BREAST CANCER

1. BREAST CANCER

2. Objectives:
• To helped us accumulate extensive knowledge
about the biological processes involved in breast
cancer onset, growth and spread in the body.
• To raise awareness and reduce the stigma of
breast cancer through education on symptoms.
• To develop safe and effective methods to
prevent, detect, diagnosed treat and ultimately
cure the breast cancer.

3. INTRODUCTION
• Breast Cancer is a fatal disease at advance
stages; However, It can be controlled through
prevention and early detection.
• Breast cancer strikes women at ages; indeed
its incidence seems to drastically increase at
the age of 40.

4. INCIDENCE
WORLDWIDE
• Breast cancer was the most common cancer in women
worldwide, contributing 25.4% of the total number
new cases diagnosed in 2018.
• Cancer is a leading cause of death worldwide,
accounting for an estimated 9.6 million deaths in 2018.
Breast CA:
• New cases -2.09 million
• Deaths -627,000

5. INCIDENCE
PHILIPPINES
• According to the WHO the number of cancer
cases in the Philippines in 2018 was at 141,021
with total deaths at 86,337.
• Breast cancer- 24,798 new cases in 2018.
• The Philippines topped #197 countries with the
most number of cases of breast cancer.

6. RISK FACTORS
Risk factors
Non-
modifiable/
Uncontrolled
factors
Modifiable
factors

7. Non-modifiable factors
• Gender
• Age
• Genetic risk function
• Family history
• Personal history of breast cancer
• Race/ethnic background
• Certain benign (not cancer) breast problems
• Menstrual periods
• Breast radiation early in life

8. Non-modifiable factors
Gender- more prevalent in women.
- One (1) in every 150 cases in (male)
Age- The chance of getting breast cancer goes
up as a woman gets older.
- Over 80% of all female breast cancers
occur among women aged 50+ years

9. Non-modifiable factors
• Genetic risk- Women who carry the BRCA1
and BRCA2 genes have a considerably higher
risk of developing breast cancer.
Lifetime breast cancer
risk
Median age of breast
cancer onset (y)
General population 11% 61
BRCA1 65% 43
BRCA2 45% 41

10. Non-modifiable factors
Family History- Breast cancer risk is higher among
women whose close blood relatives have this
disease.
Personal hx- A woman with cancer in one breast
has a greater chance of getting a new cancer in the
other breast or in another part of the same.
Race/Ethnic background- Over all, white women
are slightly more likely to get breast cancer than
African- American women

11. Incidence of breast cancer (By race)

12. Non-modifiable factors
- African- American women, are slightly more
likely to get breast cancer.
- Asian, Hispanic and native- American women have a
lower risk of getting and dying from breast cancer.

13. Non-modifiable factors
Certain benign breast problems- Women who have
breast changes may have an increased risk of breast
cancer.
Menstrual period- Women who began having periods
early (before age 12) or who went through the change
of life (menopause) after the age of 55 have a slightly
increase risk of breast cancer.

14. Non-modifiable factors
Dense breast tissue- It means there is more
gland tissue and less fatty tissue.
Breast radiation early in life- Women who have
had radiation treatment to the chest area as a
child or young adult have a greatly increased risk
of breast cancer.

15. MODIFIABLE (Controlled factors)
• Alcohol use
• Tobacco smoke
• Obesity
• Breast feeding
• Oral contraceptives
• Reproduction
• Radiation exposure
• Hormone replacement therapy

16. SIGNS AND SYMPTOMS

17. S/S:
• A lump in a breast
• A pain in the armpits or breast that does not
seem to be related to the woman’s menstrual
period.
• Pitting or redness of the skin of the breast;like the
skin of an orange.
• A rash around (or on) one of the nipples.
• A swelling (lump) in one of the armpits.
• One of the nipples has a discharge, sometimes it
may contain blood

18. S/S:
• An area of thickened tissue in a breast.
• The nipple changes in appearance; It may become
sunken or inverted.
• The size or the shape of the breast changes.
• The nipple-skin or breast-skin may have started to
peel, scale or flake.

19. S/S:
• An area of thickened tissue in a breast.
• The nipple changes in appearance; It may become
sunken or inverted.
• The size or the shape of the breast changes.
• The nipple-skin or breast-skin may have started to
peel, scale or flake.

20. Signs of breast cancer

21. S/S

22. ANATOMY

24. ANATOMY
• The breast are medically known as the mammary
glands.
• The mammary glands are made up of lobules,
milk-producing glandular structures, and a system
of ducts that transport milk to the nipple.
• Lymphatic vessels in the breast drain excess fluid.
• Gynecomastia- is a condition that makes breast
tissue swell in boys and men. It can happen when
the balance of two hormones in your body is
thrown off.

25. PATHOPHYSIOLOGY

26. Modifiable factor
• Gender M<F
• Genetic/Hereditary
Non-Modifiable
• Life style
• Sexual practice
• Virus
• Environmental
• Chemical
• Physical
Abnormal cell growth
Response with carcinogen
Damage/Change in genetic
material [DNA]
Hyperplasia
Metaplasia
Prolonged injury
↓
Mutation
Dysplasia
↓
Anaplasia

27. Decreased T-CELL
↓
Neoplasia
↓
“Promotion” CANCER
1cm growth
↓
Angiogenesis growth factor
BREAST
↓
Lump
↓
Tail of Spence
↓
Orange peel dumpling
↓
Nipple inversion
Anoxia
↓
Cell Death
Hypoxia
↓
Lactic acid
↓
Fever
↓
Pain
Metastasis

28. SURGERY

29. SURGERY
• Augmentation Mammoplasty- is
requested by women who desire larger or
fuller breast.

30. SURGERY
• Reduction mammoplasty- is usually
performed on women who have breast
hypertrophy (Excessive large breast).

31. SURGERY
• Mastopexy- is performed when the pt is
happy with her breast but wishes to have the
shape improved and a lift performed.

32. DIAGNOSTIC
EXAMINATION

33. Methods of diagnosis
Diagnostic tests and procedures for breast cancer
include:
• Breast exam
• Mammogram
• Breast UTZ Imaging Tests
• Breast MRI scan
• Biopsy

34. Diagnosis
BREAST EXAMS
Breast Self Exam
(BSE)
Clinical Breast Exam
(CBE)

35. Breast self exam
• BSE is an option for women starting in their 20’s.
• Any changes detected should be reported to a
medical expert.
• BSE: Conducted standing or reclining.

36. Breast Self Examination

37. CLINICAL BREAST EXAM
• Women in their 20’s and 30’s should have a clinical
breast exam every 3 years.
• After age of 40, women should have a breast exam
every year.

38. MAMMOGRAMS
• A technologist will position your breast for the test.
• The breast is press between 2 plates to flatten and
spread the tissue.
• The Ob gyne recommend that a woman obtain her
first baseline between the age of 35 and 40, It should
be done yearly.
• The whole process taken about 20 mins.

39. MAMMOGRAMS

40. Breast Ultrasound
• Use sound waves to outline a part of the body.
• The sound wave echoes are picked up by a computer
to create a picture on a computer screen.
• Used to investigate areas of concern found by a
mammogram.

41. Breast Ultrasound

42. Breast MRI
• Patients must or lie inside a narrow tube, face
down on a special platform.
• The platform has openings for each breast
that allow the image to be taken without
pressing on the breast.
• Contrast material may be injected into a vein
to help the MRI show more details.

43. Breast MRI

44. BIOPSY
• A biopsy is done when other tests show that
you might have breast cancer.
• It confirms if a mass is cancerous or not.
• Mass is removed and studied.

45. Examination of breast tissues
Tissues obtained during biopsy are examined to
determined:
• Malignant or benign
• Has it metastasize
• Is the lymph node affected
• Treatment

46. TYPES OF BREAST BOPSIES
• Fine needle
• Core needle
• Vacuum-assisted biopsies
• Surgical (open) biopsy
• Lymph node biopsy

47. Fine needle aspiration (FNA)
• Very fine needle is used.
• Extracts fluid from the lump.
• Guided by ultrasound
• Simple but is not 100% accurate.

48. Core needle biopsy
• Needle is larger than in fine needle biopsy.
• Removes more tissues
• Clearer results

49. Vacuum-Assisted Biopsies:
• Done with systems such as ATEC (Automated
Tissue Excision and Collection)
• Guided by MRI
• First the skin is numbed and a small (incision) is
made.
• A hallow probe is put through the cut into the
breast tissue.
• A piece of tissue is sucked out.

50. Vacuum-Assisted Biopsy

51. Surgical (open) biopsy
• Anesthesia is administered.
• Incision is made
• Part or whole lump is extracted and studies.

52. Lymph node biopsy
Lymph node biopsy
Removal of fluids
Needle biopsy
Removal of lymph nodes
Surgical biopsy

53. Lymph node biopsy

54. Other tests
Tests to find whether the cancer has spread:
• Chest x-ray: the lungs.
• Bone scan: the bones
• CT scan (computed tomography: the chest
and abdomen.
• MRI: Brain and spinal cord.
• UTZ: other parts

55. Staging of breast cancer
• Stage 0: Non- Invasive breast cancer. Has not
spread to breast tissues.
• Stage 1: <2cm and has not spread to breast
tissues.
• Stage II:
– Stage IIA: <2cm and has spread to lymph nodes or 2-
5cm and has spread to lymph nodes.
– Stage IIB: 2-5cm and has spread to lymph nodes or
>5cm and has not spread to lymph nodes.

56. Staging of breast cancer
• Stage III
– Stage IIIA: <5cm and spread to lymph nodes forming
clumps.
– Stage IIIB: Any size and spread to the skin or chest wall
Swelling.
Stage IIIC: Any size, spread to lymph nodes, skin and chest
wall
• Stage IV: Metastasized

58. Survival rates
Stage 5- Year Relative Survival Rate
0 100%
I 100%
II 93%
III 72%
IV 22%

59. TREATMENT

60. Treatment
The treatment will depend on various factors:
• The type of breast cancer
• The type and grade of the breast cancer- how
large the tumor is, whether or not it has spread,
and if so how far
• Whether or not the cancer cell are sensitive to
hormones
• The patient overall health
• The age of the patient
• The patients own preferences

61. SURGERY
• Mastectomy- Removal of the whole tissue.
• Lumpectomy- Removal of a small part of the
tissue.
• Cyrotherapy- Associated with lower risk and
less complications. Little bleeding and quick
recovery, can be performed repeatedly to
prevent recurrence of cancer.

62. Medication
• Aromatase inhibitors- Anastrozole,
Exemestane and letrozole. It treat the ER-
positive breast CA.
• Fulvestrant and toremiferene are used to treat
metastatic breast cancer.

63. NURSING DIAGNOSIS

64. Preoperative nursing dx.
• Deficient about the planned surgical treatments.
• Anxiety related to the diagnosis of cancer
• Fear related to specific treatments and body
image changes
• Risk for ineffective coping (individual or family)
Related to the diagnosis of breast cancer and
related treatment options.
• Decisional conflict related to treatment options.

65. Pre operative nursing interventions
• Providing educational and preparation about
surgical treatments.
• Reducing fear and anxiety and improving
coping ability.
• Promoting decision making ability.

66. Post operative nursing dx.
• Pain and discomfort related to surgical procedure
• Disturb sensory perception related to nerve irritation
in affected arm, breast or chest wall
• Disturbed body image related to loss or alteration of
the breast
• Risk for impaired adjustment related to the diagnosis
of cancer and surgical treatment
• Self care deficit related to partial immobility of upper
extremity on operative side
• Risk for sexual dysfunction related to loss of body part,
changes in self image and fear of partners responses.

67. Post operative nursing intervention
• Relieving pain or discomfort
• Managing post operative sensations
• Promoting positive body image
• Promoting positive adjustment and coping
• Improving sexual functions

68. INTERPRETATION
• As a future nurses we will play essential role in
oncologic care, that’s why we must educate
ourselves on learning styles and theories to
best meet the educational needs not only in
breast cancer but also in the different types of
cancer. That’s all thankyouuu