1. Breast Cancer Hitham G. Falahi 4NU04

2. The most common cancer in females…

3. A malignant tumor of the breast, usually a carcinoma, rarely a sarcoma

4. Risk Factors Genetics- BRCA1 And BRCA 2 Increasing age ( > 50yo) Family History of breast cancer Early menarche and late menopause Late age at pregnancy Nulliparity Obesity Hormonal replacement Alcohol Exposure to radiation

5. Protective factors Exercise Breast feeding Pregnancy before 30 yo

6. Pathophysiology Modifications of DNA of the breast epithelial duct cells Chromosomal alterations, gene mutations, suppression of apoptosis Modification of specific oncogenes or the loss of specific suppressor genes Proliferation of breast cells Tumor formation

7. Types of Breast Cancer Ductal Carcinoma in Situ Invasive Ductal Carcinoma - tubular - medullary -mucinous -papillary -cribriform

8. Invasive Lobular Carcinoma Inflammatory Breast Cancer Lobular Carcinoma in Situ Paget’s Disease

9. Clinical Manifestations Local pain Dimpling of the skin Nipple retraction Skin retraction Edema Nipple or areolar eczema Pitting of the skin (peau d’ orange) Reddened skin, local tenderness, and warmth

10. Dilated blood vessels Nipple discharge in nonlactating women Ulceration Hemorrhage Edema of the arm Chest pain

11. Medical Management Chemotherapy Tamoxifen Therapy Radiation Therapy

12. Surgical Management Radical Mastectomy Modified Radical Mastectomy Lumpectomy

13. Breast Cancer NURSING INTERVENTION : PRE-OP 1. Explain breast cancer and treatment options 2. Reduce fear and anxiety and improve coping abilities 3. Promote decision making abilities 4. Provide routine pre-op care: Consent, NPO, Meds, Teaching about breathing exercise

14. Breast Cancer NURSING INTERVENTION : Post-OP 1. Position patient: Supine Affected extremity elevated to reduce edema

15. Breast Cancer NURSING INTERVENTION : Post-OP 2. Relieve pain and discomfort Moderate elevation of extremity IM/IV injection of pain meds Warm shower on 2 nd day post-op

16. Breast Cancer NURSING INTERVENTION : Post-OP 3. Maintain skin integrity Immediate post-op: snug dressing with drainage Maintain patency of drain (JP) Monitor for hematoma w/in 12H and apply bandage and ice, refer to surgeon

17. Breast Cancer NURSING INTERVENTION : Post-OP 3. Maintain skin integrity Drainage is removed when the discharge is less than 30 ml in 24 H Lotions, Creams are applied ONLY when the incision is healed in 4-6 weeks

18. Breast Cancer NURSING INTERVENTION : Post-OP Promote activity Support operative site when moving Hand, shoulder exercise done on 2 nd day Post-op mastectomy exercise 20 mins TID NO BP or IV procedure on operative site

19. Breast Cancer NURSING INTERVENTION : Post-OP Promote activity Heavy lifting is avoided Elevate the arm at the level of the heart On a pillow for 45 minutes TID to relieve transient edema

20. Breast Cancer NURSING INTERVENTION : Post-OP MANAGE COMPLICATIONS Lymphedema 10-20% of patients Elevate arms, elbow above shoulder and hand above elbow Hand exercise while elevated Refer to surgeon and physical therapist

21. Breast Cancer NURSING INTERVENTION : Post-OP MANAGE COMPLICATIONS Hematoma Notify the surgeon Apply bandage wrap (Ace wrap) and ICE pack

22. Breast Cancer NURSING INTERVENTION : Post-OP MANAGE COMPLICATIONS Infection Monitor temperature, redness, swelling and foul-odor IV antibiotics No procedure on affected extremity

23. Breast Cancer NURSING INTERVENTION : Post-OP TEACH FOLLOW-UP care Regular check-up Monthly BSE on the other breast Annual mammography