breast cancer by : preethi vithana by : preethi vithana
TRANSCRIPT
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BREAST CANCER
By : Preethi Vithana
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Content
• Anatomy of Breast• What is Breast Cancer• Risk Factors• Pathophysiology• Spreading of Breast Cancer• Investigation• Treatment• Nursing care• Preventive care
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Introduction
• Most common female cancer
• Incidence high in the west
• 211,300 new cases yearly and rising
• 40,000 deaths yearly
• Incidence increasing 14 per 100000 in SL in 2000
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Anatomy of Breast
The breast consist with;
• Lobules and ducts-lobules develop in pregnancy and puberty
-15 to 20 lobules, each has separate ducts
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• Stroma -contains connective tissues and fat
• Lymph vessels
• Main blood supply by lateral thoracic artery
• Coopers ligament give support to the breast
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Definition Breast cancer is an uncontrolled growth of breast cells.
It can be ductal carcinomas or lobular carcinomas.
Ductal Carcinoma Lobular Carcinoma
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Two type of tumors
• Benign tumor -Benign tumors are
noncancerous
• Malignant tumor -Malignant tumors are cancerous Malignant Benign
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Risk Factors• Genetic
BRACA 1
BRACA2
• Reproductive history
Increased estrogen exposure
–Early menarche
–Late menopause
–Nulliparity
• Female
• Family history
• Age
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Other Risk Factors
• Obesity• Race• Alcohol • Birth control pills• Environmental
-Chemical -Radiation
-Heat
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PathophysiologyEnvironmental factor
Inherited mutation;Genetic
Damage & failure of repair DNA
Mutation in genome
Activation of growth promoting oncogenes
Inactivation of tumor suppressor genes
Unregulated cell proliferation
Alteration in genes that regulate
apoptosis
Decreasedapoptosis
Colonial expansionTumor progression
Malignant neoplasm
Hormonal changes
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Spreading of breast cancer
Breast cancer spreads in three different ways
• through the lymph system
• through the blood
• Local spread
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Classification• Histopathology
This is based upon characteristics seen upon light microscopy of biopsy specimens
• GradeThis focuses on the appearance of the breast cancer cell comparing with normal breast tissues
• Stage TNM (tumor, node, metastasis) system
• Receptor statusAccording to estrogen progesterone receptor
• DNA-based
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Staging• Primary Tumor
T1 = Tumor < 2 cm. in greatest dimensionT2 = Tumor > 2 cm. but < 5 cm.T3 = Tumor > 5 cm. in greatest dimensionT4 = Tumor of any size with direct extension to chest
wall or skin
• Regional Lymph NodesN0 = No palpable axillary nodesN1 = Metastases to movable axillary nodesN2 = Metastases to fixed, matted axillary nodes
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• Distant MetastasesM0 = No distant metastasesM1 = Distant metastases including ipsilateral
supraclavicular nodes
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Clinical Staging and prognosis
• Clinical Stage I T1 N0 M0
• Clinical Stage IIA T1 N1 M0 T2 N0 M0
• Clinical Stage IIB T2 N1 M0 T3 N0 M0
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• Clinical Stage IIIA T1 N2 M0 T2 N2 M0 T3 N1 M0 T3 N2 M0
• Clinical Stage IIIB T4 any N M0
• Clinical Stage IV any T any N M1
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• Staging prognosis for the 5 year survival rate
-stage I 93%
-stage II 72%
-stage III 41%
-stage IV 18%
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Clinical Manifestations• Painless lump or thickening
• Thickening or swelling that
persist
• Axillary lymph node edema
• Pain or Invasive nipple
• Spontaneous discharge
• A breast that appears to have
enlarged
• Peud’orange appearance
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Triple Assessment
• Clinical -Physical examination
-History
Investigations
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• Imaging -Mammograms -MRI -Ultrasound
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• Histology/cytologyFNAC (Fine needle aspiration cytology)
• HistologyCore biopsy
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Treatments
• Surgical Treatments
-Lumpectomy
-Partial Mastectomy or Quadrantectomy
-Total Mastectomy
-Modified Radical Mastectomy
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Lumpectomy
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Quadrantectomy
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Total Mastectomy
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Modified Radical Mastectomy
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• Radiation Therapy
• Chemotherapycyclosphosphamide, methotrexate, and fluorouracil
• Hormone blocking therapyTamoxifen or aromatase inhibitors Ex, Arimidex
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Nursing Care and Interventions
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• After surgery -wound care
• Long term complication -lymphedema, if present need to drainage fluid
• After radiotherapy -skin reactions occur leading to erythema, swelling and soreness of the breast. applied hydrocortisone
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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.
• Provide psychological support to the patient throughout the diagnostic and treatment process.
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• Involve the patient in planning and treatment.
• Describe surgical procedures to alleviate fear.
• Administer antiemetic prophylactically, as directed, for patients receiving chemotherapy.
• Administer I.V. fluids and hyperalimentation as indicated.
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• Help patient identify and use support persons or family or community.
• Suggest to the patient the psychological interventions may be necessary for anxiety, depression, or sexual problems.
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• Communicate feelings of comfort and decreased pain.
• Participate in her own care at the highest level possible within the limitations of her illness.
• Express positive feelings about self.
• Express increased sense of well-being.
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• Use situational supports to reduce fear.
• Maintain optimal muscle strength and joint range of motion.
• Demonstrate adequate coping behaviors.
• Free from signs and symptoms of infection.
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Preventive care• screening• physical activity• Limit alcohol• Breast-feed• Discontinue hormone
therapy• Avoid exposure to
environmental pollution• Breast self examination• Diet
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References
• http://www.breastcancer.org/symptoms/diagnosis/staging.jsp• http://www.medicinenet.com/breast_cancer/article.htm• http://www.breastcancer.org/symptoms/testing/types/
physical_exam.jsp• http://www.singhealth.com.sg/PatientCare/
ConditionsAndTreatments/Pages/Breast-Cancer.aspx?gclid=CKnIi8_8vKwCFYka6wodoHXgow
• http://www.yapstuff.org/page/healthy_breasts.html?gclid=CL_C0Mz8vKwCFUN76wod-hSipg
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Questions?
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Thank You!!!