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Breast Cancer

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Afrin Maknojia

on 4 April 2014

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Transcript of Breast Cancer

Breast Cancer
What Is breast cancer?
Breast cancer starts in the cells of the breast.
Cancer can start in cells within the ducts (ductal carcinoma) or in the lobules (lobular carcinoma). Ductal carcinoma is the most common type of breast cancer.


Risk Factors
Possible risk factors
Personal history of breast cancer
Family history of breast cancer
Dense breasts
BRCA gene mutations
Reproductive history
Ashkenazi Jewish ancestry
Exposure to ionizing radiation
Hormone replacement therapy
Hormonal contraceptives
Atypical hyperplasia
Alcohol
Being obese
High socio-economic status
Tall adult height



(Canadian Cancer Society, 2014, para.1)
Physical inactivity
Adult weight gain
Smoking and second-hand smoke
Birth weight
Night shift work
Some benign breast conditions







(Canadian Cancer Society, 2014, para.1)
Myth factors
Antiperspirants and deodorants
Abortion
Bras
Breast implants
Stress









(Canadian Cancer Society, 2014, para.1)
Signs and Symptoms
Early Signs
• A lump in the breast – the most common first sign
• A lump in the armpit (axilla)
• Changes in breast shape or size
• Skin changes
• Nipple changes

Late signs
• Bone pain
• Nausea
• Loss of appetite
• Weight loss
• Jaundice
• Buildup of fluid around the lungs (pleural effusion)
• Shortness of breath
• Cough
• Headache
• Double vision
• Muscle weakness

1.
Alkylating agents
2.
Anti metabolites
3. Anti tumor antibiotics
4.
Hormones & Hormone Antagonists
5. Natural products having anti-neoplastic activity
6. Miscellaneous anti-cancer drugs

(Adams, Holland, Bostwick & King, 2010, p.483)

Anti metabolites
Classification:

Folic Acid Antagonist:
Methotrexate ( Apo-Methotrexate )

Pyrimidine Analogs:
Capecitabine ( Xeloda )
Cytarabine ( Cytosar, Depolyt )
Fluorouracil (Fluoroplex )
Gemicitabine ( Gemzar )

Purine Analogs:
Cladribine (Leusstatin )
Fludarabine ( Fludara )
Mercaptopurine ( Purinethol )
Thioguanine ( Lanvis )




(Adams, Holland, Bostawick& King, 2010, p.486)


Indications:

Breast cancer.
Trophoblastic Tumor.
Meningeal leukaemia.
Acute lymphocytic leukaemia.
Burkitt lymphoma ( Stage I, II or III ).
Lymphosarcoma ( Stage III ).
Osteosarcoma.
Rheumatoid arthritis.
Head & Neck carcinoma.







(Lippincott, Williams & Wilkins, 2010, p. 1164.)


HORMONE ANTAGONISTS
Dosage:
Adults; 40 mg/ m2 IV on days 1 and 8 of each cycle,
combined with Cyclophosphamide and Fluorouracil.
In patients older than age 60, give 30 mg/ m2.

Half life:
For doses < 30 mg/ m2: 3-10 hrs.
for doses of 30 mg/ m2: 8-15 hrs.











(Lippincott, Williams & Wilkins, 2010, p.1164.)

Adverse Reactions:

GI:
Nausea, vomiting, anorexia, painful oral ulcers, diarrhea, pancreatitis, GI ulceration.
Hematologic:
Leukopenia, thrombocytopenia, anemia.
Hepatic:
Jaundice, hepatotoxicity.
Metabolic:
Hyper-uricemia.
Skin:
Rash, hyper-pigmentation.









(Lippincott, Williams & Wilkins, 2010, p. 1165.)



Contraindications :

Pregnancy.
Women of child bearing potential.
Breast-feeding women.
Impaired hepatic or renal function.
Peptic ulceration or ulcerative colitis.
Hypersensitivity.
Cautiously in very young, elderly or debilitated patients.



(Lippincott, Williams & Wilkins, 2010, p. 1166.)

Drugs:


Tamoxifen citrate ( Apo-Tamox, Tamofen ).
Anastrozole (Arimidex ).
Bicalutamide ( Casodex ).
Exemestane ( Aromasin ).
Flutamide ( Apo-flutamide, Euflex ).
Fulvestrant (Faslodex ).
Goserelin ( Zoladex ).
Letrozole (Femara )
Leuprolide ( Eligard, Lupron ).
Nilutamide ( Anandron ).




(Adams, Holland, Bostwick & King, 2010, p.492)


TAMOXIFEN CITRATE:

Generic name
: Tamoxifen Citrate.
Trade name
:Nolvadex, Apo-Tamox, Tamofen.


Action:
Drug of choice for treating metastatic breast cancer.
Sometimes classified as a Selective Estrogen Receptor Modulator ( SERM ).
Effective against breast tumours that require estrogen for their growth.
These susceptible cancer cells are known as Estrogen Receptor (ER) positive.






(Adams, Holland, Bostwick & King, 2010, p.493)





Adverse Reactions:

CNS:
Stroke, confusion, weakness, headache.
CVS:
Thromboembolism, fluid retention, hot flashes.
EENT:
Corneal changes, cataracts, retinopathy.
Resp.:
Pulmonary embolism (PE).
GI:
Nausea, vomiting, diarrhea.
GU:
Endometrial cancer, uterine sarcoma, vaginal bleeding/discharge, amenorrhea.
Hematologic:
Leukopenia, thrombocytopenia.
Hepatic:
Hepatic necrosis, fatty liver.
Metabolic:
Hyper-calcemia, weight weight gain or loss.
Musculoskeletal:
brief worsening of pain from osseous metastases.
Skin:
Skin changes, rash.
Other:
Temporary bone or tumour pain, alopecia.







(Lippincott, Williams & Wilkins, 2010, pp. 1192-1193.)

Contraindications:

Hypersensitivity.
Cautiously in patients with leukopenia or thrombocytopenia.
Contraindicated as therapy to reduce risk of breast cancer in high risk women, who also need anti-coagulants or in women with history of deep vein thrombosis or PE.






(Lippicott, Williams & Wilkins, 2010, p.1193.)

Alkylating agents
Adverse Reactions

CV:
Cardiotoxicity with very high doses & with doxorubicin
GI:
Nausea, vomiting, anorexia, stomatitis
GU:
Hemorrhagic cystitis, impaired fertility
Hematologic:
Leukopenia, thrombocytopenia, anemia
Hepatic:
Hepatotoxicity
Respiratory:
Pulmonary fibrosis







(Lippincott, Williams & Wilkins, 2010, p.1122)
Classification

1. Nitrogen mustards:
chlorambucil
cyclophosphamide
estramustine
melphalan

2. Nitrosoureas:

carmustine
lomustine
streptozocin

3. Miscellaneous:

carboplatin
cysplatin
temozolomide


(Adams, Holland, Bostawick & King, 2010, p.484)

Cyclophosphamide

Generic name:

Cyclophosphamide
Trade name:

Cytoxan

Action:

Cross-links strands of cellular DNA & inteferes with RNA transcription, causing an imbalance of growth that leads to cell death.




(Lippincott, Williams & Wilkins, 2010, p.1121)

Dosage:
IV- Initially for induction, 40-50mg/kg in divided doses over 2-5 days. Or, 10-15mg/kg every 7-10 days, 3-5 mg/kg twice weekly
PO- 1 to 5 mg/kg daily

Half-life:
3 to 12 hours





(Lippincott, Williams & Wilkins, 2010, p.1121)
NURSING IMPLICATIONS

For all Anti-neoplastic agents:

Use safe handling precautions if preparing IV form.
Monitor lab tests: CBC, kidney and liver function.
Monitor I & O.
Weigh client.
Prevent infection.


Alkylating agents:


If cystitis occurs, stop drug & notify physician
Adequately hydrate patient before and after dose to decrease risk of cystitis






(Herbert & Clarkson, 2008, pp.597-599)



CLIENT TEACHING


For all Anti-neoplastic agents:

Do not become pregnant or breast feed.
If hair loss occurs, it will be temporary.
Use soft-bristled toothbrush.
Inspect mouth daily for sores.
Avoid crowds and those who are ill.
Wash hands frequently.
Eat a nutritious diet.
Do not alter dosing.
Attend all physician visits and get blood tests done as ordered.




(Herbert & Clarkson, 2008, pp. 588-589)


Antimetabolites:

Give PO, topical, IM or IV.
Wear gloves for topical application.
Assess client's mouth.
Stop drug if client is confused or disoriented.
If WBC is less than 3500/cu.mm, client will need to be put in protective isolation.


Hormone Modulators:

Give PO or SC.
Pain indicates cancer is responding to drug.
Medicate with analgesics as needed.
Effects of drug may take 4-10 weeks to occur.


(Herbert & Clarkson, 2008, pp.597-599)

(Canadian Cancer Society, 2014, para.3)
(Canadian Cancer Society, 2014, para.4)
(Canadian Cancer Society, 2014, para.2)
References:

Adams, M.P., Holland, L.N. JR., Bostwick, P.M. & King, S.L. (2010).
Pharmacology for nurses: A

pathological approach
(Canadian Ed.). Toronto, ON: Pearson Education Canada. pp.483-493


Canadian Cancer Society. (2014).
What is Breast Cancer?
Retrieved March 28, 2014.
http://www.cancer.ca/en/cancer-information/cancer-type/breast/overview/?region=on

Herbert,M. & Clarkson,A.N..(2008).
Pharmacology.(
Second Edition). pp.588-599.

Lippincott, Williams & Wilkins(2010).
Nursing 2010 Drug handbook.
pp.1121-1193.















METHOTREXATE

Generic name:
Methotrexate.
Trade name:
Apo-Methotrexate, Amethopterin MTX, Folex.

Action:
Methotrexate inhibits folic acid ( Vitamin B9 ) metabolism, by blocking the synthesis of folic acid.
It inhibits replication particularly in dividing cells.










(Adams, Holland,Bostwick & King, 2010, p.487)
Indications and Dosage:

Advanced breast cancer in women and men:
Adults; 20mg - 40mg PO daily; divide doses of more than 20mg per day b.i.d.
Adjunct treatment of breast cancer:
Women; 20mg - 40mg PO daily for 5 yrs; divide doses of more than 20mg per day b.i.d.
T
o reduce great cancer occurrence:
High risk women: 20mg PO daily for 5 yrs.
Ducted Carcinoma in situ ( DCIS ) after great surgery and radiation:
Adults; 20mg PO daily for 5yrs.

Half life:
Distribution phase: 7-14 hrs.
Terminal phase: More than 7 days.



(Lippincott, Williams & Wilkins, 2010, p. 1192)
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