1. BREAST CANCER
cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk.
Breast cancer may be invasive or noninvasive. Invasive means it has spread from the milk duct or lobule to other tissues in the breast. Noninvasive means it has not yet invaded other breast tissue. 

2. Stages of Breast Cancer
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
The tumor is larger than 2 but no larger than 5 centimeters and has not spread to the axillary lymph nodes.

3. Stages of Breast Cancer
DEFINITION
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
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.

4. Stages of Breast Cancer
DEFINITION
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
the cancer has spread to lymph nodes either above or below the collarbone
the cancer may have spread to axillary lymph nodes or to lymph nodes near the breastbone.

5. Stages of Breast Cancer
DEFINITION
Stage IV
The cancer has spread — or metastasized — to other parts of the body.

6. General Breast Cancer Terms
Carcinoma
-This is a term used to describe a cancer that begins in the lining layer (epithelial cells) of organs like the breast.
Adenocarcinoma
-An adenocarcinoma is a type of carcinoma that starts in glandular tissue (tissue that makes and secretes a substance).
Carcinoma in situ
-This term is used for the early stage of cancer, when it is confined to the layer of cells where it began.

7. General Breast Cancer Terms
Invasive (infiltrating) carcinoma
-An invasive cancer is one that has already grown beyond the layer of cells where it started (as opposed to carcinoma in situ). Most breast cancers are invasive carcinomas.
Sarcoma
-Sarcomas are cancers that start from connective tissues such as muscle tissue, fat tissue, or blood vessels. Sarcomas of the breast are rare.

9. Types of Breast Cancer

10. Ductal carcinoma in situ (DCIS)
Most common type of noninvasive breast cancer
Also known as intraductal carcinoma
Characterized by the proliferation of malignant cells inside the milk ducts without invasion into the surrounding tissue.
Lobular carcinoma in situ (LCIS)
Also known as lobular neoplasia or stage 0 breast cancer
Not really cancer, but rather a noninvasive condition that increases the risk of developing cancer in the future.

11. Infiltrating ductal carcinoma
Most common histologic type of breast cancer
The tumor arise from the duct system and invade the surrounding tissues.
They often form a solid irregular mass in the breast.
Infiltrating lobular carcinoma
The tumors arise from the lobular epithelium and typically occur as an area of ill-defined thickening in the breast.
They are often multicentric and can be bilateral.

12. Medullary carcinoma Mucinous carcinoma
The tumors grow in a capsule inside a duct.
They can become large and may be mistaken for a fibroadenoma.
The prognosis is often favorable.
Mucinous carcinoma
The tumor is slow growing
The prognosis is more favorable than in many other types.

13. Tubular ductal carcinoma
They are treated like invasive ductal carcinomas, but tend to have a better prognosis than most breast cancers.
Inflammatory carcinoma
Rare and aggressive type of breast cancer that has unique symptoms.
The cancer is characterized by diffuse edema and brawny erythema of the skin, often referred to as peau d’orange (resembling an orange peel)

14. Paget’s Disease
Often represent ductal carcinoma in situ of the nipple but may have an invasive component.
If no lump can be felt in the breast tissue and the biopsy shows dcis without invasion, the prognosis is very favorable.

15. Tests used to diagnose and monitor patients with breast cancer may include:
Breast MRI to help better identify the breast lump or evaluate an abnormal change on a mammogram
Breast ultrasound to show whether the lump is solid or fluid-filled
Breast biopsy, using methods such as needle aspiration, ultrasound-guided, stereotactic, or open
CT scan to see if the cancer has spread
Mammography to screen for breast cancer or help identify the breast lump
PET scan
Sentinal lymph node biopsy to see if the cancer has spread

16. Treatment Treatment is based on many factors, including:
Type and stage of the cancer
Whether the cancer is sensitive to certain hormones
Whether the cancer overproduces
In general, cancer treatments may include:
Chemotherapy medicines to kill cancer cells
Radiation therapy to destroy cancerous tissue
Surgery to remove cancerous tissue -- a lumpectomy removes the breast lump; mastectomy removes all or part of the breast and possible nearby structures

17. Treatment
Mastectomies can be performed in four distinct methods, depending on the diagnosis and the extent of the pathologic findings.
1. Partial Mastectomy: Excision of breast tumor, leaving appropriate tumor-free margins.
2. Subcutaneous Mastectomy: Removal of all breast tissue. Overlying the skin and nipple are left intact.
3. Simple Mastectomy

18. Treatment 4. Radical Mastectomy:
Modified radical – removal of breast and axillary lymph nodes. Most frequently performed.
Classic radical – includes removal of the entire breast, pectoralis muscles, axillary lymph nodes, fats, fascia, and adjunct tissue.
Extended radical – bloc removal of breast, axillary contents, pectoralis muscles, and internal mammary lymph nodes.

20. Hormonal therapy is prescribed to women with ER-positive breast cancer to block certain hormones that fuel cancer growth.
An example of hormonal therapy is the drug tamoxifen. This drug blocks the effects of estrogen, which can help breast cancer cells survive and grow. Most women with estrogen-sensitive breast cancer benefit from this drug.
Another class of hormonal therapy medicines called aromatase inhibitors, such as exemestane(Aromasin), have been shown to work just as well or even better than tamoxifen in postmenopausal women with breast cancer. Aromatase inhibitors block estrogen from being made.

21. Combination of Treatment
Stage 0 and DCIS -- Lumpectomy plus radiation or mastectomy is the standard treatment. There is some controversy on how best to treat DCIS.
Stage I and II -- Lumpectomy plus radiation or mastectomy with some sort of lymph node removal is the standard treatment. Hormone therapy, chemotherapy, and biologic therapy may also be recommended following surgery.
Stage III -- Treatment involves surgery, possibly followed by chemotherapy, hormone therapy, and biologic therapy.
Stage IV -- Treatment may involve surgery, radiation, chemotherapy, hormonal therapy, or a combination of these treatments.

22. Nursing Responsibilities
Ensure that the woman or family member signs informed consent form.
Monitor for adverse effects of radiation therapy such as fatigue, sore throat, dry cough, nausea, anorexia.
Monitor for adverse effects of chemotherapy; bone marrow suppression, nausea and vomiting, alopecia, weight gain or loss, fatigue, stomatitis, anxiety, and depression.
Involve the patient in planning and treatment.

23. Nursing Responsibilities
Prepare the patient for the effects of chemotherapy, and plan ahead for alopecia, fatigue.
Administer antiemetics prophylactically, as directed, for patients receiving chemotherapy.
Administer I.V. fluids and hyperalimentation as indicated.
Help patient identify and use support persons or family or community.

24. Nursing Responsibilities
Suggest to the patient the psychological interventions may be necessary for anxiety, depression, or sexual problems.
Teach all women the recommended cancer-screening procedures.
Administer analgesics for pain as needed.
Perform comfort measures to promote relaxation and to relieve anxiety.

25. Nursing Responsibilities
 If immobility develops late in the disease, prevent complications by frequently repositioning the patient, using a convoluted foam mattress.
Provide skin care particularly in bony prominences.
Instruct the patient or caregiver how to manage adverse effects of treatment.
Monitor patient’s weight and nutritional intake for evidence of malnutrition.

26. Nursing Responsibilities
Inspect the skin for redness, irritation, and skin breakdown if immobility occurs.
In late disease, monitor the patient’s pain level and the efficacy of administered analgesics and non-pharmacologic measures.
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.

27. Nursing Responsibilities
 Always evaluate the patient’s feelings about her illness and determine her level of knowledge and expectations.