6. FACTS & FIGURES MOST FREQUENT SITES OF CANCER BREAST & UTERUS = WOMEN MALE & FEMALE BENIGN LESIONS MORE FREQUENT THAN MALIGNANT 182,000 NEW CASES EACH YEAR: 1/3 WILL DIE

7. Leading cause of CA death in women ages 40 to 55 MORTALITY RATE  :  SCREENING  SCREENING DETECTION @ EARLIER AGEDETECTION @ EARLIER AGE MORE EFFECTIVE TX’SMORE EFFECTIVE TX’S

8. FIBROCYSTIC BREAST CONDITION AGES 20 – 50 YRS CAUSE: FEMALE HORMONES a.MENTAL STRESS b.CAFFEINE c.NO SX USUALLY d.AFTER MENOPAUSE, HORMONES e.CYSTS IN SIZE, f.RISKS FOR BREAST CANCER THEN DANAZOL (DANOCRINE) ESTROGEN

9. FIBROADENOMA LATE TEENS – EARLY 20’S *NO MALIGNANT POTENTIAL* USUALLY FIRM, ROUND, ENCAPSULATED EASILY REMOVED WITH A SMALL INCISION <1% PROVE TO BE MALIGNANT AFRICAN AMERICAN WOMEN

10. INTRADUCTAL PAPILLOMA WART-LIKE *BENIGN TUMOR EPITHELIAL CELLS GROWS IN COLLECTING DUCT OR IN AREA OF CYSTIC DZ BLEED & BLOOD COLLECTS

11. PAGETS DISEASE > 45 YEARS – UNILATERAL BEGINS AS MILD ECZEMA CONDITION – SPREADS *TRUE CARCINOMA EARLY & TOTAL REMOVAL OF BREAST

12. DETECTION & DIAGNOSIS (CA) 90% DISCOVERED BY BSE AVERAGE SIZE OF TUMOR = 2.5CM INCIDENCE – NO CHILDREN INCIDENCE – MULTIPLE PREGNANCY OR BIRTH BEFORE 34 YEARS INCIDENCE - HYSTERECTOMY EARLY DETECTION

13. TUMORS - 2 CM OR <  LYMPH NODES 85% - 90% SURVIVAL + LYMPH NODES = 25% - 35% SURVIVAL

14. STAGING TNM SYSTEM ♦ T = PRIMARY TUMOR {TUMOR SIZE} N = REGIONAL LYMPH NODES {#NODES INVOLVED} M = DISTANT METASTASIS {METASTASES}

15. T = TUMOR T0 = NO TUMOR CLINICALLY TIS = CARCINOMA IN SITU [SITE OF ORIGIN] T1, T2, T3, T4 = ASCENDING DEGREES OF  IN TUMOR SIZE AND INVOLVEMENT

16. N = NODES N0 = NO REGIONAL LYMPH NODE INVOLVEMENT ASSESSED CLINICALLY NX = REGIONAL LYMPH NODES CANNOT BE ASSESSED CLINICALLY N1, N2, N3, N4 = ASCENDING DEGREE OF NODAL INVOLVEMENT

17. M = METASTASIS M0 = NO EVIDENCE OF DISTANT METASTASIS M1, M2, M3, M4 = ASCENDING DEGREE OF METASTATIC INVOLVEMENT OF HOST

18. CLINICAL STAGES – CA OF BREAST SIZE TUMOR LYMPH NODES METS ISMALL- 0 II  2CM  5CM - OR + 0 IIILG  5 CM+ 0 IVANY SIZE + OR - ++

19. STAGE I – CA CONFINED TO MAMMARY LOBULES; NO NODE INVOLVEMENT STAGE II – EXTENSION OUTSIDE LOBULES, TETHERING TO SKIN, AXILLARY NODES MAYBE + STAGE III – INFILTRATED SKIN, PEAU D’ ORANGE, PENETRATION STAGE IV – PEAU D’ ORANGE, FIXATION, METS

21. DIAGNOSIS SELF-EXAM ONLY 25% TO 35% WOMEN DO BSE REASONS $ FACTORS, EDUCATION, NO PAIN, *FEAR*, MODEST, DEPRESSION AGE

22. INSPECTION SYMMETRY, ERYTHEMA, EDEMA, PITTING, PEAU D’ ORANGE, ULCERATION, RASHES NIPPLE DISCHARGE, (7 DAYS) DIMPLING/RETRACTION DON’T FORGET MALE BREASTS

23.  1% IN MEN  ♦ 60 –65 YRS SIMILAR CHARACTERISTICS POORER PROGNOSIS

24. MAMMOGRAMS CAN DETECT MASSES LESS THAN 1 CM AGES 35 – 50 NEED BASELINE AMERICAN CA SOCIETY SAYS AGE 40 ULTRASOUND SOUND WAVES ♦ MRI IMAGING OF SUSPICIOUS AREAS

25. BIOPSY NEEDLE-ASPIRATION 90% ACCURATE INCISIONAL – REMOVES PIECE EXCISIONAL – REMOVES ALL

26. BREAST CANCER BEGINS IN AN ATYPICAL AREA (SINGLE TRANSFORMED CELL) PROGRESSES TO CARCINOMA IN SITU INVASIVE STAGE MOST OFTEN -  OUTER QUADRANT AS GROWS, BECOMES ATTACHED TO CHEST WALL OR OVERLYING SKIN

27. BREAST CANCER METASTASIS MOST OFTEN – LUNGS, BONES, MEDIASTINAL LYMPH NODES, LIVER IF UNTREATED – DEATH – USUALLY OCCURS 2 – 3 YEARS

28. Breast Cancer-Nursing Diagnosis  Anxiety  Grieving ♦  Acute pain  Disturbed sleep pattern  Disturbed body image  Sexual dysfunction

29. HIGH RISKS WOMEN OVER 40 YEARS OF AGE NATURAL MENOPAUSE AFTER 50 FAMILIAL HISTORY EARLY MENARCHE CHRONIC STRESS NO KIDS OR 1 ST CHILD AFTER 30 EXPOSURE OTHER CANCER

30. SINGLE MOST MAJOR RISK ----OLDER ---FEMALE

31. CLINICAL MANIFESTATIONS USUALLY  OUTER QUADRANT NO PAIN, LOCALIZED DISCOMFORT, BURNING, STINGING, ACHING, DIMPLING, ORANGE PEEL APPEARANCE, ASYMMETRY, ELEVATION OF AFFECTED BREAST, NIPPLE RETRACTION, ULCERATION, MALNUTRITION, GENERAL ILL HEALTH

32. 4 ORGANS – BREAST METASTASIS 1. LUNGS & PLEURA 2. BONES 3. CNS (BRAIN) 4. LIVER

33. HORMONES LUMPECTOMY OOPHORECTOMY ADRENALECTOMY ANTIESTROGEN THERAPY TAMOXIFEN

34. Breast Cancer-Interventions ♦  Nonsurgical management  Hormonal therapy  Chemotherapy  Radiation  Surgical management  Breast-conserving surgery 1. Lumpectomy 2. Partial mastectomy  Modified radical mastectomy  Breast reconstruction

35. RADIATION THERAPY 5 – 6 WEEKS 5 DAYS/WEEK M – F WEEKEND RESTS SIDE EFFECTS: FATIGUE, EDEMA, TENDERNESS OF BREAST, SKIN CHANGES

36. SURGICAL PROCEDURES 1.SIMPLE EXCISION (LUMP) 2.SIMPLE MASTECTOMY (BREAST) 3.MODIFIED RADICAL MASTECTOMY ENTIRE BREAST, NIPPLE & AXILLARY LYMPH NODES 4.RADICAL MASTECTOMY – ENTIRE BREAST, AXILLARY LYMPH NODES, BOTH PECTORALIS MUSCLES

37. 1 1 1 2 2 3 3 4 4

38. CHEMOTHERAPY ANTIMETABOLITES (CELL CYCLE SPECIFIC) ALKYLATING AGENTS (DNA LADDER STRUCTURE) CORTICOSTERIODS (PREDNISONE)

39. BREAST RECONSTRUCTION 1.SILICONE IMPLANTATION 2.TISSUE EXPANSION 3.MYOCUTANEOUS FLAP TRAM

40. PSYCHOSOCIAL CARE 1)RECURRENCE OF DX 2)PERSONAL, SOCIAL, SEXUAL MEANINGS 3)PHYSICAL EFFECTS & ADJUVANT TX

41. FACTORS INFLUENCING ADJUSTMENTS 1.PATIENTS PERSONALITY 2.PAST & PRESENT COPING MECHANISMS 3.QUALITY OF FAMILY, SEXUAL, SOCIAL 4.PSYCHOSOCIAL SUPPORTS 8-10 WEEKS POST-OP

42. PRE-OP TEACHING DETAILS OF SX – LOCATION & EXTENT BLOOD LOSS RADIATION & SIDE EFFECTS CHEMO PHYSICAL ‘S

43. POST OP - TO WATCH FOR INTEGUMENTARY OXYGENATION CIRCULATION MUSCULOSKELETAL EXERCISES PSYCHOSOCIAL

44. POST-OP TEACHING INFECTION PNEUMONIA HEMORRHAGE EXERCISES PSYCHOSOCIAL VASOCONSTRICTION REACH TO RECOVERY

45. HAND AND ARM CARE FOLLOWING A MASTECTOMY PROTECT HAND AND ARM ON OPERATED SIDE APPLY HAND LOTION USE A THIMBLE WHEN SEWING WEAR A MEDIC ALERT TAG NOTIFY MD IF ARM GET RED OR SWOLLEN AVOID: CUTS, BRUISES, BURNS WORKING NEAR THORNY BUSHES DIGGING IN THE GARDEN BLOOD DRAW INJECTIONS B/P TAKEN ON AFFECTED ARM CARRYING HEAVY PURSE

57. QUESTIONS