Ma ‘DIBDIBANG’ Usapan

8/7/2019 Ma DIBDIBANG Usapan

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R

eview of theAnatomy and Physiology

of the Breast


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What is breast cancer?


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Common causes Gender is the biggest risk because

breast cancer occurs mostly in women.

Age is another critical factor. Breast

cancer may occur at any age, but it ismore common in age 40 and up.

A woman with a personal history of

cancer in one breast . Genetic causes. Family history has long

been known to be a risk facto for

breast cancer.


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Common causes Lifestyle and diet. Breast cancer seems

to occur more frequently in countries

with high dietary intake of fat, and

being overweight or obese is a knownrisk factor for breast cancer,

particularly in postmenopausal

women.

Environmental causes like exposure

from radiation.


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Symptoms Early breast cancer has no symptoms. It is usually

not painful.

A lump in the armpit or above the collarbone

that does not go away.

Breast discharge. Discharge is most concerning ifit is from only one breast or if it is bloody.

Nipple inversion. Nipple inversion is a common

variant of normal nipples, but nipple inversion

that is a new development can be of concern. Changes in the skin of the breast include redness,

changes in texture, and puckering. These changes

are usually caused by skin diseases but

occasionally can be associated with breastcancer.


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Diagnostic Tests

Examination ofthe Breast

A complete breast examination includes

visual inspection and careful palpation

(feeling) of the breasts, the armpits,and the areas around your collarbone.

During that exam, your health-care

provider may palpate a lump or just feela thickening.


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Diagnostic TestsMammography

Mammograms are x-rays of the breast that

may help define the nature of a lump.

Mammograms are also recommended for

screening to find early cancer. Usually, it is possible to tell from the

mammogram whether a lump in the breast is

breast cancer, but no test is 100% reliable.

Mammograms are thought to miss as manyas 10-15% of breast cancers.


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Diagnostic TestsUltrasound

Ultrasound of the breast is often done

to evaluate a breast lump.

Ultrasound waves create a "picture" of

the inside of the breast.

It can demonstrate whether a mass is

filled with fluid (cystic) or solid. Cancers

are usually solid, while many cysts arebenign.

Ultrasound might also be used to guide

a biopsy or the removal of fluid.


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Diagnostic TestsMRI

MRI may provide additional information

and may clarify findings which have

been seen on mammography or

ultrasound.

MRI is not routine for screening for

cancer but may be recommended in

special situations.


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Diagnostic TestsBiopsy

The only way to diagnose breast cancer withcertainty is to biopsy the tissue in question.

Biopsy means to take a very small piece of

tissue from the body for examination and

testing by a pathologist to determine if canceris present. A number of biopsy techniques are

available.

Fine-needle aspiration consists of placing a

needle into the breast and sucking out some

cells to be examined by a pathologist. This

technique is used most commonly when a

fluid-filled mass is identified and cancer is not

likel .


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Diagnostic Tests Core-needle biopsy is performed with a

special needle that takes a small piece oftissue for examination. Usually the needle is

directed into the suspicious area with

ultrasound or mammogram guidance. This

technique is being used more and morebecause it is less invasive than surgical biopsy.

It obtains only a sample of tissue rather than

removing an entire lump. Occasionally, if the

mass is easily felt, cells may be removed witha needle without additional guidance.


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Diagnostic Tests Surgical biopsy is done by making an

incision in the breast and removing thepiece of tissue. Certain techniques

allow removal of the entire lump.

Regardless of how the biopsy is taken,the tissue will be reviewed by a

pathologist. These are physicians who

are specially trained in diagnosing

diseases by looking at cells and tissues

under a microscope.


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Diagnostic Tests If a cancer is diagnosed on biopsy, the tissue

will be tested for hormone receptors.Receptors are sites on the surface of tumor

cells that bind to estrogen or progesterone. In

general, the more receptors, the more

sensitive the tumor will be to hormonetherapy. There are also other tests (for

example, measurement of HER-2/neu

receptors) that may be performed to help

characterize a tumor and determine the typeof treatment that will be most effective for a

given tumor.


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Stages ofbreast cancer Stage 0 is noninvasive breast cancer, that is,

carcinoma in situ with no affected lymph nodes or

metastasis. This is the most favorable stage of breast

cancer.

Stage I is breast cancer that is less than 2 cm (3/4 in)

in diameter and has not spread from the breast.

Stage II is breast cancer that is fairly small in size buthas spread to lymph nodes in the armpit OR cancer

that is somewhat larger but has not spread to the

lymph nodes.

Stage III is breast cancer of a larger size, greater than5 cm (2 in), with greater lymph node involvement, or

of the inflammatory type.

Stage IV is metastatic breast cancer: a tumor of any

size or type that has metastasized to another part of

the body. This is the least favorable stage.


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TreatmentRadiation therapy is used to kill tumor cells if there are

any left after surgery.

Radiation is a local treatment and therefore works

only on tumor cells that are directly in its beam.

Radiation is used most often in people who have

undergone conservative surgery such as lumpectomy.

Conservative surgery is designed to leave as much ofthe breast tissue in place as possible.

Radiation therapy is usually given five days a week

over five to six weeks. Each treatment takes only a

few minutes. Radiation therapy is painless and has relatively few

side effects. However, it can irritate the skin or cause

a burn similar to a bad sunburn in the area.


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TreatmentChemotherapy consists of the administration

ofmedications that kill cancer cells or stop them from

growing. In breast cancer, three different

chemotherapy strategies may be used:

1. Adjuvant chemotherapy is given to people who have

had curative treatment for their breast cancer, such

as surgery and radiation. It is given to reduce thepossibility that the cancer will return.

2. Pre-surgical chemotherapy is given to shrink a large

tumor and/or to kill stray cancer cells. This increases

the chances that surgery will get rid of the cancer

completely.

3. Therapeutic chemotherapy is routinely administered

to women with breast cancer that has spread

beyond the confines of the breast or local area.


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TreatmentHormonal therapy may be given because breast

cancers (especially those that have ampleestrogen or progesterone receptors) are

frequently sensitive to changes in hormones.

Hormonal therapy may be given to prevent

recurrence of a tumor or for treatment ofexisting disease.

Tamoxifen (Nolvadex), an antiestrogen (a

drug that blocks the effect of estrogen), hasbeen the most commonly prescribed

hormone treatment. It is used both for breast

cancer prevention and for treatment.


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Treatment Fulvestrant (Faslodex) is another drug

that acts via the estrogen receptor, butinstead of blocking it, this drug

eliminates it. It can be effective if the

breast cancer is no longer responding to

tamoxifen. Fulvestrant is only given to

women who are already in menopause

and is approved for use in women with

advanced breast cancer. Toremifene (Fareston) is another anti-

estrogen drug closely related to

tamoxifen.


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Treatment

Aromatase inhibitors, which block theeffect of a key hormone affecting the

tumor, may be more effective than

tamoxifen in the adjuvant setting. Thedrugs anastrozole (Arimidex),

exemestane (Aromasin), and letrozole

(Femera) have a different set of side

effects and risks than tamoxifen.


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At the time of lumpectomy, the axillary lymph

nodes (the glands in the armpit) need to be

evaluated for the spread of cancer. This can

be done by either removing the lymph nodesor by sentinel node biopsy (biopsy of the

closest lymph node to the tumor).

If a sentinel node biopsy is done at the time

of lumpectomy, it may allow the surgeon to

remove only some of the lymph nodes. In this

procedure, a dye is injected into the area of

the tumor. The path of the substance is then

followed as it travels to the lymph nodes. The

first node reached is the sentinel node. This

node is considered most important to biopsy

when evaluating the spread of the tumor.


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Radical mastectomy involves removal ofthe breast and the underlying chest wall

muscles, as well as the underarm

contents. This surgery is no longer done

because current therapies are less

disfiguring and have fewer

complications.


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Prevention

Mammograms are recommended every one to two

years starting at age 40 years. For women at high risk

for the development of breast cancer, mammogramscreening may start earlier, generally 10 years prior to

the age at which the youngest close relative developed

breast cancer.

Obesity after menopause and excessive alcohol intakemay increase the risk of breast cancer slightly.

Physically active women may have a lower risk. All

women are encouraged to maintain normal body

weight, especially after menopause and to limit excess

alcohol intake. Hormone replacement should belimited in duration if it is medically required.


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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.

Realize that a diagnosis of breast cancer is adevastating emotional shock to the woman. Provide

psychological support to the patient throughout the

diagnostic and treatment process.

Involve the patient in planning and treatment.

Describe surgical procedures to alleviate fear.

Prepare the patient for the effects of chemotherapy,

and plan ahead for alopecia, fatigue.


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Nursing Interventions

Administer antiemetics prophylactically, as directed,

for patients receiving chemotherapy. Administer I.V.

fluids as indicated.

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 sexualproblems.

Teach all women the recommended cancer-screening

procedures.


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