Breast Cancer

Hitham G. Falahi4NU04

The most common cancer in females…

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

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

Protective factors

• Exercise• Breast feeding• Pregnancy before 30 yo

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

Types of Breast Cancer

• Ductal Carcinoma in Situ• Invasive Ductal Carcinoma

- tubular- medullary-mucinous-papillary-cribriform

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

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

• Dilated blood vessels• Nipple discharge in nonlactating

women• Ulceration• Hemorrhage• Edema of the arm• Chest pain

Medical Management

• Chemotherapy• Tamoxifen Therapy• Radiation Therapy

Surgical Management

• Radical Mastectomy• Modified Radical Mastectomy• Lumpectomy

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

Breast Cancer

NURSING INTERVENTION : Post-OP

1. Position patient: • Supine• Affected extremity elevated

to reduce edema

Breast Cancer

NURSING INTERVENTION : Post-OP2. Relieve pain and discomfort• Moderate elevation of extremity• IM/IV injection of pain meds• Warm shower on 2nd day post-op

Breast Cancer

NURSING INTERVENTION : Post-OP3. 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

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

Breast CancerNURSING INTERVENTION : Post-

OPPromote activity• Support operative site when

moving• Hand, shoulder exercise done

on 2ndday• Post-op mastectomy exercise

20 mins TID• NO BP or IV procedure on

operative site

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

Breast Cancer

NURSING INTERVENTION : Post-OPMANAGE 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

Breast Cancer

NURSING INTERVENTION : Post-OPMANAGE COMPLICATIONS• Hematoma• Notify the surgeon• Apply bandage wrap (Ace

wrap) and ICE pack

Breast Cancer

NURSING INTERVENTION : Post-OPMANAGE COMPLICATIONSInfection• Monitor temperature,

redness, swelling and foul-odor

• IV antibiotics• No procedure on affected

extremity

Breast Cancer

NURSING INTERVENTION : Post-OPTEACH FOLLOW-UP care• Regular check-up• Monthly BSE on the other

breast• Annual mammography