2. Breast Cancer
Where does breast cancer originate?
The breast is composed of glandular ducts and lobules, connective tissue, and fat, with most of the
benign and malignant pathology arising in the duct and lobular network. Specifically, most breast cancer
is thought to originate in the terminal ductal lobular unit (TDLU).
7. Types
Types of breast cancer include ductal carcinoma in situ, invasive ductal carcinoma,
inflammatory breast cancer, and metastatic breast cancer.
Metastatic breast cancer is classified as Stage 4 breast cancer. The cancer has spread to other parts of the
body. This usually includes the lungs, liver, bones or brain.
• If the breast or chest wall is affected, symptoms may include pain, nipple discharge, or a lump or thickening
in the breast or underarm.
• If the bones are affected, symptoms may include pain, fractures, constipation or decreased alertness due to
high calcium levels.
• If the liver is affected, symptoms may include nausea, extreme fatigue, increased abdominal girth, swelling
of the feet and hands due to fluid collection and yellowing or itchy skin.
• If breast cancer spreads to the brain or spinal cord and forms tumors, symptoms may include pain,
confusion, memory loss, headache, blurred or double vision, difficulty with speech, difficulty with
movement or seizures.
8. Ductal carcinoma in situ (DCIS) is a non-invasive cancer where abnormal cells have been found
in the lining of the breast milk duct. The atypical cells have not spread outside of the ducts into the
surrounding breast tissue.
• does not cause any symptoms. Rarely, a woman may feel a lump in the
breast or have nipple discharge. However, most cases of DCIS are
detected with a mammogram.
Invasive Ductal Carcinoma: The abnormal cancer cells that began forming in the milk ducts
have spread beyond the ducts into other parts of the breast tissue. Invasive cancer cells can also spread to
other parts of the body. It is also sometimes called infiltrative ductal carcinoma. This is the most common
type that can affect men too.
•A lump or mass in the breast
•Swelling of all or part of the breast, even if no lump is felt
•Skin irritation or dimpling
•Breast or nipple pain
•Nipple retraction (turning inward)
•The nipple or breast skin appears red, scaly, or thickened
•Nipple discharge
•A lump or swelling in the underarm lymph nodes
9. Triple Negative Breast Cancer: These results mean the growth of the cancer is not
fueled by the hormones estrogen and progesterone, or by the HER2 protein. So, triple-
negative breast cancer does not respond to hormonal therapy medicines or medicines that
target HER2 protein receptors.
Inflammatory breast cancer is an an aggressive and fast growing breast cancer in which
cancer cells infiltrate the skin and lymph vessels of the breast. It often produces no
distinct tumor or lump that can be felt and isolated within the breast. But when the lymph vessels
become blocked by the breast cancer cells, symptoms begin to appear. It may not appear on
mamograph.
•Red, swollen, itchy breast that is tender to the touch
•The surface of the breast may take on a ridged or pitted appearance, similar to an
orange peel (often called peau d’orange)
•Heaviness, burning, or aching in one breast
•One breast is visibly larger than the other
•Inverted nipple (facing inward)
•No mass is felt with a breast self-exam
•Swollen lymph nodes under the arm and/or above the collarbone
•Symptoms unresolved after a course of antibiotics
10.
11. • Physicians may refer to cancers as invasive if they
spread to other tissues. Cancer that does not spread
to other tissues is noninvasive. Carcinoma in situ is
a noninvasive cancer.
• Breast cancer is staged from 0 to IV. You might see
a TNM staging system based on the tumor size,
lymph node involvement, and whether metastasis
has occurred. This TNM system is used to
determine the final staging from 0 to IV.
12.
13. Diagnosis
• Mammography (most accurate method of
detecting non-palpable lesions) shows lesions
and cancerous changes, such as
microcalcification. Ultrasonography may be
used to distinguish cysts from solid masses.
• Biopsy or aspiration confirms diagnosis and
determines the type of breast cancer.
• Estrogen or progesterone receptor assays,
proliferation or S phase study (tumor
aggressive), and other test of tumor cells
determine appropriate treatment and prognosis.
• Blood testing detects metastasis; this includes
liver function tests to detect liver metastasis and
calcium and alkaline phosphatase levels to detect
bony metastasis.
14. Surgery to remove the whole breast, called a mastectomy, or to remove just the tumor and tissues around it,
called a lumpectomy or breast-conserving surgery. There are different types of mastectomies and lumpectomies.
Radiation Therapy, which uses high-energy waves to kill cancer cells.
Other treatments destroy or control cancer cells all over the body:
Chemotherapy uses drugs to kill cancer cells. As these powerful medicines fight the disease, they also can
cause side effects, like nausea, hair loss, early menopause, hot flashes, and fatigue.
Hormone therapy uses drugs to prevent hormones, especially estrogen, from fueling the growth of breast
cancer.
Targeted Therapy prompt the body’s immune system to help destroy cancer cells. These medicines prompt
the body's immune system to destroy cancer. They target breast cancer cells that have high levels of a protein
called HER2.
Treatment
15.
16. How to prevent it
• It's been suggested that regular exercise can reduce
your risk of breast cancer by as much as a third.
Regular exercise and a healthy lifestyle can also
improve the outlook for people affected by breast
cancer.
• If you've been through the menopause, it's
particularly important that you're not overweight or
obese.
• This is because being overweight or obese causes
more oestrogen to be produced, which can increase
the risk of breast cancer.
17. • 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.
Nursing Intervention
18. •Prepare the patient for the effects of chemotherapy, and plan
ahead for alopecia, fatigue.
•Administer antiemetics prophylactically, as directed, for patients
receiving chemotherapy.
•Administer I.V. fluids and hyperalimentation as indicated.
•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.
•Teach all women the recommended cancer-screening procedures.
