m

1. Benign tumor & Breast cancer
Logman Mohammed

2. Anatomy review

3. 3
Lymphatic drainage of the breast

4. 4
BENIGN TUMORS OF THE BREAST
 Benign tumors of the breast are benign lesions
that persistent over time. Approximately 90% are
found by women themselves; 90% of breast lumps
are benign.
 Pathophysiology and Etiology
Fibrocystic changes : solid lumps may be fatty or
fibrous tissue or fluid-filled cysts
 Galactocele : a milk-filled cyst.

5. 5
 Fibroadenoma :
 a benign breast tumor composed of epithelial
and stromal components.
 Common in young women.
 is a risk for breast cancer
 Other benign tumors include adenosis,
intraductal papillomas, lipomas, and
neurofibromatosis that may produce a palpable
mass

6. 6
Clinical Manifestations
1. Gross cysts :
- may be tender or nontender.
- Consistency depends on pressure of fluid within
cyst and breast tissue around them; may be soft
and fluctuant or may feel like a solid tumor if
dense.
• Galactocele : firm, nontender mass.
• Fibroadenoma : may be a firm, smooth, movable
lump that is usually painless.

7. 7
Diagnostic Evaluation
 To identify present of lesions
and its characterize by :
 Physical examination,
 mammography,
 ultrasound

8. 8
 Cyst aspiration : diagnostic
aspiration is usually curative in a
galactocele or breast cyst.
 excisional biopsy to rule out cancer If
a lump does not respond to cyst
aspiration,

9. 9
Management and Nursing
Interventions
 Nursing care is directed toward support
woman to go through diagnostic process
 and Advice young women to observe
Undetected masses during menstrual
cycles for appearance of the mass.
 In general, any distinct and persistent solid
lump should have biopsy and possibly
excision.

10. 10
BREAST CANCER

11. 11
Breast cancer
 Breast cancer is the malignent
neoplasm of breast tissue
 is the most common invasive
cancer in women.and second most
common malignancy causing death
in women .
 Malignancy in women less than 35
years of age is often familial and
more aggressive .

12. 12
Causes
 There are no specific cause but there risk factors
 Risk Factors for Breast Cancer
 Genetic causes :
- Family history of breast malignancy first degree
relatives
- Genetic mutations .

13. 13
Risk Factors for Breast Cancer continue
 Hormonal causes
- Early menarche before 11 years
- Late menopause over 52 years
- Nulliparity
- First child after 30 years of age
- Estrogen replacement therapy or oral
contraceptive use

14. 14
 Environmental causes :
 Exposure to radiation between 10 – 14 years
of age
 High-fat diet
 Alcohol intake
 Others :
 Age : raise continuously with age
 History of cancer in contralateral breast or
endometrial or ovarian cancer
 Obesity

15. 15
Clinical Manifestations

16. 16
Clinical Manifestations
 Breast lump is palpable if larger than one cm
 Lump characteristic : hard or stony , pain less ,
irregular in shape , fixed or movable , often
found in upper lateral guaderant 50%
 Enlargement of axillary or supraclavicular
lymph nodes may indicate metastasis.
 Nipple discharge : bloody, or serous

17. 17
 Advance disease may show the following :
 Nipple retraction or discharge , Breast dimpling,
 Contour change (Breast asymmetry ) a change
in the size or shape
 pain , ulceration
 Inflammation : redness , heat , odema
 orange-peel skin
 Palpable axillary lymph node

18. 18
Clinical Manifestations continue
 Inflammatory breast cancer may present with
erythema.
 Noninvasive breast cancer (DCIS) rarely
presents with a palpable mass : usually
presents as microcalcifications found on
mammography

19. 19
Diagnostic Evaluation of
breast cancer
 Mammography : most accurate method to
detect nonpalpable lesion.
 Biopsy or aspiration : conclusive for
cancer diagnosis and to determine type of
breast cancer.
 Estrogen/progesterone : tests .

20. 20
Diagnostic Evaluation of breast cancer continue
 Laboratory tests to detect metastasis.
Increased values on liver function tests
indicate possible liver metastasis.
Increased calcium and alkaline
phosphatase levels indicate possible
bony metastasis.
 chest X-ray, bone scan, brain CT, chest CT
scan. MRI may be recommended to detect
metastasis.

21. 21
Management
 Surgical Management : is to local control of
the disease s
 lumpectomy : Removal of tumor and
surrounding tissue

22. 22
 Simple mastectomy : Surgical removal of the
entire breast
 radical mastectomy : removal of inter breast ,
the underline chest muscle and lymph node
under the arm

23. 23
 Radiation therapy :
 Used following breast cancer surgery to decrease
recurrence for invasive breast cancer
 It May be used preoperatively to shrink a large
tumor

24. 24
 Chemotherapy :
 usually begins 4 weeks after surgery
 Main drugs used for breast cancer include
cyclophosphamide , methotrexate
(Mexate), doxorubicin and others

25. 25
 Hormonal Therapy
 Antiestrogens, such as tamoxifen (Nolvadex), bind
estrogen receptors, thereby blocking effects of
estrogen.
 Is given to treat breast cancer in has high risk for
adjuvant chemotherapy ..

26. 26
Complications of breast cancer:
 Metastasis : most common sites: lymph
nodes, lung, bone, liver, and brain.
 Signs and symptoms of metastasis may
include :
 bone pain, neurologic changes, weight loss,
anemia, cough, shortness of breath, pleuritic
pain, and vague chest discomfort.

27. 27
Nursing Assessment
 Assess general health status
 Assess knowledge of patient and family and provide
information about disease and psychological support
 Determine level of anxiety, fears, and concerns.
 Identify coping ability and availability of support
systems

28. 28
Nursing Diagnoses
 Anxiety related to diagnosis of cancer
 Nursing Interventions
 Reducing Anxiety
- Emotional Support to pt and family .
- Interpret the results of each test in language the
patient can understand.
- Stress the advances made in earlier diagnosis and
treatment options.

29. 29
Deficient Knowledge related to disease
process and treatment options
 Providing Information about Treatment
 Involve patient in treatment planning.
 Describe surgical procedures.
 Educate patient about the effects of chemotherapy ,
radiation therapy.
 Teach patient about hormonal therapy
 Encourage patient to continue follow up and report
any new symptoms
 Stress importance of continued yearly mammogram

30. 30
Preoperative Management
 Explain the procedure to pt and relative and
postoperative care that includes drain care,
location of the incision, and mobility of the arm and
possible post operative complications .
 Discuss concerns regarding body image changes
and support
 Do other preoperative prepation

31. 31
AFTER SURGERY FOR BREAST
CANCER
 Assess for bleeding , pain from the incision and
notify surgeon for increased pain or bleeding.
 Assess drainage for amount, color, and odor.
Report if grossly bloody, purulent, or excessive in
amount (may have 100 to 200 mL in the first 24
hours).
 Observe affected Arm side for edema, erythema,
and pain.
 Patient teaching about drain care, exercises,
surgical outcome, and BSE occurs

32. 32
Nursing Diagnoses
of post surgery

33. 33
Impaired Physical Mobility related to
impaired movement of arm on operative side
 Nursing Interventions
 Mobilizing Affected Arm
- Assess patient's ability to perform self-care and
factors impeding performance.
- Initially encourage wrist and elbow flexion and
extension.
- Encourage use of arm for washing face, combing
hair, and brushing teeth. Encourage patient to
gradually increase use of arm.

34. 34
Risk for infection
o Assess dressing for bleeding , drainage , color , odor
every 4 hours for 24 hours
o Observe incision site for pain , redness, swelling ,
drainage
o Assess drainage system for patency and adequate
suction and note color and amount of drainage .
o Use sterile technique to change dressing .
o Encourage protein rich diet
o Instruct pt to report S/S of infection at surgical site or
purulent drainage

35. 35
 Instruct pt to avoid deodorant powder until
complete healing .
 Encourage patient to avoid abduction initially to
prevent seroma formation.
 Support arm in sling if prescribed to prevent
abduction of the arm.
 Instruct and provide patient with exercises to do
when permitted

36. 36
Deficient Knowledge related to care of incision,
arm, and performance of BSE
 Increasing Knowledge
 Explain wound care
 Instruct patient on signs of infection, hematoma,
or seroma formation to be reported.
 Teach patient to bathe incision gently and to
carefully to dry
 Teach care of drains, to empty contents, and
measured
 Teach importance of BSE, mammograms, and
regular follow-up visits

37. 37
Ineffective Tissue Perfusion of
affected arm related to lymphedema
 Promoting Lymphatic Drainage
– Instruct patient in potential problem of lymphedema
post surgery
– Do not take blood pressure, draw blood, inject
medications, or start intravenous lines in affected
arm.
– Elevate affected arm on pillows, above level of heart,
and hand above elbow to promote gravity drainage of
fluid.

38. 38
 Teach patient to massage affected arm if
prescribed to increase circulation and decrease
edema.
 Treat severe lymphedema as prescribed by
application of elastic bandages .
 Teach patient care of the affected arm to prevent
lymphedema and infection.

39. 39
Disturbed Body Image related to loss of
breast (for mastectomy patient)
 Enhancing Body Image
 Assess mastectomy patient's knowledge of
prosthesis and reconstruction options, and provide
information as needed.
 Discuss patient's views on her altered body image.
 Suggest clothing adjustments to hide loss of
breast.

40. 40
 Assist patient to obtain a
temporary prosthesis if indicated .
 Encourage patient to allow herself
to experience the grief process
over the loss of her breast and to
learn to cope with these feelings.

41. 41
 Anxiety related to diagnosis of
cancer
 Reducing Anxiety
 Physchological support patient

42. 42
Potential Complications
postoperatively
 Infection
 Hematoma, seroma
 Lymphedema
 Paresthesia, pain of axilla and
arm
 Impaired mobility of arm

43. 43