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Breast Cancer Case Study
Transcript of Breast Cancer Case Study
Why might an individual delay breast examination?
Differentiate between malignant and benign lumps?
Anatomically, which area of the breast is most likely to develop cancerous lumps?
Which tests are specifically used in the diagnosis of breast cancer?
Following diagnosis of breast cancer, which interventions are advised to promote optimum health?
Can men be diagnosed with breast cancer? Reason for admission: Lump in right breast 3 Days Later Estrogen Receptor Assay:
Tumor was estrogen-dependent Common diagnostic tests for breast cancer Mrs. C often used when a mammogram or ultrasound are suspicious of malignancy Mrs. C 2 months ago:
her husband noticed a small lump on her right breast
she assumed that it was related to her period as her breasts usually become lumpy prior to her period.
she became concerned when it failed to resolve and began to grow Age: 47 F Personal hx: Does not smoke, does not drink, follows daily exercise Medication hx: Took oral contraceptives for 5 Family hx: Mother died of breast cancer 5 years ago. Father is alive and well. Hx of heart disease on both sides of the family years, discontinued use one year ago. Physical Exam Right breast: 2-3cm mass palpated in upper quadrant. Fixed and tender to Left breast moveable masses palpated expected menstruation. It is now five days before her expected menstruation. Pt describes her breasts as normally "lumpy" before her period one pea-sized node was palpated in right axilla no discharge or inversion of nipple. No discoloration or retraction of skin palpation two 1-2 cm, soft, Pt states that these lumps became palpable 12 days before Reproductive hx: Onset of menarche at age 10. No hx of dysmenorrhea associated with periods. pap smear in 2011 negative for any abnormalities. Two children, delivered by vaginal birth Mammography results Presence of a 3cm mass in upper quadrant of right breast. Three 1.5 cm masses on left breast. Bone scan results Negative Modified radical
mastectomy performed Tissue samples were taken... Histological examination:
T2a; N1b; MO Pathological examination:
Stage 2 Pt returned to her room with a Hemovac in place.
Dressing was dry and intact
able to turn, cough and deep breath independently
Temperature within normal limits
Began ambulation on 2nd post operative day 3 Days After Surgery!!! Right arm became increasingly edematous and painful Most common tests: useful because it can be done on your own allows you to visualize the internal structure of the breast
digitally or by using x-rays.
detects tumors and cysts that cannot be palpated can differentiate between a benign and malignant tumor measures the heat being radiated from the breasts to detect changes in breast tissue.
Can be done multiple times because it doesn’t use radiation. Breast examination Mammography Ultrasound Thermotherapy MRI – Other less common tests Percutaneous needle aspiration Biopsy Hormone receptor assays NURSING STATION Common Treatment Options Masectomy Lumpectomy Radiation therapy Chemotherapy Hormone Therapy Breast Cancer occurs most often in the inner lining of the milk ducts or the lobules that supply the ducts with milk
roughly 80% of breast lumps found are actually benign
tender breast lumps are more likely to be benign
malignant lumps are more likely to have irregular borders, and to be fixed to the tissue beneath it
Cells become cancerous when they lose their ability to stop dividing, to attach to other cells, to stay where they belong, and to die at the proper time
They begin grow out of control
Breast cancer accounts for 22.9% of all cancers in women, and is responsible for roughly 459, 000 deaths per year
In developed countries, the five-year survival rate for women is 84% Cancer that originates in breast tissue Signs and Symptoms of Breast Cancer most common signs is a lump felt within breast tissue (accounts for 80% of all discoveries)
change in skin color or texture
change in nipple appearance (ex. pulling in of the nipple or sudden inversion)
clear or bloody discharge from the nipple
lump in the lymph nodes in the axilla
Constant pain in breast or armpit(can be an unreliable sign) Breast Cancer Keeping this in mind, let's look at the case study for Mrs. C.... Underlined information is present in the case study!! Heads up! Infiltrating Ductal Carcinomas
63-68% Types of Breast Cancer Noninvasive
22% Infiltrating Lubular Carcinomas
10-15% Infiltrating Ductal Carcinomas Colloid (muscinous)
Inflammatory Cancer cells block lymph channels
Most malignant, aggressive, fast-growing
Skin: red, warm, thickened (like an orange peel)
Misdiagnosed as infection Paget's Disease Persistent lesion of the nipple and areola
Palpable mass may or may not be present
itching, burning, bloody nipple discharge
Misdiagnosed as infection or dermatitis Medullary
Tubular Noninvasive Lobular Carcinoma in Situ (LCIS) Non-premalignant lesion
No treatment needed
Increases risk for developing breast cancer Ductal Carcinoma in Situ (DCIS) Unilateral, premalignant lesion
Likely progresses to breast cancer Infiltrating Lobular Carcinoma Cancer has broken through wall of the lobule and invaded breast tissue
May spread to lymph nodes
Most often occurs later in life: age 55 or older Case Study Analysis Looks like cancer Doesn't look like cancer 5 year hx of birth control use Has two children Family hx of breast cancer Began mensuration at age 10 Negative bone and blood tests Indicate that cancer has not metastasized Pt states that breasts typically become "lumpy" before menstruation. This is a normal tissue response- swelling in response to menstruation - likely benign Increases risk for cancer No skin abnormalities (dimpling, color change etc)
No change in nipple appearance
No nipple discharge Breast lumps palpable
Breast lump located under right axilla
Lump on right breast was fixed 50% of breast cancers are found under the axilla Analysis of Mastectomy Modified radical mastectomy performed This surgery includes removal of some lymph nodes in the axilla A common side effect of removal of lymph nodes is lymphadema, accumulation of lymph fluid in the arm. Looks good!!! T2a; N1b; Mo 2cm <Tumor< 5cm
It has spread to regional lymph nodes
There was no distant metastases In English: The tumor is also estrogen sensitive: Estrogen supplementation will increase the rate of growth of the tumor. Therefore, the patient should not take hormonal replacement therapy Nursing Considerations
Fear r/t disease process and prognosis
Decisional conflict about treatment r/t concerns about risks and benefits
Ineffective tissue perfusion r/t edema
Disturbed body image r/t loss of breast
Acute pain r/t surgery Nursing Diagnoses Nursing interventions Client Goals/Outcomes Evaluate the patients feelings about her illness and determine her level of knowledge and expectations
Administer analgesics for pain as needed
Perform comfort measures to promote relaxation and to relieve anxiety
Encourage hand washing to decrease risk for infection
Teach the patient about breast self examination and the proper method to do so
Do not take blood pressure on the patients arm with lympadema
Teach the patient the option of breast reconstruction
Teach patient to use caution when moving the arm on the operated side and to avoid lifting heavy objects Patients ability to deep breath, cough, turn and ambulate are expected results following a modified radical mastectomy • The client will remain free from lymphadema or infection
• The client will state that she feels positive about her self-image
• Maintain adequate tissue perfusion
• Maintain minimal pain or discomfort during recovery
• Maintain a positive body image, regardless of her decision about reconstruction
• The client will demonstrate the correct method of breast self examination and practice this on a monthly basis How to do a breast self examination References
Huether, S.E., & McCance, K.L. (2012). Understanding pathophysiology.
(5th ed.). St. Louis, MO: Elsevier Mosby
Ridner, S. (2002)..
Medical surgical nursing in Canada: Assessment and management of
clinical problems (2nd ed.). St. Louis: Mosby.
Ridner, S. (2002). Breast cancer lymphedema: pathophysiology and risk
reduction guidelines. Oncology Nursing Forum, 29(9), 1285-1293.
Underwood, S. (2006). Breast cancer in African American women:
nursing essentials. ABNF Journal, 17(1), 3-14.
Watts, T. (2013). Primary Breast Cancer: what do practice nurses need
to know?. Practice Nurse, 43(2), 36-42.
Weiss, D. M. (2012, September 17). ILC - Invasive Lobular Carcinoma.
Retrieved April 5, 2013, from Breastcancer.org:
WordPress. (2011, February 8). How to Do a Breast Self-Exam (BSE).
Retrieved April 6, 2013, from A Clean Breast: http://acleanbreast.wordpress.com/2011/02/08/how-to-do-a-breast-self-exam-bse/ Risk Factors for Breast Cancer Female gender
Age over 50
Family history of breast cancer
Late age at first pregnancy
Early menarche (<12 years)
High alcohol consumption
Recent oral contraceptive use
Late menopause (WordPress, 2011) regimen (Ridner, 2002) (Underwood, 2006) (Ridner, 2002). (Lewis, Heitkemper, Dirksen, O’Brien & Bucher, 2010). (Lewis, Heitkemper, Dirksen, O’Brien & Bucher, 2010). (Lewis, Heitkemper, Dirksen, O’Brien & Bucher, 2010). (Weiss, 2012) (Lewis, Heitkemper, Dirksen, O’Brien & Bucher, 2010). (Lewis, Heitkemper, Dirksen, O’Brien & Bucher, 2010). (Huether & McCance, 2012; Lewis, Heitkemper, Dirksen, O’Brien & Bucher, 2010) (Huether & McCance, 2012; Lewis, Heitkemper, Dirksen, O’Brien & Bucher, 2010) (Huether & McCance, 2012; Lewis, Heitkemper, Dirksen, O’Brien & Bucher, 2010) (Huether & McCance, 2012; Lewis, Heitkemper, Dirksen, O’Brien & Bucher, 2010; Watts, 2013).