Oncology Assessment and Management of Patients With Cancer Breast

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Oncology Assessment and Management of Patients
With Cancer Breast

• Prepared by Dr. Iman Abdullah

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Out Line

• Pathophysiology of the Malignant Process
• Proliferative Patterns
• Characteristics of Malignant Cells
• Management of Cancer
• Radiation Therapy
• Types of Radiation
• Toxicity
• Nursing Management in Radiation Therapy
• Chemotherapy
• Administration of Chemotherapeutic Agents
• Special Problems Extravasation
• Toxicity
• Nursing Management in Chemotherapy

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Out Line

• Anatomic and Physiologic Overview of Breast
• Assessment
• Malignant Conditions of the Breast
• Types of Breast Cancer
• Risk Factors
• Breast Cancer Prevention Strategies in the
  High-Risk Patient
• Clinical Manifestations
• Assessment and Diagnostic Findings
• Staging or Classification of Tumors
• Prognosis
• Surgical Management
• Nursing Process
• Systemic Treatments

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Learning Objectives

• On completion of this lecture, the student will
  be able to
• Compare the structure and function of the normal
  cell and the cancer cell
• Differentiate between benign and malignant
  tumors.
• Describe the roles of radiation therapy, and
  chemotherapy in treating cancer.
• Describes the special nursing needs of patients
  receiving chemotherapy.
• Develop a teaching plan for breast
  self-examination

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Cont.

• Identify the diagnostic tests used to detect the
  breast disorders.
• Use the nursing process as a framework for care
  of the patient undergoing breast cancer surgery.
• Compare the therapeutic usefulness of
  chemotherapy, surgery and radiation in treating
  breast cancer
• Describe the physical, psychological and
  rehabilitative needs of the patient who has had
  mastectomy

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Pathophysiology of the Malignant Process

• Cancer is a disease process that begins when an
  abnormal cell is transformed by the genetic
  mutation of the cellular DNA.
• Proliferative Patterns
• Characteristics of Malignant Cells

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Management of Cancer

• Surgery
• Radiation therapy
• Chemotherapy
• Bone Marrow Transplantation
• Hyperthermia
• Targeted therapies
• Photodynamic therapy

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Radiation Therapy

• Types of Radiation
• External Radiation
• Internal radiation
• Radiation Dosage

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Toxicity

• Altered skin integrity is a common effect
• Alterations in oral mucosa
• The entire gastrointestinal mucosa may be
  involved
• Anorexia nausea, and vomiting, and diarrhea
• If sites containing bone marrow (Anemia,
  Leukopenia, Thrombocytopenia (bleeding)
• Systemic side effects

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Nursing Management in Radiation Therapy

• Protecting skin and oral mucosa
• Protecting caregivers

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Chemotherapy

• Administration of Chemotherapeutic Agents
• The route of administration usually depends on
• The type of agent
• The required dose
• The type, location, and extent of tumor being
  treated
• Special Problems Extravasation
• Indications of extravasation during
  administration of vesicant agents

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Toxicity

• Cells with rapid growth rates (eg, epithelium,
  bone marrow, hair follicles, sperm) are very
  susceptible to damage, and various body systems
  may be affected as well.
• Gastrointestinal System
• Hematopoietic System
• Cardiopulmonary System
• Renal System
• Reproductive System
• Neurologic System
• Miscellaneous

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Nursing Management in Chemotherapy

• Assessing fluid and electrolyte status
• Modifying risks for infection and bleeding
• Administering chemotherapy
• Protecting caregivers

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Anatomic and Physiologic Overview
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Assessment

• Health History
• Physical Assessment Female Breast
• Diagnostic Evaluation

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Malignant Conditions of the Breast

• Types of Breast Cancer
• Ductal Carcinoma in Situ (DCIS)
• Invasive Cancer
• Infiltrating Ductal Carcinoma
• Infiltrating Lobular Carcinoma
• Medullary Carcinoma
• Mucinous Carcinoma
• Tubular Ductal Carcinoma
• Inflammatory Carcinoma
• Paget Disease

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Risk Factors

• Non Genetic Risk Factors
• Gender and Age
• Personal History
• Hormonal Factors
• Radiation Exposure
• Benign Proliferative Breast Disease
• Fat Intake and Obesity
• Alcohol Use
• Other Possible Risk Factors

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Genetic Risk Factors

• More than 80 of all breast cancer cases have no
  known family history of the disease.
• In familial cases, the risk is determined by
  which family member has the disease. Having a
  first-degree relative increase the risk twofold.
• Protective Factors

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Breast Cancer Prevention Strategies in the
High-Risk Patient

• Long-Term Surveillance
• Chemoprevention
• Chemoprevention
• Prophylactic Mastectomy

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Clinical Manifestations
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Assessment and Diagnostic Findings

• Techniques to determine the diagnosis of breast
  cancer include various types of biopsy, which
  have been discussed previously.

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Staging or Classification of Tumors

• Stage 0
• Stage 1
• Stage II and stage III, stage IV

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Prognosis

• The two most important factors when determining
  the prognosis of a patient with breast cancer
  are
• Tumor size
• Whether the tumor has spread to the lymph nodes
  under the arm (axilla).

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Surgical Management

• Modified Radical Mastectomy
• Total Mastectomy
• Breast Conservation Treatment

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Nursing Process

• The Patient Undergoing Surgery for Breast Cancer
• Assessment
• Diagnosis (Preoperative Nursing Diagnosis)
• Diagnosis (Postoperative Nursing Diagnosis)
• Potential Complications
• Planning and Goals
• Preoperative Nursing Interventions
• Postoperative Nursing Interventions

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Monitoring and managing potential complications

• Lymphedem
• Hematoma Formation
• Seroma Formation
• Infection
• Promoting Home and Community-Based Care

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Radiation Therapy

• Types of radiation
• External-beam radiation
• Brachytherapy
• Intraoperative radiation therapy
• Acute Side Effects
• Nursing Management

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Systemic Treatments

• I- Chemotherapy
• Common physical side effects of chemotherapy for
  breast cancer
• Specific side effects vary with the type of
  chemotherapeutic agent used.
• The side effects of the anthracyclines
• Nursing Management

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II- Hormonal Therapy

• Managing Side Effects of Adjuvant Hormonal
  Therapy in Breast Cancer
• Hot Flashes
• Vaginal Dryness
• Nausea and Vomiting
• Musculoskeletal Symptoms
• Risk of Endometrial Cancer
• Risk for Thromboembolic Events
• Risk for Osteoporosis or Fractures

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III- Targeted Therapy

• Trastuzumab (Herceptin) is a monoclonal antibody
  that binds specifically to the HER-2/neuprotein.
• This protein, which regulates cell growth, is
  present in small amounts on the surface of normal
  breast cells and in most breast cancers.
• Trastuzumab targets and inactivates the
  HER-2/neuprotein, thus slowing tumor growth.
• Unlike chemotherapy, trastuzumab spares the
  normal cells and has limited adverse reactions,
  which may include fever, chills, nausea,
  vomiting, diarrhea, and headache.

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Reference

• Brunner, L. and Suddarath, D. (2010). Text Book
  of Medical Surgical Nursing. 12th Edition. J.B.
  Lippincott Williams Wilikins, Library of
  Congress Catalging-in-Publication Data.

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• Thank you