1. Oncology Assessment and Management of Patients With Cancer Breast
Prepared by Dr. Iman Abdullah

2. Out Line Pathophysiology of the Malignant Process
Proliferative Patterns
Characteristics of Malignant Cells
Management of Cancer
Radiation Therapy
Types of Radiation
Toxicity
Nursing Management in Radiation Therapy
Chemotherapy
Administration of Chemotherapeutic Agents
Special Problems Extravasation
Nursing Management in Chemotherapy

3. Out Line Anatomic and Physiologic Overview of Breast Assessment
Malignant Conditions of the Breast
Types of Breast Cancer
Risk Factors
Breast Cancer Prevention Strategies in the High-Risk Patient
Clinical Manifestations
Assessment and Diagnostic Findings
Staging or Classification of Tumors
Prognosis
Surgical Management
Nursing Process
Systemic Treatments

4. Learning Objectives
On completion of this lecture, the student will be able to:
Compare the structure and function of the normal cell and the cancer cell
Differentiate between benign and malignant tumors.
Describe the roles of radiation therapy, and chemotherapy in treating cancer.
Describes the special nursing needs of patients receiving chemotherapy.
Develop a teaching plan for breast self-examination

5. Cont.
Identify the diagnostic tests used to detect the breast disorders.
Use the nursing process as a framework for care of the patient undergoing breast cancer surgery.
Compare the therapeutic usefulness of chemotherapy, surgery and radiation in treating breast cancer
Describe the physical, psychological and rehabilitative needs of the patient who has had mastectomy

6. Pathophysiology of the Malignant Process
Cancer is a disease process that begins when an abnormal cell is transformed by the genetic mutation of the cellular DNA.
Proliferative Patterns
Characteristics of Malignant Cells

7. Management of Cancer Surgery Radiation therapy Chemotherapy
Bone Marrow Transplantation
Hyperthermia
Targeted therapies
Photodynamic therapy

8. Radiation Therapy Types of Radiation External Radiation
Internal radiation
Radiation Dosage

9. Toxicity Altered skin integrity is a common effect
Alterations in oral mucosa
The entire gastrointestinal mucosa may be involved
Anorexia nausea, and vomiting, and diarrhea
If sites containing bone marrow (Anemia, Leukopenia, Thrombocytopenia (bleeding)
Systemic side effects

10. Nursing Management in Radiation Therapy
Protecting skin and oral mucosa
Protecting caregivers

11. Chemotherapy Administration of Chemotherapeutic Agents
The route of administration usually depends on:
The type of agent
The required dose
The type, location, and extent of tumor being treated
Special Problems Extravasation
Indications of extravasation during administration of vesicant agents

12. Toxicity Gastrointestinal System Hematopoietic System
Cells with rapid growth rates (eg, epithelium, bone marrow, hair follicles, sperm) are very susceptible to damage, and various body systems may be affected as well.
Gastrointestinal System
Hematopoietic System
Cardiopulmonary System
Renal System
Reproductive System
Neurologic System
Miscellaneous

13. Nursing Management in Chemotherapy
Assessing fluid and electrolyte status
Modifying risks for infection and bleeding
Administering chemotherapy
Protecting caregivers

14. Anatomic and Physiologic Overview

15. Assessment Health History Physical Assessment: Female Breast
Diagnostic Evaluation

16. Malignant Conditions of the Breast
Types of Breast Cancer
Ductal Carcinoma in Situ (DCIS)
Invasive Cancer
Infiltrating Ductal Carcinoma
Infiltrating Lobular Carcinoma
Medullary Carcinoma
Mucinous Carcinoma
Tubular Ductal Carcinoma
Inflammatory Carcinoma
Paget Disease

17. Risk Factors Non Genetic Risk Factors Gender and Age Personal History
Hormonal Factors
Radiation Exposure
Benign Proliferative Breast Disease
Fat Intake and Obesity
Alcohol Use
Other Possible Risk Factors

18. Genetic Risk Factors
More than 80% of all breast cancer cases have no known family history of the disease.
In familial cases, the risk is determined by which family member has the disease. Having a first-degree relative increase the risk twofold.
Protective Factors

19. Breast Cancer Prevention Strategies in the High-Risk Patient
Long-Term Surveillance
Chemoprevention
Prophylactic Mastectomy

20. Clinical Manifestations

21. Assessment and Diagnostic Findings
Techniques to determine the diagnosis of breast cancer include various types of biopsy, which have been discussed previously.

22. Staging or Classification of Tumors
Stage 0
Stage 1
Stage II and stage III, stage IV

23. Prognosis
The two most important factors when determining the prognosis of a patient with breast cancer are:
Tumor size
Whether the tumor has spread to the lymph nodes under the arm (axilla).

24. Surgical Management Modified Radical Mastectomy Total Mastectomy
Breast Conservation Treatment

25. Nursing Process Assessment Diagnosis (Postoperative Nursing Diagnosis)
The Patient Undergoing Surgery for Breast Cancer
Assessment
Diagnosis (Preoperative Nursing Diagnosis)
Diagnosis (Postoperative Nursing Diagnosis)
Potential Complications
Planning and Goals
Preoperative Nursing Interventions
Postoperative Nursing Interventions

26. Monitoring and managing potential complications
Lymphedem
Hematoma Formation
Seroma Formation
Infection
Promoting Home and Community-Based Care

27. Radiation Therapy Types of radiation Acute Side Effects
External-beam radiation
Brachytherapy
Intraoperative radiation therapy
Acute Side Effects
Nursing Management

28. Systemic Treatments I- Chemotherapy Nursing Management
Common physical side effects of chemotherapy for breast cancer
Specific side effects vary with the type of chemotherapeutic agent used.
The side effects of the anthracyclines
Nursing Management

29. II- Hormonal Therapy
Managing Side Effects of Adjuvant Hormonal Therapy in Breast Cancer
Hot Flashes
Vaginal Dryness
Nausea and Vomiting
Musculoskeletal Symptoms
Risk of Endometrial Cancer
Risk for Thromboembolic Events
Risk for Osteoporosis or Fractures

30. III- Targeted Therapy
Trastuzumab (Herceptin) is a monoclonal antibody that binds specifically to the HER-2/neuprotein.
This protein, which regulates cell growth, is present in small amounts on the surface of normal breast cells and in most breast cancers.
Trastuzumab targets and inactivates the HER-2/neuprotein, thus slowing tumor growth.
Unlike chemotherapy, trastuzumab spares the normal cells and has limited adverse reactions, which may include fever, chills, nausea, vomiting, diarrhea, and headache.

31. Reference
Brunner, L. and Suddarath, D. (2010). Text Book of Medical Surgical Nursing. 12th Edition. J.B. Lippincott Williams & Wilikins, Library of Congress Catalging-in-Publication Data.]

32. Thank you