This document provides an overview of breast cancer. It begins with defining breast cancer as a malignant condition where cells grow uncontrollably in the breast. It then lists the main risk factors like older age, family history, and obesity. The stages of breast cancer are explained from stage 0 to IV. Common signs and diagnostic tests are also outlined. Treatment options discussed include surgery, chemotherapy, radiation therapy, and hormonal therapy. Prevention strategies and nursing management of breast cancer are briefly addressed before concluding with a bibliography.

1. BREAST CANCER
DEPARTMENT
OF
MEDICAL SURGICAL NURSING

2. At the end of this lecturer, students should be able to:
• Define breast cancer.
• Enumerate the risk factors.
• Explain the pathophysiology.
• List out the clinical manifestations and diagnostic
measures.
• Explain the management of breast cancer.
Learning Objectives

3. • Cancer is a dreadful disease.80% to 90% of all cancers are the
result of the things we do to ourselves. Among women breast
cancer is the second most common cancer. Breast cancer is the
most common malignant condition of breast.
Introduction

5. • Breast cancer is the most common malignant condition of breast.
Malignant means cells that grow harmfully and uncontrollably.
Definition

6. Most common type of cancer in women,
2nd most common Cause of cancer death in women .Approximately 1,700
women will be diagnosed with breast cancer and 450 will die each year.
Incidence

7. • Older age
• Early onset of menses or late menopause
• Diets high in saturated fat
• Elderly primigravidae mothers or
• Nulliparous women's
• A personal history of breast cancer or benign (non-cancer) breast disease
RISK FACTORS

8. • A family history
• Treatment with radiation therapy to the breast/chest
• Enlarged Breast tissue
• Taking hormones
• Obesity
• Moderate alcoholic intake
• Gene Mutation
RISK FACTORS

10. Pathophysiology

11. Stage III
Tumor is >5cm in diameter
Cancer has spread to
LYMPHNODE
Stage I
Spread of cancer from lobules or
duct into nearby tissues
Tumor 2cm or less in diameter
Cancer has not spread to
surrounding tissue
Stage 0
Cancer cells may be
present in either lining of
breast lobule or duct but have
not spread to surrounding
fatty tissue
Stage II
Tumor ranges from 2-5cm
Cancer has not spread to
surrounding tissue
Stage IV
• Metastatic stage of cancer
• Cancer may spread to other
organs like BONE, LIVER,
LUNGS, BRAIN etc

12. Clinical Manifestations
Changes in breast
• You may experience nipple tenderness
• Notice a lump or thickening in or near the
breast or in the underarm area.
• A change in the size or shape of the breast.

13. • Nipple may turned slightly inward.
• Skin of the breast, areola or nipple may appear scaly, red or swollen or may
have ridges or pitting that resembles the skin of an orange.
• Retracted nipples

14. • Orange or yellowish or greenish discharge from the
Nipple
• Nipple discharge
• Breast shrinkage
• Breast becomes hard and tendered
• Bone pain
• Back pain

15. • History Collection
• Physical Examination
• Mammograms
• Ultrasound - to indentify breast nodules & swelling
• X-ray
Diagnostic Evaluation

16. • CT Scan or MRI
• Needle aspiration for culture
• Mammotome test
• Open surgical Biopsy
• Core biopsy - find needle aspiration is done.

18. Treatment

19. • If the woman has reached menopause
• The extent to which the breast cancer has spread
• The cell type of the breast cancer
TREATMENT

20. • Chemotherapy uses drugs to destroy cancer cells. Chemotherapy
is sometimes given before surgery in women with larger breast
tumors.
• Chemotherapy is also used in women whose cancer has already
spread to other parts of the body.
Chemotherapy

21. • AT: Adriamycin and Taxotere
• AC ± T: Adriamycin and Cytoxan, with or without Taxol or
Taxotere
• CMF: Cytoxan, methotrexate, and fluorouracil

22. • CEF: Cytoxan, Ellence, and fluorouracil
• FAC: fluorouracil, Adriamycin, and Cytoxan
• CAF: Cytoxan, Adriamycin, and fluorouracil (The FAC and CAF
regimens use the same medicines but use different doses and
frequencies)
• TAC: Taxotere, Adriamycin, and Cytoxan
• GET: Gemzar, Ellence, and Taxol

23. • Hormonal therapy is prescribed to women with ER-positive breast
cancer to block certain hormones that fuel cancer growth. An
example of hormonal therapy is the drug tamoxifen. This drug
blocks the effects of estrogen, which can help breast cancer cells
survive and grow. Most women with estrogen-sensitive breast
cancer benefit from this drug.
Hormonal Therapy

24. • Another class of hormonal therapy medicines called aromatase
inhibitors, such as exemestane (Aromasin), have been shown to
work just as well or even better than tamoxifen in postmenopausal
women with breast cancer. Aromatase inhibitors block estrogen
from being made.

25. • Radiation therapy is an adjuvant treatment for most women who
have undergone lumpectomy and for some women who have
mastectomy surgery. In these cases the purpose of radiation is to
reduce the chance that the cancer will recur.
Radiation Therapy

26. • This radiation is very effective in killing cancer cells that may
remain after surgery or recur where the tumour was removed.
• Radiation therapy can be delivered by either external beam
radiotherapy or brachytherapy (internal radiotherapy).

27. • Lumpectomy
• Segmental (partial) mastectomy
(with or without radiation treatment )
• Total mastectomy
• Modified radical mastectomy
• Ovarian ablation
SURGERY

28. • This is also referred to as breast- conserving therapy. The surgeon
removes the cancerous area and a surrounding margin of normal
tissue. A second incision may be made in order to remove the
lymph nodes.
Lumpectomy

29. • An operation to remove the cancer and some normal tissue around
it, but not the breast itself. Some lymph nodes under the arm may
be removed for biopsy. Part of the chest wall lining may also be
removed if the cancer is near it. Also called breast-conserving
surgery, breast-sparing surgery
Segmental (partial) mastectomy

30. • A total mastectomy, also known as a simple mastectomy,
involves removal of the entire breast, including the breast
tissue, areola and nipple. A sentinel lymph node biopsy may
be done at the time of a total mastectomy.
Total mastectomy

31. • A modified radical mastectomy is a procedure in which
the entire breast is removed, including the skin, areola,
nipple, and most axillary lymph nodes, but the pectoralis
major muscle is spared. Historically, a modified radical
mastectomy was the primary method of treatment of breast
cancer.
modified radical mastectomy

33. • Ovarian ablation has been used for more than a century in
the treatment of breast cancer. Methods of
irreversible ovarian ablation include surgical oophorectomy
and ovarian irradiation. Potentially reversible castration can
be accomplished medically using luteinizing hormone
releasing hormone (LHRH) analogues.
Ovarian ablation

34. • Get screened for breast cancer regularly
• Control weight and Do regular exercise
• Know family history of breast cancer
• Limit the amount of alcohol
• Avoid induced abortions
•
Prevention

35. • Avoid unnecessary Medical radiation exposure
• Preventive mastectomy
• Mammograms may be recommended in certain high-
risk younger women.
• Vitamin D :
• A dose of 400 I.U. per day is an appropriate
preventative measure.

37. Nursing management

38. So far we have discussed about definition, risk factors, clinical
manifestation, diagnostic evaluation and management of breast cancer.
Summary

39. • Lewis et al, Medical Surgical Nursing, Mosby Elsevier,7th
edition.
• Joyce.M.Black et al, Medical Surgical Nursing, Saunders
publication.
• Brunner and Siddhartha, Medical Surgical Nursing,
Lippincott Williams and Wilkins.
Bibliography

40. Thank You