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Breast cancer

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isabelle filion

on 12 May 2015

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Transcript of Breast cancer

Breast Cancer
Targeted Therapy
Ms. Maria Yanez, a 67-year-old married Hispanic woman, found a large lump in the upper outer quadrant of her left breast while showering. She states, “My breasts are lumpy, but this feels different.”


Pathophysiology
Treatment Options
Chemotherapy
Radiation Therapy
Hormone Therapy
Surgery
MASTECTOMY
BREAST CONSERVING SURGERY
Breast Anatomy and Pathophysiology

Primarily composed of:
- Connective tissue
- Fat
- Duct system --> lactation
- Abundant blood supply
- Extensive lymphatic network

Breast cancer:

Loss of normal differentiation and proliferation function


Genetic mutation of DNA (P53, BRCA -1 and BRCA-2 genes)


Alters apoptosis function and activates growth-promoting oncogenes, hormones


Inactivation of tumor suppressor genes (PTEN)


Further deterioration in differentiation and proliferation function


Growth of a malignant tumor

Breast Anatomy and Pathophysiology

Nine most common types of breast cancer:

1. Ductal Carcinoma In-Situ (DCIS)
2. Invasive Ductal Carcinoma (IDC)
3. Invasive Lobular Carcinoma (ILC)
4. Inflammatory Breast Cancer (IBC)
5. Lobular Carcinoma in Situ (LCIS)
6. Medullary Carcinoma
7. Tubular Carcinoma
8. Mucinous Carcinoma (Colloid)
9. Paget's Disease of the nipple

Focus on three most common:

- Ductal Carcinoma In-Situ (DCIS)
- Invasive Ductal Carcinoma (IDC)
- Invasive Lobular Carcinoma (ILC)

Pathophysiology
Most common type of non-invasive breast cancer
- Ductal -> cancer that starts in milk ducts
- Carcinoma -> cancer begins in the skin, other tissues including breast tissue
- In situ -> in its original place

DCIS:

- Non-invasive
- Not life-threatening
- Risk of developing invasive breast cancer
- Gene mutation and abnormal gene regulation cause cells that line the ducts to change and look like cancer cells
- Carcinoma does not invade through the basement membrane of the lobular ducts or terminal ducts

Invasive Ductal Carcinoma (IDC)
- Infiltrating Ductal Carcinoma
- Most common type of invasive breast cancer
- Invades and metastasizes to surrounding breast tissue
- Breaks through the wall of the milk ducts
- Metastasis to lymph nodes

Invasive Lobular Carcinoma (ILC)
Ductal Carcinoma In-Situ (DCIS)
- Cancer begins in milk-producing lobules
- Breaks through the wall of the lobules
- Invades tissues of the breast
- Metastasis to lymph nodes

*Lumpectomy*
Removes tumor and a small amount of surrounding tissue
Partial Mastectomy
Removes small part of breast with cancer and surrounding tissue
Total Mastectomy
Modified Radical Mastectomy
Segmental Mastectomy
Remove the whole breast with cancer + lymph nodes
Remove whole breast with cancer, lymph nodes, chest muscles, and chest wall muscle
Removes small part of breast with cancer and surrounding tissue & part of chest muscle
Radioactive substance administered via needle, catheter, etc. that are placed directly into or near the tumor)
Internal
External
Radiation from outside the body
1.
2.
Systemic
IV chemo
Oral medication
Only 1 area of the body, depending on the stage of the breast cancer
Regional
A surgery, radiation or a drug treatment to stop the functioning of the ovaries, thus stopping the production of estrogen.
Ovarian Ablation
Given in early stages
Tamoxifen
Aromatase Inhibitor
Prevents the formation of estradiol by interfering with an aromatase enzyme -> thus inhibits androgen from developing into a type of estrogen
Monoclonal antibodies: Man-made antibodies that can identify cancer cells or substances that cause cancer growth.

There are certain targeted therapies that specifically attack a protein called HER-2; which in some breast cancers, accelerates abnormal cell growth.
Risk Factors
Non-modifiable Risk Factors
Modifiable Risk Factors

~ Being Overweight
~ Alcohol Consumption
~ Lack of Physical Activity
~
* Having Dense Breasts
~ Smoking
-
* Reproductive history (3 children after age 30)
- Exposure to ionizing radiation
-
* Hormone replacement therapy (14 years)
- Oral contraceptives
- High socio-economic status
- Late menopause

~
*Age

(67)
(
Increased with age)
~
*Being a Woman
~ Genetics
~
*Family History

~ Race Ethnicity (White Women have a high risk)
~
* Menstrual Hx (menarche at age 11)
The earlier on in life you begin menstruation, the greater your risk for developing Breast Ca
Self Breast Examination
- Once per month
- Best done between day 3 and 10 post menstrual cycle
- Just look at your breasts
- Are they dimpling?
- Is there any redness in only one area?
- Any discoloration that was not there last month?
- Do your nipples look the same?
- Is there any discharge coming from your nipple?

Epidemiology
1. Most common cancer among CDN women

2. Second leading cause of death in CDN women

3. African American women are more likely to develop aggressive & advanced stage

Diagnostic Tests
Clinical Manifestations
-
*A lump in the breast
– most common 1st sign

- A lump in the armpit

- Change in breast shape or size

- Skin changes

- Nipple changes
Late Signs & Symptoms
* These appear when the cancer grows larger or spreads to others parts of the body
- Bone pain
- Nausea
- Loss of appetite
- Weight loss
- Jaundice
- Pleural effusion
- Headache
- Double vision
- Muscle weakness
Screening
Screening for breast cancer
- Breast screening programs
- Screening mammography
- Benefits and risks of mammography
- Know what puts at high risk
- Clinical breast exam (CBE)
- Know your breasts

- *Medical History & Physical examination

- Diagnostic Mammography

- *Ultrasound

- Scintimammography

- Ductography
Staging & other tests
-
*Lymph node biopsy
- Blood chemistry Tests
- Bone scan
- Liver ultrasound
- Chest x-ray
- *Magnetic resonance imaging (MRI)

- Hormone receptor tests
- *HER2 status testing
Strategies to lower your risk
• Don’t smoke & Avoid second-hand smoke
• Avoid exposure to radiation
• Maintain a healthy body weight
• Eat a balance diet
• Be physically active minimum 30 minutes per day
• Avoid alcohol or less than 1 drink per day

• Wear sunscreen & Avoid using tanning beds
• Plan an early 1st full-term pregnancy
• Breast feed for longer duration
• Avoid Hormone replacement therapy (estrogen/progesterone)
• Be aware of side effect with birth control
• Make sure your vaccines are up to date
• Once a month, perform a self breast examination & notify your doctor of any changes
Incidence
1. For every 10,000 people, 1 male will be newly diagnosed whereas 100 females will be newly diagnosed.

• In 2013, an estimated 82 % of new breast cancer cases will occur in Canadian women over the age of 50

Prevalence


1 in 9 CDN women to develop BrCa in lifetime, 1 in 30 will die.

Mortality:
1. 90% of BrCa deaths, occur after 50 years of age
2. 24,400 women will be diagnosed with BrCa=26% of new cancer for 2014
3. 5,000 will die from BrCa=14% of cancer related death in CDN women for 2014
4. 67 CDN women diagnosed every day for 2014
5. 14 CDN women die every day from BrCa for 2014
6. 210 men diagnosed with BrCa & 60 will die from it in 2014
7. Death rate for every 100,000 people=Males 0.3 and females 18

“Breast cancer mortality rates have decreased by 42 % from 1986
due to earlier detection: screening, and improved treatments.”

* Maria actually has a decreased risk of breast cancer due to her ethnicity
Strategies to lower your risk
1. Biopsy
*
Definitive means of diagnosing cancer
&
will guide treatment decision
Isabelle Filion - Kristina-Ray Prévost - Kourtney Myiow - Melissa Castro - Samantha Gilbert :)
ADPIE
A
: 67-year-old Hispanic woman, large lump in the upper outer quadrant of left breast (new) palpable, firm, fixed, 1.5 cm, no skin or nipple changes, family history of breast cancer and cervical cancer, onset of menarche at age 11, three children; 2 daughters (34 & 32) 1 son (30), no prior history of breast cancer, took combined hormone replacement therapy for 14 years, last mammogram & clinical breast examination 2 years ago & afraid of cancer
D
: Breast Cancer
P
: Lumpectomy, sentinel lymph node dissection; auxiliary dissection
I
: Provide reassurance/support; administer medications as ordered; refer to support groups; teaching plan r/t diagnosis, apply the McGill Model of Nursing & Stress & Coping Concept
E
: Reassess; psychosocial; pain management; support systems

CLARA
SOPHIE
Psychosocial Concept
Stress and Coping
Stressful factors:

- Diagnosis of breast cancer
- Family history
- Fear of becoming a burden for the family
- Disturbed body image
- Fear of death
Coping:
McGill Model
of
Nursing
https://www.cancer.ca/en/cancer-information/cancer-type/breast/statistics/?region=on
* Lumpectomy and sentinel lymph node dissection
with possible axillary dissection


Lymphedema
Seromas
Possible Complications
Full transcript