BREAST CANCER Prepared by Hai Lam Lynn Yu

BREAST CANCER Prepared by: Hai Lam Lynn Yu Racheal Richie Trina Jones

Pathophysiology � http: //www. youtube. com/watch? v=YNUBn. X 9 JH Qs&feature=related � http: //www. youtube. com/watch? v=hswn 7 Hl. Lkls &feature=related

Clinical Manifestations � Lump � Most commonly in upper, outer quadrant of breast � Palpation: hard, may be irregularly shaped, poorly delineated, nonmobile, nontender • Mammographic Abnormalities

Clinical Manifestations � Other Signs of Breast Cancer: �Lump or swelling felt on lymph nodes �Swelling of all or part of breast �Nipple discharge; Nipple retraction �Redness, Scaliness, or Thickening of nipple or breast skin �Peau d’orange

Signs and Symptoms � http: //www. youtube. com/watch? v=y. THy. MNBkb OY

Nursing Diagnosis Risk for disturbed body image related to anticipated physical and emotional effects of treatment modalities.

Interventions 1. Incorporate psychosocial questions related to body image as part of nursing assessment to identify clients at risk for body image disturbance. 2. IF the nursing assessment reveals body image concerns related to a disfiguring condition, assist the client in voicing his/her concerns and if appropriate, coaching the client in how to respond to questions from other in social situations. 3. Encourage the client to discuss interpersonal and social conflicts that may arise 4. Encourage clients to verbalize treatment preferences and play a role in treatment decisions. 5. Refer clients with body image disturbance for CBT and/or social skills training if indicated.

Goals of Care Patients with breast cancer will actively participate in the decision-making process related to treatment options, comply with therapeutic plan, manage the side effects of adjuvant therapy, and be supported to access and benefit from the support provided by significant others and health care providers.

Desired Outcomes Breast cancer patients will be able to verbalize fears and will have created a recovery plan that includes exercises and skills that will help them learn to cope with whatever happens in the future and return to their previous lives as easily as possible

Management Therapeutic regimen determined by clinical stage and biology of cancer. Diagnosis Screening � Physical exam, Mammography, Breast MRI, Biopsy After Diagnosis � Axillary node dissection � Lymphatic Mapping and Sentinel lymph node dissection � Find tumor size � Find Estrogen and Progesterone receptor status � Find Expression of HER-2 receptor � Find DNA content

Management � � Staging Breast Cancer: TNM system � T: Tumor size � N: Nodal involvement � M: Metastasis

Management � Local vs Systemic Therapy � Local: Surgery, Radiation � Systemic: Chemotherapy, Hormone Therapy, Targeted Therapy � Adjuvant vs Neoadjuvant Therapy � Adjuvant: Additional treatment to prevent recurrence Radiation, Chemotherapy, Hormonal and Targeted Therapy � Neoadjuvant: Chemo/Hormone therapy before surgery to allow for less extensive operation

Management � Breast-Conserving Surgery (Lumpectomy) Removal of entire tumor w/ margin of normal tissue � Usually done with Axillary Lymph Node Dissection (ALND) � In combination with radiation therapy: preserves the breast � � Mastectomy (remove entire breast) � Simple Mastectomy: removes entire breast including nipple but not underarm lymph nodes or muscle tissue Most common type of mastectomy Modified Radical Mastectomy: removes breast and axillary lymph nodes but preserves pectoralis muscle � Prophylactic (Elective) Mastectomy: removal of breasts to prevent /reduce risk of cancer �

Management � � Radiation therapy always follows lumpectomy Can be used as: � Primary Treatment Prevent local breast recurrences after breastconserving surgery � Adjuvant Treatment Prevent local and nodal recurrences after mastectomy � Palliative Treatment for Pain

Management � � Most effective when combo of 1 or more drugs used 2 Major Categories: � Cell Cycle Phase – Nonspecific Break double helix of DNA, inhibit replication and enzyme function, inhibit transcription and translation � Cell Cycle Phase – Specific Interfere with cell cycle � � IV is most common route Side Effects Acute Toxicity: anaphylactic rxns, flare, N/V Delayed Effects: bone marrow depression, altered bowel function, neurotoxicities � Chronic Toxicities: organ damage (heart, liver, kidneys, lungs) � �

Management � Hormonal Therapy � Removes/Blocks source of Estrogen to promote regression of tumor � Can be used as adjuvant treatment or in pts with recurrent or metastatic cancer � Postmenopausal women more likely to have hormone-dependent tumors Tamoxifen is drug of choice (blocks estrogen receptors on cancer cells)

Management � Targeted Therapy � HER 2: a receptor that binds to growth factors HER 2 -Positive cancers: breast cancers with amplified HER 2 gene Contributes to uncontrolled growth and survival of these cancer � Trastuzumab (Herceptin) An antibody that binds to HER 2 Prevents receptor from activating pathway that promotes cell growth and survival Only used when tumor overexpresses HER 2

Compare and Contrasting Different Types of Cancer

Statistics � � Women: 2 nd most prevalent type of cancer Women: 2 nd leading cause of cancer death 200, 000 women & 1, 700 men DX each year 40, 000 women & 450 men die each year

Types � � Ductal Carcinoma in Situ (DCIS) Invasive Ductal Carcinoma (IDC) � � � Tubular Carcinoma of the Breast Medullary Carcinoma of the Breast Mucinous Carcinoma of the Breast Papillary Carcinoma of the Breast Cribriform Carcinoma of the Breast Lobular Carcinoma in Situ (LCIS) Invasive Lobular Carcinoma (ILC) Inflammatory Breast Cancer Lobular Carcinoma in Situ (LCIS) Paget’s Disease of the Nipple Phyllodes Tumors of the Breast

Ductal Carcinoma in situ (DCIS)

Invasive Ductal Carcinoma (IDC) Cancer has broken through the wall of the milk duct and invades the tissue of the breast. A Ducts B Lobules C Dilated section of duct to hold milk D Nipple E Fat F Pectoralis major muscle G Chest wall/rib cage Cell A Normal duct cell B Ductal cancer cells breaking through the basement membrane. C Basement membrane

Invasive Ductal Carcinoma (IDC) Tubular Carcinoma of the Breast � Carcinomas small made tubules, slow growth Medullary Carcinoma of the Breast � Tumor is soft, fleshy resembling “medulla” Mucinous Carcinoma of the Breast � Abnormal cells “float” in pools of mucus Papillary Carcinoma of the Breast � Cells are small, finger-like projections Cribriform Carcinoma of the Breast � Cancer invades the connective tissue � Tumor cell mass looks like Swiss cheese

Inflammatory Breast Cancer � � No lump Start with reddening and swelling of the breast Paget’s disease of the nipple • Unusual changes in the nipple and aerola • Scaly, red, itchy, irritated

Breast Cancer in Men Rare • Less than 1 % of all breast cancers • Men have breast tissue • Typically men don’t make breast stimulating hormones • Breasts on a man are typically mounds of fat • Developing real breast gland tissue • Medications • Abnormal hormone levels •

Staging Breast Cancer Stage Description 5 -year Survival Rate 0 Carcinoma in situ 93 % I Tumor 2 cm or less in greatest dimension No axillary lymph node metastasis or Evidence of distant metastasis 88 % Tumor 2 cm or less but 1 -3 positive lymph nodes Tumor 2 -5 cm with or without axillary lymph nodes Tumor < 5 cm without spread to lymph nodes No distant metastasis A: 81 % B: 74 % II III Any size tumor with 4 -9 positive axillary lymph nodes or With with direct extension to the chest wall or skin Inflammatory breast cancer NO evidence of distant metastasis A: 67 % B: 41 % C: 49 % IV Any of the above plus distant metastasis (ie, liver, lungs, bone, brain) 15 %

Risk Factors

References