Breast Cancer

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Breast Cancer

• Prepared by
• Hai Lam
• Lynn Yu
• Racheal Richie
• Trina Jones

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(No Transcript)
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Pathophysiology

• http//www.youtube.com/watch?vYNUBnX9JHQsfeature
  related
• http//www.youtube.com/watch?vhswn7HlLklsfeature
  related

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Clinical Manifestations

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

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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 dorange

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Signs and Symptoms

• http//www.youtube.com/watch?vyTHyMNBkbOY

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Nursing Diagnosis

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

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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.

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Goals of Care

• Patients with breast cancer will actively
• participate in the decision-making process
  related
• to treatment options, comply with the 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.

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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

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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

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Management

• Staging Breast Cancer
• TNM system
• T Tumor size
• N Nodal involvement
• M Metastasis

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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

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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

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Management

• Radiation therapy always follows lumpectomy
• Can be used as
• Primary Treatment
• Prevent local breast recurrences after
  breast-conserving surgery
• Adjuvant Treatment
• Prevent local and nodal recurrences after
  mastectomy
• Palliative Treatment for Pain

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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)

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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)

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Management

• Targeted Therapy
• HER2 a receptor that binds to growth factors
• HER2-Positive cancers breast cancers with
  amplified HER2 gene
• Contributes to uncontrolled growth and survival
  of these cancer
• Trastuzumab (Herceptin)
• An antibody that binds to HER2
• Prevents receptor from activating pathway that
  promotes cell growth and survival
• Only used when tumor overexpresses HER2

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Compare and Contrasting Different Types of
Cancer
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Statistics

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

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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)
• Pagets Disease of the Nipple
• Phyllodes Tumors of the Breast

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Ductal Carcinoma in situ (DCIS)
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Invasive Ductal Carcinoma (IDC)
Normal breast with invasive ductal carcinoma
(IDC) in an enlarged cross-section of the duct
Breast profileA DuctsB LobulesC Dilated
section of duct to hold milkD NippleE fatF
pectoralis major muscleG Chest wall/rib
cage EnlargementA Normal duct cellB Ductal
cancer cells breaking through the basement
membrane.C Basement membrane
Cancer has broken through the wall of the milk
duct and invades the tissue of the breast.
A DuctsB LobulesC Dilated section of
duct to hold milkD NippleE FatF
Pectoralis major muscleG Chest wall/rib
cage CellA Normal duct cellB Ductal
cancer cells breaking through the basement
membrane.C Basement membrane
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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

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Inflammatory Breast Cancer

• No lump
• Start with reddening and swelling of the breast

Pagets disease of the nipple

• Unusual changes in the nipple and aerola
• Scaly, red, itchy, irritated

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Breast Cancer in Men

• Rare
• Less than 1 of all breast cancers
• Men have breast tissue
• Typically men dont make breast stimulating
  hormones
• Breasts on a man are typically mounds of fat
• Developing real breast gland tissue
• Medications
• Abnormal hormone levels

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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
II Tumor 2 cm or less but 1-3 positive lymph nodes Tumor 2-5 cm with or without axillary lymph nodes Tumor lt 5 cm without spread to lymph nodes No distant metastasis A 81 B 74
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
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Risk Factors
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References