Oncology Assessment and Management of

Patients With Cancer Breast

Prepared by Dr. Iman Abdullah

Out Line Pathophysiology of the Malignant Process Proliferative Patterns Characteristics of Malignant Cells Management of Cancer Radiation Therapy Types of Radiation Toxicity Nursing Management in Radiation Therapy Chemotherapy Administration of Chemotherapeutic Agents Special Problems Extravasation Toxicity Nursing Management in Chemotherapy

Out Line Anatomic and Physiologic Overview of Breast Assessment Malignant Conditions of the Breast Types of Breast Cancer Risk Factors Breast Cancer Prevention Strategies in the High-Risk Patient Clinical Manifestations Assessment and Diagnostic Findings Staging or Classification of Tumors Prognosis Surgical Management Nursing Process Systemic Treatments

Learning ObjectivesOn completion of this lecture, the student will be able to:

Compare the structure and function of the normal cell and the cancer cellDifferentiate between benign and malignant tumors.Describe the roles of radiation therapy, and chemotherapy in treating cancer.Describes the special nursing needs of patients receiving chemotherapy.Develop a teaching plan for breast self-examination

Cont.Identify the diagnostic tests used to detect the breast disorders.

Use the nursing process as a framework for care of the patient undergoing breast cancer surgery.

Compare the therapeutic usefulness of chemotherapy, surgery and radiation in treating breast cancer

Describe the physical, psychological and rehabilitative needs of the patient who has had mastectomy

Pathophysiology of the Malignant Process

Cancer is a disease process that begins when an abnormal cell is transformed by the genetic mutation of the cellular DNA.

Proliferative Patterns

Characteristics of Malignant Cells

Management of Cancer

Surgery

Radiation therapy

Chemotherapy

Bone Marrow Transplantation

Hyperthermia

Targeted therapies

Photodynamic therapy

Radiation TherapyTypes of Radiation

External Radiation

Internal radiation

Radiation Dosage

Toxicity

Altered skin integrity is a common effect

Alterations in oral mucosa

The entire gastrointestinal mucosa may be involved

Anorexia nausea, and vomiting, and diarrhea

If sites containing bone marrow (Anemia, Leukopenia, Thrombocytopenia (bleeding)

Systemic side effects

Nursing Management in Radiation Therapy

Protecting skin and oral mucosa

Protecting caregivers

ChemotherapyAdministration of Chemotherapeutic AgentsThe route of administration usually depends on:

The type of agentThe required dose The type, location, and extent of tumor being

treated

Special Problems Extravasation Indications of extravasation during administration of

vesicant agents

Toxicity Cells with rapid growth rates (eg, epithelium, bone marrow, hair follicles, sperm) are very susceptible to damage, and various body systems may be affected as well.Gastrointestinal SystemHematopoietic SystemCardiopulmonary SystemRenal SystemReproductive System

Neurologic System

Miscellaneous

Nursing Management in Chemotherapy

Assessing fluid and electrolyte status

Modifying risks for infection and bleeding

Administering chemotherapy

Protecting caregivers

Anatomic and Physiologic Overview

Assessment Health History

Physical Assessment: Female Breast

Diagnostic Evaluation

Malignant Conditions of the Breast Types of Breast Cancer

Ductal Carcinoma in Situ (DCIS) Invasive Cancer • Infiltrating Ductal Carcinoma• Infiltrating Lobular Carcinoma• Medullary Carcinoma• Mucinous Carcinoma • Tubular Ductal Carcinoma• Inflammatory Carcinoma• Paget Disease

Risk Factors Non Genetic Risk Factors Gender and Age

Personal History

Hormonal Factors

Radiation Exposure

Benign Proliferative Breast Disease

Fat Intake and Obesity

Alcohol Use

Other Possible Risk Factors

Genetic Risk Factors

More than 80% of all breast cancer cases have no known family history of the disease.

In familial cases, the risk is determined by which family member has the disease. Having a first-degree relative increase the risk twofold.

Protective Factors

Breast Cancer Prevention Strategies in the High-Risk Patient

Long-Term Surveillance

Chemoprevention

Chemoprevention

Prophylactic Mastectomy

Clinical Manifestations

Assessment and Diagnostic FindingsTechniques to determine the diagnosis of breast cancer

include various types of biopsy, which have been discussed previously.

Staging or Classification of Tumors

Stage 0

Stage 1

Stage II and stage III, stage IV

Prognosis

The two most important factors when determining the prognosis of a patient with breast cancer are:

Tumor size

Whether the tumor has spread to the lymph nodes under the arm (axilla).

Surgical Management

Modified Radical Mastectomy

Total Mastectomy

Breast Conservation Treatment

Nursing ProcessThe Patient Undergoing Surgery for Breast Cancer

Assessment

Diagnosis (Preoperative Nursing Diagnosis)

Diagnosis (Postoperative Nursing Diagnosis)

Potential Complications

Planning and Goals

Preoperative Nursing Interventions

Postoperative Nursing Interventions

Monitoring and managing potential complications

Lymphedem

Hematoma Formation

Seroma Formation

Infection

Promoting Home and Community-Based Care

Radiation TherapyTypes of radiation

External-beam radiation

Brachytherapy

Intraoperative radiation therapy

Acute Side Effects

Nursing Management

Systemic Treatments I- Chemotherapy

Common physical side effects of chemotherapy for breast cancer

Specific side effects vary with the type of chemotherapeutic agent used.

The side effects of the anthracyclines

Nursing Management

II- Hormonal TherapyManaging Side Effects of Adjuvant Hormonal

Therapy in Breast Cancer Hot Flashes Vaginal Dryness Nausea and Vomiting Musculoskeletal Symptoms Risk of Endometrial Cancer Risk for Thromboembolic Events Risk for Osteoporosis or Fractures

III- Targeted Therapy

Trastuzumab (Herceptin) is a monoclonal antibody that binds specifically to the HER-2/neuprotein.

This protein, which regulates cell growth, is present in small amounts on the surface of normal breast cells and in most breast cancers.

Trastuzumab targets and inactivates the HER-2/neuprotein, thus slowing tumor growth.

Unlike chemotherapy, trastuzumab spares the normal cells and has limited adverse reactions, which may include fever, chills, nausea, vomiting, diarrhea, and headache.

ReferenceBrunner, L. and Suddarath, D. (2010). Text Book of Medical Surgical Nursing. 12th Edition. J.B. Lippincott Williams & Wilikins, Library of Congress Catalging-in-Publication Data.]

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