Breast Cancer

Hitham G. Falahi 4NU04

The most common cancer in females

 A malignant tumor of the breast, usually a carcinoma, rarely a sarcoma

Risk Factors
Genetics- BRCA1 And BRCA 2 Increasing age ( > 50yo) Family History of breast cancer Early menarche and late menopause Late age at pregnancy Nulliparity Obesity Hormonal replacement Alcohol Exposure to radiation

Protective factors
Exercise Breast feeding Pregnancy before 30 yo

Pathophysiology
Modifications of DNA of the breast epithelial duct cells Chromosomal alterations, gene mutations, suppression of apoptosis Modification of specific oncogenes or the loss of specific suppressor genes Proliferation of breast cells Tumor formation

Types of Breast Cancer

Ductal Carcinoma in Situ Invasive Ductal Carcinoma - tubular - medullary -mucinous -papillary -cribriform

Invasive Lobular Carcinoma Inflammatory Breast Cancer Lobular Carcinoma in Situ Pagets Disease

Clinical Manifestations
Local pain Dimpling of the skin Nipple retraction Skin retraction Edema Nipple or areolar eczema Pitting of the skin (peau d orange) Reddened skin, local tenderness, and warmth

 Dilated blood vessels Nipple discharge in nonlactating women Ulceration Hemorrhage Edema of the arm Chest pain

Medical Management
Chemotherapy Tamoxifen Therapy Radiation Therapy

Surgical Management
Radical Mastectomy Modified Radical Mastectomy Lumpectomy

Breast Cancer
NURSING INTERVENTION : PRE-OP 1. Explain breast cancer and treatment options 2. Reduce fear and anxiety and improve coping abilities 3. Promote decision making abilities 4. Provide routine pre-op care: Consent, NPO, Meds, Teaching about breathing exercise

Breast Cancer
NURSING INTERVENTION : Post-OP 1. Position patient: Supine Affected extremity elevated to reduce edema

Breast Cancer
NURSING INTERVENTION : Post-OP 2. Relieve pain and discomfort Moderate elevation of extremity IM/IV injection of pain meds Warm shower on 2nd day post-op

Breast Cancer
NURSING INTERVENTION : Post-OP 3. Maintain skin integrity Immediate post-op: snug dressing with drainage Maintain patency of drain (JP) Monitor for hematoma w/in 12H and apply bandage and ice, refer to surgeon

Breast Cancer
NURSING INTERVENTION : Post-OP 3. Maintain skin integrity Drainage is removed when the discharge is less than 30 ml in 24 H Lotions, Creams are applied ONLY when the incision is healed in 4-6 weeks

Breast Cancer
NURSING INTERVENTION : Post-OP Promote activity Support operative site when moving Hand, shoulder exercise done on 2ndday Post-op mastectomy exercise 20 mins TID NO BP or IV procedure on operative site

Breast Cancer
NURSING INTERVENTION : Post-OP Promote activity Heavy lifting is avoided Elevate the arm at the level of the heart On a pillow for 45 minutes TID to relieve transient edema

Breast Cancer
NURSING INTERVENTION : Post-OP MANAGE COMPLICATIONS Lymphedema 10-20% of patients Elevate arms, elbow above shoulder and hand above elbow Hand exercise while elevated Refer to surgeon and physical therapist

Breast Cancer
NURSING INTERVENTION : Post-OP MANAGE COMPLICATIONS Hematoma Notify the surgeon Apply bandage wrap (Ace wrap) and ICE pack

Breast Cancer
NURSING INTERVENTION : Post-OP MANAGE COMPLICATIONS Infection Monitor temperature, redness, swelling and foul-odor IV antibiotics No procedure on affected extremity

Breast Cancer
NURSING INTERVENTION : Post-OP TEACH FOLLOW-UP care Regular check-up Monthly BSE on the other breast Annual mammography