1. BREAST CANCER
By : Preethi Vithana

2. Content Anatomy of Breast What is Breast Cancer Risk Factors
Pathophysiology
Spreading of Breast Cancer
Investigation
Treatment
Nursing care
Preventive care

3. Introduction Most common female cancer Incidence high in the west
211,300 new cases yearly and rising
40,000 deaths yearly
Incidence increasing 14 per in SL in 2000

4. Anatomy of Breast The breast consist with; Lobules and ducts
-lobules develop in pregnancy and puberty
-15 to 20 lobules, each has separate ducts

5. Stroma
-contains connective tissues and fat
Lymph vessels
Main blood supply by lateral thoracic artery
Coopers ligament give support to the breast

6. Definition It can be ductal carcinomas or lobular carcinomas.
Breast cancer is an uncontrolled growth of breast cells.
It can be ductal carcinomas or lobular carcinomas.
Ductal Carcinoma
Lobular Carcinoma

7. Two type of tumors Benign tumor -Benign tumors are noncancerous
Malignant tumor
-Malignant tumors are
cancerous
Malignant Benign

8. Risk Factors Genetic BRACA 1 BRACA2 Reproductive history
Increased estrogen exposure
Early menarche
Late menopause
Nulliparity
Female
Family history
Age

9. Other Risk Factors Obesity Race Alcohol Birth control pills
Environmental
-Chemical
-Radiation
-Heat

10. Pathophysiology Inherited mutation; Environmental factor Genetic
Damage & failure of repair DNA
Hormonal changes
Mutation in genome
Activation of growth promoting oncogenes
Inactivation of tumor suppressor genes
Alteration in genes that regulate apoptosis
Decreased
apoptosis
Unregulated cell proliferation
Tumor progression
Colonial expansion
Malignant neoplasm

11. Spreading of breast cancer
Breast cancer spreads in three different ways
through the lymph system
through the blood
Local spread

12. Classification Histopathology
This is based upon characteristics seen upon light microscopy of biopsy specimens
Grade
This focuses on the appearance of the breast cancer cell comparing with normal breast tissues
Stage
TNM (tumor, node, metastasis) system
Receptor status
According to estrogen progesterone receptor
DNA-based

13. Staging Primary Tumor T1 = Tumor < 2 cm. in greatest dimension
T2 = Tumor > 2 cm. but < 5 cm.
T3 = Tumor > 5 cm. in greatest dimension
T4 = Tumor of any size with direct extension to chest wall or skin
Regional Lymph Nodes
N0 = No palpable axillary nodes
N1 = Metastases to movable axillary nodes
N2 = Metastases to fixed, matted axillary nodes

14. Distant Metastases
M0 = No distant metastases
M1 = Distant metastases including ipsilateral supraclavicular nodes

15. Clinical Staging and prognosis
Clinical Stage I T1 N M0
Clinical Stage IIA T1 N M0
T2 N M0
Clinical Stage IIB T2 N M0
T3 N M0

16. Clinical Stage IIIA T1 N2 M0
Clinical Stage IIIB T4 any N M0
Clinical Stage IV any T any N M1

17. Staging prognosis for the 5 year survival rate
-stage I %
-stage II %
-stage III %
-stage IV %

18. Clinical Manifestations
Painless lump or thickening
Thickening or swelling that
persist
Axillary lymph node edema
Pain or Invasive nipple
Spontaneous discharge
A breast that appears to have
enlarged
Peud’orange appearance

19. Investigations Triple Assessment Clinical -Physical examination
-History

20. Imaging
-Mammograms
-MRI
-Ultrasound

21. Histology/cytology
FNAC (Fine needle aspiration cytology)
Histology
Core biopsy

22. Treatments Surgical Treatments -Lumpectomy
-Partial Mastectomy or Quadrantectomy
-Total Mastectomy
-Modified Radical Mastectomy

23. Lumpectomy

24. Quadrantectomy

25. Total Mastectomy

26. Modified Radical Mastectomy

27. Hormone blocking therapy
Radiation Therapy
Chemotherapy
cyclosphosphamide, methotrexate, and fluorouracil
Hormone blocking therapy
Tamoxifen or aromatase inhibitors
Ex, Arimidex

28. Nursing Care and Interventions

29. After surgery
-wound care
Long term complication
-lymphedema, if present need to drainage fluid
After radiotherapy
-skin reactions occur leading to erythema, swelling and soreness of the breast. applied hydrocortisone

30. Nursing Interventions
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.
Provide psychological support to the patient throughout the diagnostic and treatment process.

31. Involve the patient in planning and treatment.
Describe surgical procedures to alleviate fear.
Administer antiemetic prophylactically, as directed, for patients receiving chemotherapy.
Administer I.V. fluids and hyperalimentation as indicated.

32. Help patient identify and use support persons or family or community.
Suggest to the patient the psychological interventions may be necessary for anxiety, depression, or sexual problems.

33. Communicate feelings of comfort and decreased pain.
Participate in her own care at the highest level possible within the limitations of her illness.
Express positive feelings about self.
Express increased sense of well-being.

34. Use situational supports to reduce fear.
Maintain optimal muscle strength and joint range of motion.
Demonstrate adequate coping behaviors.
Free from signs and symptoms of infection.

35. Preventive care screening physical activity Limit alcohol Breast-feed
Discontinue hormone
therapy
Avoid exposure to
environmental pollution
Breast self examination
Diet

36. References http://www.breastcancer.org/symptoms/diagnosis/staging.jsp

37. Questions?

38. Thank You!!!