breast cancer hitham g. falahi 4nu04. the most common cancer in females…
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Breast Cancer
Hitham G. Falahi4NU04
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• Paget’s 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-OP2. 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-OP3. 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 CancerNURSING INTERVENTION : Post-
OPPromote 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-OPMANAGE 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-OPMANAGE COMPLICATIONS• Hematoma• Notify the surgeon• Apply bandage wrap (Ace
wrap) and ICE pack
Breast Cancer
NURSING INTERVENTION : Post-OPMANAGE COMPLICATIONSInfection• Monitor temperature,
redness, swelling and foul-odor
• IV antibiotics• No procedure on affected
extremity
Breast Cancer
NURSING INTERVENTION : Post-OPTEACH FOLLOW-UP care• Regular check-up• Monthly BSE on the other
breast• Annual mammography