1. Prepared by: Hai Lam Lynn Yu Racheal Richie Trina Jones

3.  http://www.youtube.com/watch?v=YNUBnX 9JHQs&feature=related http://www.youtube.com/watch?v=YNUBnX 9JHQs&feature=related  http://www.youtube.com/watch?v=hswn7Hl Lkls&feature=related http://www.youtube.com/watch?v=hswn7Hl Lkls&feature=related

4.  Lump  Most commonly in upper, outer quadrant of breast  Palpation: hard, may be irregularly shaped, poorly delineated, nonmobile, nontender Mammographic Abnormalities

5.  Other Signs of Breast Cancer:  Lump or swelling felt on lymph nodes  Swelling of all or part of breast  Nipple discharge; Nipple retraction  Redness, Scaliness, or Thickening of nipple or breast skin  Peau d’orange

6.  http://www.youtube.com/watch?v=yTHyMN BkbOY http://www.youtube.com/watch?v=yTHyMN BkbOY

7. Risk for disturbed body image related to anticipated physical and emotional effects of treatment modalities.

8. 1. Incorporate psychosocial questions related to body image as part of nursing assessment to identify clients at risk for body image disturbance. 2. IF the nursing assessment reveals body image concerns related to a disfiguring condition, assist the client in voicing his/her concerns and if appropriate, coaching the client in how to respond to questions from other in social situations. 3. Encourage the client to discuss interpersonal and social conflicts that may arise 4. Encourage clients to verbalize treatment preferences and play a role in treatment decisions. 5. Refer clients with body image disturbance for CBT and/or social skills training if indicated.

9. Patients with breast cancer will actively participate in the decision-making process related to treatment options, comply with the therapeutic plan, manage the side effects of adjuvant therapy, and be supported to access and benefit from the support provided by significant others and health care providers.

10. Breast cancer patients will be able to verbalize fears and will have created a recovery plan that includes exercises and skills that will help them learn to cope with whatever happens in the future and return to their previous lives as easily as possible

11. Therapeutic regimen determined by clinical stage and biology of cancer. Diagnosis Screening  Physical exam, Mammography, Breast MRI, Biopsy After Diagnosis  Axillary node dissection  Lymphatic Mapping and Sentinel lymph node dissection  Find tumor size  Find Estrogen and Progesterone receptor status  Find Expression of HER-2 receptor  Find DNA content

12.  Staging Breast Cancer:  TNM system  T: Tumor size  N: Nodal involvement  M: Metastasis

13.  Local vs Systemic Therapy  Local: Surgery, Radiation  Systemic: Chemotherapy, Hormone Therapy, Targeted Therapy  Adjuvant vs Neoadjuvant Therapy  Adjuvant: Additional treatment to prevent recurrence  Radiation, Chemotherapy, Hormonal and Targeted Therapy  Neoadjuvant: Chemo/Hormone therapy before surgery to allow for less extensive operation

14.  Breast-Conserving Surgery (Lumpectomy)  Removal of entire tumor w/ margin of normal tissue  Usually done with Axillary Lymph Node Dissection (ALND)  In combination with radiation therapy: preserves the breast  Mastectomy (remove entire breast)  Simple Mastectomy: removes entire breast including nipple but not underarm lymph nodes or muscle tissue  Most common type of mastectomy  Modified Radical Mastectomy: removes breast and axillary lymph nodes but preserves pectoralis muscle  Prophylactic (Elective) Mastectomy: removal of breasts to prevent /reduce risk of cancer

15.  Radiation therapy always follows lumpectomy  Can be used as:  Primary Treatment  Prevent local breast recurrences after breast-conserving surgery  Adjuvant Treatment  Prevent local and nodal recurrences after mastectomy  Palliative Treatment for Pain

16.  Most effective when combo of 1 or more drugs used  2 Major Categories:  Cell Cycle Phase – Nonspecific  Break double helix of DNA, inhibit replication and enzyme function, inhibit transcription and translation  Cell Cycle Phase – Specific  Interfere with cell cycle  IV is most common route  Side Effects  Acute Toxicity: anaphylactic rxns, flare, N/V  Delayed Effects: bone marrow depression, altered bowel function, neurotoxicities  Chronic Toxicities: organ damage (heart, liver, kidneys, lungs)

17.  Hormonal Therapy  Removes/Blocks source of Estrogen to promote regression of tumor  Can be used as adjuvant treatment or in pts with recurrent or metastatic cancer  Postmenopausal women more likely to have hormone-dependent tumors  Tamoxifen is drug of choice (blocks estrogen receptors on cancer cells)

18.  Targeted Therapy  HER2: a receptor that binds to growth factors  HER2-Positive cancers: breast cancers with amplified HER2 gene  Contributes to uncontrolled growth and survival of these cancer  Trastuzumab (Herceptin)  An antibody that binds to HER2  Prevents receptor from activating pathway that promotes cell growth and survival  Only used when tumor overexpresses HER2

20.  Women: 2nd most prevalent type of cancer  Women: 2 nd leading cause of cancer death  200,000 women & 1,700 men DX each year  40,000 women & 450 men die each year

21.  Ductal Carcinoma in Situ (DCIS)  Invasive Ductal Carcinoma (IDC)  Tubular Carcinoma of the Breast  Medullary Carcinoma of the Breast  Mucinous Carcinoma of the Breast  Papillary Carcinoma of the Breast  Cribriform Carcinoma of the Breast  Lobular Carcinoma in Situ (LCIS)  Invasive Lobular Carcinoma (ILC)  Inflammatory Breast Cancer  Lobular Carcinoma in Situ (LCIS)  Paget’s Disease of the Nipple  Phyllodes Tumors of the Breast

23. Normal breast with invasive ductal carcinoma (IDC) in an enlarged cross-section of the duct Breast profile: A Ducts B Lobules C Dilated section of duct to hold milk D Nipple E fat F pectoralis major muscle G Chest wall/rib cage Enlargement A Normal duct cell B Ductal cancer cells breaking through the basement membrane. C Basement membrane A Ducts B Lobules C Dilated section of duct to hold milk D Nipple E Fat F Pectoralis major muscle G Chest wall/rib cage Cell A Normal duct cell B Ductal cancer cells breaking through the basement membrane. C Basement membrane Cancer has broken through the wall of the milk duct and invades the tissue of the breast.

24. Tubular Carcinoma of the Breast  Carcinomas small made tubules, slow growth Medullary Carcinoma of the Breast  Tumor is soft, fleshy resembling “medulla” Mucinous Carcinoma of the Breast  Abnormal cells “float” in pools of mucus Papillary Carcinoma of the Breast  Cells are small, finger-like projections Cribriform Carcinoma of the Breast  Cancer invades the connective tissue  Tumor cell mass looks like Swiss cheese

25.  No lump  Start with reddening and swelling of the breast Paget’s disease of the nipple Unusual changes in the nipple and aerola Scaly, red, itchy, irritated

26. Rare Less than 1 % of all breast cancers Men have breast tissue Typically men don’t make breast stimulating hormones Breasts on a man are typically mounds of fat Developing real breast gland tissue Medications Abnormal hormone levels

27. StageDescription5-year Survival Rate 0Carcinoma in situ93 % ITumor 2 cm or less in greatest dimension No axillary lymph node metastasis or Evidence of distant metastasis 88 % IITumor 2 cm or less but 1-3 positive lymph nodes Tumor 2-5 cm with or without axillary lymph nodes Tumor < 5 cm without spread to lymph nodes No distant metastasis A: 81 % B: 74 % IIIAny size tumor with 4-9 positive axillary lymph nodes or With with direct extension to the chest wall or skin Inflammatory breast cancer NO evidence of distant metastasis A: 67 % B: 41 % C: 49 % IVAny of the above plus distant metastasis (ie, liver, lungs, bone, brain) 15 %