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Breast Cancer

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Breast Cancer . Prepared by: Hai Lam. Lynn Yu. Racheal Richie . Trina Jones – PowerPoint PPT presentation

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Title: Breast Cancer


1
Breast Cancer
  • Prepared by
  • Hai Lam
  • Lynn Yu
  • Racheal Richie
  • Trina Jones

2
(No Transcript)
3
Pathophysiology
  • http//www.youtube.com/watch?vYNUBnX9JHQsfeature
    related
  • http//www.youtube.com/watch?vhswn7HlLklsfeature
    related

4
Clinical Manifestations
  • Lump
  • Most commonly in upper, outer quadrant of breast
  • Palpation hard, may be irregularly shaped,
    poorly delineated, nonmobile, nontender
  • Mammographic Abnormalities

5
Clinical Manifestations
  • 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 dorange

6
Signs and Symptoms
  • http//www.youtube.com/watch?vyTHyMNBkbOY

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

8
Interventions
  • 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
Goals of Care
  • 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
Desired Outcomes
  • 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
Management
  • 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
Management
  • Staging Breast Cancer
  • TNM system
  • T Tumor size
  • N Nodal involvement
  • M Metastasis

13
Management
  • 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
Management
  • 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
Management
  • 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
Management
  • 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
Management
  • 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
Management
  • 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

19
Compare and Contrasting Different Types of
Cancer
20
Statistics
  • Women 2nd most prevalent type of cancer
  • Women 2nd leading cause of cancer death
  • 200,000 women 1,700 men DX each year
  • 40,000 women 450 men die each year

21
Types
  • 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)
  • Pagets Disease of the Nipple
  • Phyllodes Tumors of the Breast

22
Ductal Carcinoma in situ (DCIS)
23
Invasive Ductal Carcinoma (IDC)
Normal breast with invasive ductal carcinoma
(IDC) in an enlarged cross-section of the duct
Breast profileA DuctsB LobulesC Dilated
section of duct to hold milkD NippleE fatF
pectoralis major muscleG Chest wall/rib
cage EnlargementA Normal duct cellB 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.
A DuctsB LobulesC Dilated section of
duct to hold milkD NippleE FatF
Pectoralis major muscleG Chest wall/rib
cage CellA Normal duct cellB Ductal
cancer cells breaking through the basement
membrane.C Basement membrane
24
Invasive Ductal Carcinoma (IDC)
  • 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
Inflammatory Breast Cancer
  • No lump
  • Start with reddening and swelling of the breast

Pagets disease of the nipple
  • Unusual changes in the nipple and aerola
  • Scaly, red, itchy, irritated

26
Breast Cancer in Men
  • Rare
  • Less than 1 of all breast cancers
  • Men have breast tissue
  • Typically men dont make breast stimulating
    hormones
  • Breasts on a man are typically mounds of fat
  • Developing real breast gland tissue
  • Medications
  • Abnormal hormone levels

27
Staging Breast Cancer
Stage Description 5-year Survival Rate
0 Carcinoma in situ 93
I Tumor 2 cm or less in greatest dimension No axillary lymph node metastasis or Evidence of distant metastasis 88
II Tumor 2 cm or less but 1-3 positive lymph nodes Tumor 2-5 cm with or without axillary lymph nodes Tumor lt 5 cm without spread to lymph nodes No distant metastasis A 81 B 74
III Any 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
IV Any of the above plus distant metastasis (ie, liver, lungs, bone, brain) 15
28
Risk Factors
29
(No Transcript)
30
References
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