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Oncology Assessment and Management of Patients With Cancer Breast

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Title: Oncology Assessment and Management of Patients With Cancer Breast


1
Oncology Assessment and Management of Patients
With Cancer Breast
  • Prepared by Dr. Iman Abdullah

2
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

3
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

4
Learning Objectives
  • On completion of this lecture, the student will
    be able to
  • Compare the structure and function of the normal
    cell and the cancer cell
  • Differentiate 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

5
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

6
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

7
Management of Cancer
  • Surgery
  • Radiation therapy
  • Chemotherapy
  • Bone Marrow Transplantation
  • Hyperthermia
  • Targeted therapies
  • Photodynamic therapy

8
Radiation Therapy
  • Types of Radiation
  • External Radiation
  • Internal radiation
  • Radiation Dosage

9
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

10
Nursing Management in Radiation Therapy
  • Protecting skin and oral mucosa
  • Protecting caregivers

11
Chemotherapy
  • Administration of Chemotherapeutic Agents
  • The route of administration usually depends on
  • The type of agent
  • The required dose
  • The type, location, and extent of tumor being
    treated
  • Special Problems Extravasation
  • Indications of extravasation during
    administration of vesicant agents

12
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 System
  • Hematopoietic System
  • Cardiopulmonary System
  • Renal System
  • Reproductive System
  • Neurologic System
  • Miscellaneous

13
Nursing Management in Chemotherapy
  • Assessing fluid and electrolyte status
  • Modifying risks for infection and bleeding
  • Administering chemotherapy
  • Protecting caregivers

14
Anatomic and Physiologic Overview
15
Assessment
  • Health History
  • Physical Assessment Female Breast
  • Diagnostic Evaluation

16
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

17
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

18
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

19
Breast Cancer Prevention Strategies in the
High-Risk Patient
  • Long-Term Surveillance
  • Chemoprevention
  • Chemoprevention
  • Prophylactic Mastectomy

20
Clinical Manifestations
21
Assessment and Diagnostic Findings
  • Techniques to determine the diagnosis of breast
    cancer include various types of biopsy, which
    have been discussed previously.

22
Staging or Classification of Tumors
  • Stage 0
  • Stage 1
  • Stage II and stage III, stage IV

23
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).

24
Surgical Management
  • Modified Radical Mastectomy
  • Total Mastectomy
  • Breast Conservation Treatment

25
Nursing Process
  • The 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

26
Monitoring and managing potential complications
  • Lymphedem
  • Hematoma Formation
  • Seroma Formation
  • Infection
  • Promoting Home and Community-Based Care

27
Radiation Therapy
  • Types of radiation
  • External-beam radiation
  • Brachytherapy
  • Intraoperative radiation therapy
  • Acute Side Effects
  • Nursing Management

28
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

29
II- Hormonal Therapy
  • Managing 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

30
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.

31
Reference
  • Brunner, 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.

32
  • Thank you
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