1. BREAST CANCER
 Presented to:-
Mrs. Mamta Toppo
Associate professor
College of Nursing
RIMS, Ranchi
 Presented by:-
Priyanka Bauri
Roll. No:- 23
Basic B.sc Nursing 3rd year
College of Nursing RIMS Ranchi

2. Content
Anatomy of normal breast
Introduction
Definition
Forms of breast cancer
Risk factors
Stages
Clinical manifestation
Warning sings of breast cancer
Diagnostic evaluation
Screening and early detection
Management
Side effects
Nursing management
Post-operative exercises
Rehabilitation
Recent research
Assignment
Summary
Evaluation
References
Bibliography

3. Anatomy of breast

4. Introduction
 The term “breast Caner” refers to a malignant tumor that has
developed from cell in the breast . Breast cancer occure
anywhere in the breast, but most are found in the Upper
outer quadrant,where most breast tissue is located. Usually
breast cancer either begins in the cells of the lobules, which
are the milk- producing glands, or the ductsz the passages
that Drain milk from the lobules to the nipple.less commonly,
breast cancer can begin in the stromal tissues, which include
the fatty and fibrous connective tissue of the breast.

5. Definition
 Breast cancer is a malignant tumor that starts in the cells on
the breast.

8. Forms of breast cancer
1. Invasive ductal carcinoma- This type of breast cancer develops in
the milk ducts and account for about 79% of cases. It can break through
the duct wall and invade the breasts fatty tissue, then metastasize(spread)
to other part of the body through the bloodstream or lymphatic system.

9. 2. Invasive lobular carcinoma
This type of breast cancer accounts for about 10% of cases and originates in
the breasts milk- producing lobules. It also can spread to the breasts fatty
tissue and other place in the body.
3. Medullary, mucinous and tubular
carcinomas
 These are three slow- growing types of breast cancer. Together they
represent about 10% of all breast cancer.

10. 4. Pagets Diseases
 This type represents about 1% of breast cancers. It starts in the milk ducs
of the nipple and can spread to the areola (dark circles around the nipple).
Women who get pagets Diseases usually have a history of nipple crusting,
scaling, itching or inflammation.
5. Inflammatory carcinoma
 This type accounts for about 1 % of all cases. Of all breast cancers,
inflammatory carcinoma is the most aggressive and difficult to treat,
because it spread so quickly.

11. Ductal carcinoma in situ ( DCIS)
 DCIS occurs when cancer cells fill the ducts but haven’t yet
spread through the walls into fatty tissue. Nearly all women
diagnosed at this early stage can be cured. Without treatment,
about 25% of DCIS case will lead to invasive breast cancer
within 10 years.

13. Lobular carcinoma in situ ( LCIS)
 LCIS is less common and less of a treat than DCIS. It develops
in the breasts milk- producing lobules. LCIS doesn’t require
treatment, but it does increase a women’s risk of developing
breast cancer.

15. Risk factors
No one know the exact cause of
breast cancer. A “risk factor” is
anything that in creases your risk of
developing breast cancer. Studies have
found the following risk factors for
breast cancer.
 Age
 Gender
 Personal history of breast cancer
 Family history
 Certain breast changes
 Gene changei
 Reproductive and menstrual history
 Radiation therapy to the chest
 Breast density
 Atypical hyperplasia
 Hormone replacement therapy
 Oral contraceptive use
 Overweight or obese after
menopause
 Lack of physical activity
 Drinking alcohol

17. Stages of breast cancer
Stage Definition
Stage
0
Carsinoma in situ .
Cancer cell remain inside the brest ducts, without invasion into normal adjacent breast tissue.
Stage
I
Cancer is 2 cm or less and is confined to the breast .
Cancer cells have not spread beyond the breast.
Stage
II
The tumor is larger than 2 but no larger than 5cm and has not spread to the axillary lymph
nodes.

18. Contt….
S
t
a
g
e
II
Locally advanced cancer. It is decided into stage IIIA, IIIB, and IIIC .
S
t
a
g
e
III
A
No tumor is found in the brest. Cancer is found in axillary lymph nodes
that are sticking together or to other structures, or cancer maybe found
in lymph nodes near the breastbone or the tumor is any size. Cancer has
spread to the axillary lymph nodes, which are sticking together or to other structures,
or cancer may be found in lymph nodes near the breastbone.
S
t
a
g
e
III
The tumor may be any size and has spread to the chest wall and /or skin of the breast and may have spread to
axillary lymph nodes that are clumped together or sticking to other structures or cancer may have spread to
lymph nodes near the breastbone. Inflammatory breast cancer is considered at least stage IIIB.

19. Contt….
S
a
g
e
II
C
There may either be no sign of cancer in the breast or a tumor may be any size
and may have spread to the chest wall and/or the skin of the breast and the cancer
has spread to lymph nodes either above or below the collarbone and the cancer
may have spread to axillary lymph nodes or to lymph nodes near the breastbone.
St
a
g
e
IV
The cancer has spread or metastasized to other parts of the body.

21. Clinical manifestation
 According to American Cancer Society, any of the following
unusual changes in the breast can be a symptom of breast
cancer:
 A lump or thickening in or near the breast or in the
underarm area
 A change in the size or shape of the breast
 The skin of the breast, areola, or nipple may be scaly,red, or
swollen.
 Skin irritation or dimpling
 Breast pain
 Nipple pain or tenderness
 A nipple turned inward into the breast
 Unilateral nipple discharge other than breast milk
 Enlarged axillary or supraclavicular lymph nodes

23. Diagnostic evaluations
 Diagnostic mammogram
 Ultrasound
 Magnetic resonance imaging
 Biopsy
 Hormone receptor test
 CT- scan
 Bone scan

25. Screening and early detection
 Screening for breast cancer before there are symptoms can be
important. Screening can help doctors find and treat cancer early.
Doctor may suggest the following screening test for breast cancer.
 Yearly mammograms are recommended starting at age 40 and
continuing for as long as a women is in good health. A mammograms
can often show a breast lump before it can be felt.
 Clinical breast exam ( CBE) about every 3 years for women in their
20s and 30s and every year for women 40 and over. A through clinical
breast exam may take about 10 min . During ba clinical breast exam,
your health care provider checks your breasts . Health care provider
looks for differences in size or shape between your breasts. The skin of
your breasts is checked for a rash, dimpling, or other abnormal signs.
Your nipples may be squeezed to check for fluid.

27. Management
 Women with breast cancer have many treatment options. These
include surgery, radiation therapy, chemotherapy, hormone therapy,
and biological therapy. Many women receive more then one type of
treatment. Cancer treatment is either local therapy or systemic
therapy:
 Local therapy: Surgery and radiation therapy are local treatment.
They remove or destroy cancer in the breast . When breast cancer is
spread to other parts of the body, local therapy may be use to control
the Diseases in thode specific areas.
 Systemic therapy: Rest of the therapies are systemic treatment. They
enter the bloodstream and destroy or control cancer throughout the
body. Some women with breast cancer have systemic therapy to
shrink the tumor before surgery or radiation. Others have systemic
therapy after surgery and /or radiation to prevent the Cancer from
coming back . Systemic treatments also are used for cancer that has
spread.

28. A. Surgery
 Surgery is the most common treatment for breast cancer.
There are several type of surgery.
1. Mastectomy: an operation to remove the breast ( or as
much of the breast tissue as possible) is a mastectomy. This
procedure is generally done for carcinoma in situ. In the most
caaes, the surgeon also removes lymph nodes under the arm.
Some women have radiation therapy after surgery. It can be
done in several forms:
 Total mastectomy
 Redical mastectomy
 Modified redical mastectomy

29. 2. Lymph node Dissection
 The surgeon often Removes the underarm lymph nodes as well. A
separate incisions is made. This procedure is called an axillary lymph
node Dissection. It shows whether cancer cells have enter the lymphatic
system.
3 Breast sparing surgery
 An operation to remove the cancer but not thebreast is breast sparing
surgery. It is also called breast conserving surgery, lumpectomy,
segmental mastectomy, parital mastectomy and removal of axillary lymph
nodes. Sometime an excisional biopsy serves as a lumpectomy because
the surgeon removes the whole lump. After breast- sparing surgery,
most women receive radiation therapy to the breast . This treatment
destroys cancer cells that may remain in the breast.

30. 4. Prophylactic ovary removal
 It is a preventive Surgery that lowers the amount of estrogen
in the body, making it harder for estrogen to stimulate the
development of breast cancer.
5. Cryotherapy
 Cryotherapy, is also called cryosurgery, uses extreme cold to
freeze and kill cancer cells . It also use to control pain and
control bleeding . Right now , cryotherapy is an experimental
treatment for breast cancer. All cells, including cancer cells,
contain water. When cryotherapy freeze the cells, the water
turns to ice crystal. These ice crystals, along with the cold it
self, destroy the cancer cells.

31. 6. Breast reconstructive surgery
 Breast reconstruction is the rebuilding of the breast after
mastectomy and sometimes lumpectomy. Reconstruction
can take place at the same time as cancer removing surgery,
or months to year later. It is done to hence body image to
provide symmetry of breast.

33. B. Radiation therapy
 External radiation
 Internal radiation
C. Chemotherapy
D. Hormon therapy
E. Biological therapy

34.  Nursing Diagnosis
 Based on the health history and other assessment
data,major preOperative Nursing may include the
following.
1. Deficient knowledge about planned surgical treatments
2. Anxiety related to the diagnosis of cancer
3. Fear related to specific treatments and body image
changes
4. Risk for ineffective coping “ individual or family” related
to the diagnosis of breast cancer and related to
treatment options.
5. Decisional conflict related to treatment options.
Nursing management
Preoperative Nursing care

35. Nursing interventions
1. Providing education and preparation about surgical treatment
 Prepare the patient for what to expect before, during and after surgery
 Describe surgical procedure
 Inform the patients about post operative Drain, inform about drain care
instruction will be provided prior to discharge.
 Inform the patients about decrease arm and shoulder mobility after
surgery
 Administer antiemetics prophylactically , as directed, for patients
receiving chemotherapy
 Administor I.V fluids and hyperalimentation as indicated
 Help patient identify and use support persons or family or community

36. 2. Reducing fear, anxiety and improving coping
ability
 Providing the patient with realistic expectation about the
healing process and expected recovery can help alleviate
pain.
 Marinating open communication and assuring the patient.
Involve the patient in planning and treatment.
 Increase patient awareness of available resources at the
treatment facility such as psychiatrist , social workers and
support group.
 Realize that a diagnosis of breast cancer is a devastating
emotional shock to the women. Provide psychological
support to the patient throughout the diagnostic and
treatment process.

37. 3. Promoting decision making ability
 Give the patient treatment option and asked to make a
choice. The nurse help the patient weight the and benefits of
each option.
 The patient may be presented with option of having breast
conservation treatment followed by radiation and
mastectomy.
 Prepare the patient for the effects of chemotherapy, and
plan ahead for alopecia, fatigue.

38. Post operative Nursing care
Nursing diagnosis
1. Risk for infection related to surgical incision.
2. Ineffective tissue perfusion related to lymphedema
3. Acute pain and discomfort related to surgical procedure
4. Disturb body image related to breast changes or loss of
breast.
5. Impaired skin integrity related to surgical incision and
radiation

39.  Elevate the surgical site extremely to releive pain and edema. Elevation of
extremity decrease tension on surgical incision and promote blood
circulation.
 An icepack may be helpful to decrease discomfort and swelling,
particularly to the armpit after a lymph node Dissection.
 A small pillow positioned in the armpit also may decrease discomfort and
to promote gravity drainage of fluide.
 Teach her to use caution when moving the arm on the operated side, to
avoid strenuous activity, lifting heavy objects , and vigorous exercise until
the stitches are removed.
 Administer I.V or I.M opioid analgesics ( Vicodin) for the management of
moderate pain.
 Teach the patient about the importance of handwashing, specially wound
and drain care. Discuss the postoperative drainage device and it’s
management.
Nursing interventions

40. Post- operative
Mastectomy exercises

52. Summary
 Breast cancer is an uncontrollable growth of breast .breast
cancer occure anywhere of the breast, but most are found in
the Upper upper outer quadrant,where most breast- tissue is
located. Through this presentation we come to know about
the types , risk factors, stages , clinical manifestation, and its
management .

53. Evaluation
What is breast cancer?
 Enlist the types of breast cancer?
What are the risk factor of breast cancer?
What are the diagnostic evaluation done to detect
breast cancer?

54. References
Book
Internet
Discussion with teacher

55. Bibliography
1. Javed Ansari; A textbook of medical surgical
Nursing-II , PV publications,
Page no : 817- 829.
2. www.slideshare.com
3. www.wikipedia.Com
4. Www.researchgate.com