – PEAU D’ ORANGE, FIXATION, METS

DIAGNOSIS SELF-EXAM ONLY 25% TO 35% WOMEN DO BSE REASONS $ FACTORS, EDUCATION, NO PAIN, *FEAR*, MODEST, DEPRESSION AGE

INSPECTION SYMMETRY, ERYTHEMA, EDEMA, PITTING, PEAU D’ ORANGE, ULCERATION, RASHES NIPPLE DISCHARGE, (7 DAYS) DIMPLING/RETRACTION DON’T FORGET MALE BREASTS

 1% IN MEN  ♦ 60 –65 YRS SIMILAR CHARACTERISTICS POORER PROGNOSIS

MAMMOGRAMS CAN DETECT MASSES LESS THAN 1 CM AGES 35 – 50 NEED BASELINE AMERICAN CA SOCIETY SAYS AGE 40 ULTRASOUND SOUND WAVES ♦ MRI IMAGING OF SUSPICIOUS AREAS

BIOPSY NEEDLE-ASPIRATION 90% ACCURATE INCISIONAL – REMOVES PIECE EXCISIONAL – REMOVES ALL

BREAST CANCER BEGINS IN AN ATYPICAL AREA (SINGLE TRANSFORMED CELL) PROGRESSES TO CARCINOMA IN SITU INVASIVE STAGE MOST OFTEN -  OUTER QUADRANT AS GROWS, BECOMES ATTACHED TO CHEST WALL OR OVERLYING SKIN

BREAST CANCER METASTASIS MOST OFTEN – LUNGS, BONES, MEDIASTINAL LYMPH NODES, LIVER IF UNTREATED – DEATH – USUALLY OCCURS 2 – 3 YEARS

Breast Cancer-Nursing Diagnosis  Anxiety  Grieving ♦  Acute pain  Disturbed sleep pattern  Disturbed body image  Sexual dysfunction

HIGH RISKS WOMEN OVER 40 YEARS OF AGE NATURAL MENOPAUSE AFTER 50 FAMILIAL HISTORY EARLY MENARCHE CHRONIC STRESS NO KIDS OR 1 ST CHILD AFTER 30 EXPOSURE OTHER CANCER

SINGLE MOST MAJOR RISK ----OLDER ---FEMALE

CLINICAL MANIFESTATIONS USUALLY  OUTER QUADRANT NO PAIN, LOCALIZED DISCOMFORT, BURNING, STINGING, ACHING, DIMPLING, ORANGE PEEL APPEARANCE, ASYMMETRY, ELEVATION OF AFFECTED BREAST, NIPPLE RETRACTION, ULCERATION, MALNUTRITION, GENERAL ILL HEALTH

4 ORGANS – BREAST METASTASIS 1. LUNGS & PLEURA 2. BONES 3. CNS (BRAIN) 4. LIVER

HORMONES LUMPECTOMY OOPHORECTOMY ADRENALECTOMY ANTIESTROGEN THERAPY TAMOXIFEN

Breast Cancer-Interventions ♦  Nonsurgical management  Hormonal therapy  Chemotherapy  Radiation  Surgical management  Breast-conserving surgery 1. Lumpectomy 2. Partial mastectomy  Modified radical mastectomy  Breast reconstruction

RADIATION THERAPY 5 – 6 WEEKS 5 DAYS/WEEK M – F WEEKEND RESTS SIDE EFFECTS: FATIGUE, EDEMA, TENDERNESS OF BREAST, SKIN CHANGES

SURGICAL PROCEDURES 1.SIMPLE EXCISION (LUMP) 2.SIMPLE MASTECTOMY (BREAST) 3.MODIFIED RADICAL MASTECTOMY ENTIRE BREAST, NIPPLE & AXILLARY LYMPH NODES 4.RADICAL MASTECTOMY – ENTIRE BREAST, AXILLARY LYMPH NODES, BOTH PECTORALIS MUSCLES

CHEMOTHERAPY ANTIMETABOLITES (CELL CYCLE SPECIFIC) ALKYLATING AGENTS (DNA LADDER STRUCTURE) CORTICOSTERIODS (PREDNISONE)

BREAST RECONSTRUCTION 1.SILICONE IMPLANTATION 2.TISSUE EXPANSION 3.MYOCUTANEOUS FLAP TRAM

PSYCHOSOCIAL CARE 1)RECURRENCE OF DX 2)PERSONAL, SOCIAL, SEXUAL MEANINGS 3)PHYSICAL EFFECTS & ADJUVANT TX

FACTORS INFLUENCING ADJUSTMENTS 1.PATIENTS PERSONALITY 2.PAST & PRESENT COPING MECHANISMS 3.QUALITY OF FAMILY, SEXUAL, SOCIAL 4.PSYCHOSOCIAL SUPPORTS 8-10 WEEKS POST-OP

PRE-OP TEACHING DETAILS OF SX – LOCATION & EXTENT BLOOD LOSS RADIATION & SIDE EFFECTS CHEMO PHYSICAL ‘S

POST OP - TO WATCH FOR INTEGUMENTARY OXYGENATION CIRCULATION MUSCULOSKELETAL EXERCISES PSYCHOSOCIAL

POST-OP TEACHING INFECTION PNEUMONIA HEMORRHAGE EXERCISES PSYCHOSOCIAL VASOCONSTRICTION REACH TO RECOVERY

HAND AND ARM CARE FOLLOWING A MASTECTOMY PROTECT HAND AND ARM ON OPERATED SIDE APPLY HAND LOTION USE A THIMBLE WHEN SEWING WEAR A MEDIC ALERT TAG NOTIFY MD IF ARM GET RED OR SWOLLEN AVOID: CUTS, BRUISES, BURNS WORKING NEAR THORNY BUSHES DIGGING IN THE GARDEN BLOOD DRAW INJECTIONS B/P TAKEN ON AFFECTED ARM CARRYING HEAVY PURSE

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