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CASE PRESENTATION

GROUP 2
INTRODUCTION
GENERAL OBJECTIVE

This presentation aims to identify and further discuss the case of


Invasive ductal carcinoma left breast with pulmonary
metastases. With the data collection, gathering and analysis,
the team shall be able to concisely discuss the health history,
laboratory and diagnostic examinations, anatomy and
physiology of the system in which the illness evidently affects,
pathophysiology, clinical manifestations, risk factors,
complications and other necessary information.
SPECIFIC OBJECTIVE

To define Invasive ductal carcinoma left breast with pulmonary


metastases.
To discuss its types, etiology, risk factors, and clinical
manifestations of the disease
To distinguish and present laboratory results and tests done to
the client and correlate it to the disease process.
To discuss the anatomy and physiology of the disease.
Toelaborately discuss the relations between the health history,
pathophysiology and the complications that would occur with
the disease process
To
state and describe the treatment modalities and medical
management used in the management of the disease.
Toprovide and rationalize adequate nursing interventions for
the patient
To discuss the prognosis and recommendations intended for the
client.
INTRODUCTION TO THE DISEASE PROCESS:

BREAST CANCER

The most commonly diagnosed cancer in women, second only


to lung cancer for cancer mortality. Breast cancer mortality
could be reduced by 30% through early detection using routine
screening mammography alone or together with annual clinical
breast examination by a primary health care provider beginning
between 40 and 50 years of age
ETIOLOGY AND RISK FACTOR

Gender- women are more likely than men to develop breast cancer.
Age the incidence of breast cancer increases with age. Most breast
cancer cases are diagnosed in women 40 years of age and older, but
majority of cases occur in women over 50 of age.
Personal history of cancer- previous diagnosis of breast increases a
womans lifetime risk for developing a second breast cancer in the
opposite (collateral) breast.
Family history of cancer and genetics women with a family history of
breast cancer in one-degree relative (mother, sister, or daughter)
increases risk of developing breast cancer.
Hormonal factor exact role of hormones in developing breast
cancer has not precisely determined. Early onset of menarche
(before age 12) , late menopause (at 55 or above), and greater total
duration of years of regular menses are associated with an increased
risk of breast cancer. This is risk is thought to be due to the total lifetime
exposure of the breast to estrogen and progesterone, with fluctuation
in cell and change in the breast tissues with each ovulatory cycle.
Having no children (nulliparity) or he first full term pregnancy after age
30 .
Use of oral contraceptive or hormone replacement therapy
Non-breastfeeding women
Benign breast disease- encompasses a broad array of
histopathologic tissue diagnosis
Fibrocystic changes- normal breast changes
Non proliferative lesions- when found alone, are generally not
associated with any increased risk of breast cancer.
Proliferative lesions without atypia- increased growth of
epithelial cells in the ductal or lobular tissue of the breast,
include ductal epithelial hyperplasia of then (common) type,
sclerosing adenosis, radial scar, and intraductal papillomas.
Proliferative lesions with atypia, or typical hyperplasia- the
proliferation of abnormal-looking cells within ducts or lobules.
This constitute the third category of benign breast disease.
OBESITY AND DIETARY FAT
high socioeconomic status and increased consumption of
dietary fat.
RADIATION EXPOSURE
ALCOHOL CONSUMPTION
PREVENTION, SCREENING AND DETECTION

MAMMOGRAPHY -only proven means of detecting breast cancer before it


can be discovered BY CBE or BSE. This is used in detecting cancer in
asymptomatic women.
SCREENING MAMMOGRAPHY- consist of two views of each breast: one from
side to side that includes then axilla and the upper outer quadrant of the
breast(mediolateral oblique) and one from the top to
bottom(craniocaudal).
DIAGNOSTIC MAMMOGRAPHY-consist of additional views of the breast to
help delineate an area of concern found or a screening mammogram or a
palpable mass.
BREAST SELF-EXAMINATION- a free, private, and relatively simple examination.
CLINICAL BREAST EXAMINATION -important adjunct to mammography.
CLASSIFICATION

Noninvasive a malignancy confined to the ducts or lobules


Ductal carcinoma in situ- arose in the ductal system
Lobular carcinoma in situ in the lobule system
Infiltrating or invasive ductal/lobular carcinoma- when
malignant cells penetrate the tissue outside the ducts or
lobules.
DIAGNOSIS

Tissue diagnosis
FINE-NEEDLE ASPIRATION (FNA) BIOPSY
CORE NEEDLE BIOPSY
Mammogram
Ultrasound
MRI
CLINICAL FEATURES
Mass (particularly if hard, irregular, nontender) or thickening in breast or
axilla.
Spontaneous, persisitent, unilateral nipple discharge that is
seroussanguineous, bloody, or watery.
Nipple retraction or inversion
Change in size, shape, or texture of breast (asymmetry)
Dimpling or puckering of skin
Scaly skin around the nipple
Redness, ulceration, edema, or dilated veins
Peau d orange skin changes
Enlargement of lymphnodes on axilla
STAGING
Stage 0 - carcinoma in situ (Tis-NO-M0)
Stage 1 tumor of under 2 cm with negative nodes (T1-N0-M0)
(includes microinvasive T1, less than 0.1 cm)

Stage 11A tumor of 0 to 2 cm with positive nodes (including


micrometastasis N1, of less than 2mm), or 2 to 5 cm with negative nodes
(T0-N1, T1-N1, T2-N0, all M0)
Stage 11B - tumor of 2 to 5 cm with positive nodes or greater than 5 cm
with negatives nodes (T2-N1, T3-N0, all M0)
Stage 111A- no evidence of primary tumor or tumor of less than 2 cm
with involved lymph nodes, or any size tumor with involved internal
mammary lymph nodes (T0-N2, T1-N2,T2-N2, T3-NI, T3-N2, all M0)
Stage 111b- tumor of any size with direct extension to chest wall or
skin, with or without involved lymph nodes, or any size tumor with
involved internal mammary lymph node (T4-any N, any T-N3, all M0))
Stage1V- any distant metastasis (includes ipsilateral supraclavicular
nodes).
Statistical reports commonly refer stage as Local (lymph nodes or
surrounding tissue involved) and Distant (metastasis present).

Three tumors markers with some value in breast cancer treatment


are carcinoembryonic antigen (CEA) , CA 15-3, CA 27-29.
PROGNOSTIC INDICATORS

PROGNOSTIC INDICATORS

PROGNOSTIC FACTOR FAVORABLE RANGE


TUMOR SIZE Noninvasive

AXILLARY LYMPHNODE STATUS Negative

ESTROGEN RECEPTORS Positive

PROGESTERONE RECEPTORS Positive

HISTOLOGIC GRADE Well-differentiated

NUCLEAR GRADE Low grade

DNA CONTENT
PLOIDY Diploid (DNA=1.00%)
S-PHASE Low (4%)

ONCOGENES
HER2/neu Low expression

TUMOR SUPPRESS GENES


P53 Low expression
MEDICAL MANAGEMENT

Surgery
Modified radical mastectomy
Total mastectomy
Lumptectomy /segmental mastectomy
Quadrantectomy
Breast-conserving treatment
Breast reconstruction
Radiation therapy
Chemotherapy
Targeted therapy
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 a devastating 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.
7.Prepare the patient for the effects of chemotherapy, and plan ahead
for alopecia, fatigue.
8.Administer antiemetics prophylactically, as directed, for patients
receiving chemotherapy.
9.Administer I.V. fluids and hyperalimentation as indicated.
10.Help patient identify and use support persons or family or
community.
11.Suggest to the patient the psychological interventions may be
necessary for anxiety, depression, or sexual problems.
12.Teach all women the recommended cancer-screening procedures.
CONSIDERATIONS

Prevention and detection


Incorporate assessments of cognitive function, physical limitations and sensory
deficits, and support network into baseline and follow-up assessments.
Address knowledge and confidence in breast self-examination (BSE), knowledge
and confidence in mammography and clinical breast examination (CBE), and
belief about benefits of early detection in all patient education.
Attempt to coordinate care with one or as few provides as possible (e.g,
advocate, case manager) to enhance continuity and participation in care.
Community-based breast cancer screening, going to whether seniors live and
socialize, may be beneficial.
Health care provider education is still needed to encourage regularly scheduled
screening of elderly women. Annual screening mammography should begin at
age 40 with no upper age limit for discontinuation.
DIAGNOSIS AND TREATMENT

Patient involvement in decision making is important at every age.


Age alone does not determine the type or extent of surgery or subsequent
therapy.
Care throughout the operative phase includes careful preoperative assessment
and intraoperative and postoperative physiologic monitoring.
Early comprehensive discharge must involve the patient and significant other.
Side effects with radiation and chemotherapy may be enhanced or prolonged.
Most trials or systemic therapy have excluded women over 70 years old.
Rehabilitation
Return to or maintenance of precancer level of functioning is a reasonable goal at any
age.
Psychosexual assessment and intervention should be incorporated as appropriate for all
ages.
Physical illness can impair developmental task completion.
Depression in elderly women may be masked by physical symptoms.
PULMONARY METASTASES

Where a cancer starts is called the primary cancer. If some cells break
away from the primary cancer, they can move through the
bloodstream of lymph system and spread to another part of the
body, where they can form a new tumour. This is called a secondary
cancer. Secondary cancers are also called metastases .

Sometimes breast cancer cells spread to one or both lungs through


the blood or lymph system. The cells that have spread to the lungs are
breast cancer cells. It is not the same as having cancer that starts in
the lungs (a lung cancer). When breast cancer spreads to the lungs it
can be treated but it can't be cured.
CAUSES:
METASTATIC TUMORS IN THE LUNGS ARE MALIGNANCIES
(CANCERS) THAT DEVELOPED AT OTHER SITES AND
SPREAD VIA THE BLOOD STREAM TO THE LUNGS.

Bladder Cancer
Breast Cnacer
Colon Cancer
Kidney cancer
Neuroblastoma
Prostate cancer
Sarcoma
Wilms Tumor
TESTS
may include a chest X-ray and CT scan.
These tests diagnose secondary lung cancer and can also show any
build up of fluid around the lungs (pleural effusion).

Symptoms
Breathlessness
Cough
Pain
Pleural effusion
Loss of appetite and weight loss
TREATMENT

The aim of treatment is to control and slow down the spread of


the cancer, relieve symptoms and give you the best quality of
life for as long as possible.
treatment may include:
chemotherapy
hormone therapy
targeted therapies.
*These treatments can be given alone or in combination.
NURSING INTERVENTIONS

Elevate the head of the bed to ease the work of breathing and to prevent
fluid collection in upper body (from superior vena cava syndrome).
Teach breathing retraining exercises to increase diaphragmatic excursion
and reduce work of breathing.
Augment the patients ability to cough effectively by splinting the patients
chest manually.
Instruct the patient to inspire fully and cough two to three times in one
breath.
Provide humidifier or vaporizer to provide moisture to loosen secretions.
Teach relaxation techniques to reduce anxiety associated with dyspnea.
Allow the severely dyspneic patient to sleep in reclining chair.
Encourage the patient to conserve energy by decreasing activities.
Instruct the patient to inspire fully and cough two to three times
in one breath.
Provide humidifier or vaporizer to provide moisture to loosen
secretions.
Teach relaxation techniques to reduce
anxiety associated with
dyspnea. Allow the severely dyspneic patient to sleep in
reclining chair.
Encourage the patient to conserve energy by decreasing
activities.
Ensure adequate protein intake such as milk, eggs, oral
nutritional supplements; and chicken, and fish if other
treatments are not tolerated to promote healing and prevent
edema.
Advise the patient to eat small amounts of high-calorie and
high-protein foods frequently, rather than three daily meals.
Suggest eating the major meal in the morning if rapid satiety is
the problem.
Change the diet consistency to soft or liquid if patient has
esophagitis from radiation therapy.
Consider alternative pain control methods, such as
biofeedback and relaxation methods, to increase the patients
sense of control.
Teach the patient to use prescribed medications as needed for
pain without being overly concerned about addiction.