breast cancer presentation

1. COURSE TITLE: SRGICAL NURSING I
COURSE CODE: SPHN 305
TOPICS: BREAST CANCER
LEVEL 300: PHN (SANDWITCH)
BY
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2. OBJECTIVES
• By the end of the topic, students will be able
to:
• Define breast cancer
• State the types of breast cancer
• List the risk factors of breast cancer
• Pathophysiology of breast cancer
• Signs and symptoms of breast cancer
• Complications of breast cancer
• Diagnostic investigations
• Treatment of breast cancer
• Nursing care of patient with breast cancer
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3. REVIEW OF ANATOMY & PHYSIOLOGY OF BREAST
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4. REVIEW OF ANATOMY & PHYSIOLOGY OF BREAST
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6. CONDITIONS AFFECTING THE BREAST
• Mastitis
• Breast abscess
• Benign tumours/disorders of breast (fibro
adenoma, fibrocystic breast disease, ductal
ectasia, intraductal ectasis, gynaecomastia)
• Malignanat tumours of breast-breast
cancer
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7. Definition of breast cancer
Breast cancer is a disease that is
characterized by uncontrolled and
unregulated growth of cells in the breast.
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8. TYPES OF BREAST CANCERS
1. Ductal Carcinoma in Situ (DCIS)
2. Invasive Cancer
3. Infiltrating Ductal Carcinoma
4. Infiltrating Lobular Carcinoma
5. Medullary Carcinoma
6. Mucinous Carcinoma
7. Tubular Ductal Carcinoma
8. Inflammatory Breast Carcinoma
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9. RISK FACTORS
• Gender - female
• Old Age
• Hereditary –family history of breast cancer
• Personal History of Benign Proliferative Breast Disease/breast
cancer
• Hormonal Factors-first child after 30 years
• Nulliparirty
• Radiation Exposure
• Obesity
• High saturated fatty foods, foods with high aflotoxin content, low
fiber diet
• Alcoholism
• Infections
• Drugs (contraceptive pills and some injectables)
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10. GENDER - All
women are
at risk
Age
Family/Personal
History
Reproductive
History
Menstrual
History
Race
Genetic
Factors
Breast Cancer Risk Factors
that cannot be changed
Radiation
Treatment with
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11. All
women are
at risk
Obesity
Breastfeeding
Not having
children
Birth Control
Pills
Alcohol
Hormone
Replacement
Therapy
Exercise
All
women are
at risk
Obesity
Breastfeeding
Not having
children
Birth Control
Pills
Alcohol
Hormone
Replacement
Therapy
Breast Cancer Risk Factors
that can be controlled
Exercise
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12. CLINICAL FEATURES OF BREAST CANCER
• Lump in the breast which may be movable or
fixed
• Dimpling of the breast
• Retracted nipple/nipple inversion
• Enlargement of one breast showing significant
asymmetry
• Discharge from the nipple (bloody)
• Ulceration of breast
• Pain in the breast
• Puckering (wrinkling, crumpling) of the breast
skin
• Orange pale appearance of the skin
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15. COMPLICATIONS OF BREAST CANCER
1. Lymphatic blockage and oedema
2. Orange peel appearance of the skin
3. Enlarged axillary nodes
4. Metastasis :Breast cancer primarily
metastasizes to the bone (MOST COMMON) ,
lungs, regional lymph nodes, skin, liver and
brain
5. Ulceration of skin
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16. 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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19. DIAGNOSTIC INVESTIGATIONS
• Breast self examination
• Clinical breast examination
• Mammography
• Ultrasonography
• Chest X-ray
• Biopsy
• Staging
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20. STAGING
• Staging is a means of describing the extent of
cancer growth.
• Breast cancer is 'staged' after diagnosis by
information that is obtained from clinical,
radiological and pathological findings
• Staging helps to predict how an individual will fare
over time.
• Stage 0, I, II and IIIa constitute early breast cancer
• Stages IIIb and IV are referred to as advanced
breast cancer
• Thus the lower the stage, the better the prognosis
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21. STAGING CONT’D
• Another staging classification that describes
the extent of spread in greater detail is the
Tumour- Node- Metastasis (TNM).
• Within the TNM system:
"T" refers to tumour size,
"N" refers to lymph node involvement, and
"M" refers to the extent of metastasis.
The TNM classification is ranked within one of
the following categories.
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22. STAGE TNM Classifications
Stage 0: Stage 0: in situ breast cancer -
Tis, N0, M0
Stage I: T1, N0, M0
Stage IIa: T0-1, N1, M0, or T2, N0, M0
Stage IIb: T2, N1, M0, or T3, N0, M0
Stage IIIa: T0-2, N2, M0, or T3, N1-2, M0
Stage IIIb: T4, N (any), M0, or T(any), N3, M0
Stage IV: T(any), N(any), M1
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23. TREATMENT OF BREAST CANCER
• Chemotherapy
• Radiation therapy
• Hormonal therapy
• Surgery
• ****(combined therapy)*****
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24. TREATMENT OF BREAST CANCER CONT’D
A. local or
B. systemic.
• Local treatments (surgery and radiation therapy)
destroy or control cancer cells in a specific area.
• Systemic treatments (chemotherapy and
hormonal therapy) destroy/control cancer cells
throughout the body
• Depending on the condition, patients may receive
a single treatment or a combination of therapies
given at the same time or in succession
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25. SIDE EFFECTS OF CANCER TREATEMNT
• Depend on the type and extent of the
treatment. Physical side effects include:
• Pain
• changes in body image
• Anaemia
• Loss of appetite
• Nausea
• Vomiting
• Diarrhoea or constipation and
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26. SIDE EFFECTS OF CANCER TREATEMNT CONT’D
• Muscle ache
• Tiredness
• Skin reactions
• Hair loss (ALOPECIA)
• Tiredness
• Mouth sore
• Developing secondary cancer
• Vaginal dryness
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27. SIDE EFFECTS OF CANCER TREATEMNT CONT’D
• Lymphoedema
• Immune suppression
• Opportunistic infections
• Delayed blood clotting time
• Hot flashes
• Peripheral neuropathy
• Weight gain
• Insomnia
• Interrupted menstrual periods
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28. SIDE EFFECTS OF CANCER TREATEMNT CONT’D
Psychosocial effects of cancer treatment
include
• Distress
• Anxiety
• Depression
• Fear of the future
• Impotency
• Loss of sexual desire and
• Loss of fertility
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29. SIDE EFFECTS OF CANCER TREATEMNT CONT’D
• Treatments such as surgery, radiotherapy,
hormone therapy, biological therapy and
chemotherapy are used to:
• Control symptoms
• Improve quality of life, and
• Prolong survival
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30. EDUCATION ON SIDE EFFECTS OF CHEMOTHERAPY
• The patient should be informed about the
systemic action of the drugs that will affect both
cancer and normal cells.
• She should be told of the generalized side effects
and toxicities associated with chemotherapeutic
agents.
• Side effects should be discussed in detail with
patients that the body systems.
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31. EDUCATION ON SIDE EFFECTS OF CHEMOTHERAPY
• Commonly affected include gastrointestinal,
Vascular, skin etc.
• The Gastrointestinal system causing nausea
and vomiting diarrhea and constipation -
changes in taste and appetite.
• Vascular system causing bone marrow
depression leading to leucopenia,
thrombocytopenia and anaemia.
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32. • EDUCATION ON SIDE EFFECTS OF CHEMOTHERAPY
• The skin causing hair loss (alopecia)
• Mucositis – leading to inflammation of mucous
lining of cavities eg. Gastrointestinal.
• Fatigue which may affect one’s output of work,
she should be advised to exercise
• Daily and take naps early to prevent sleeplessness
at night.
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33. • EDUCATION ON SIDE EFFECTS OF CHEMOTHERAPY
• She should be informed on how to manage side effects of
therapy like hair loss by putting on artificial wigs to avoid
body image disturbance, cut the hair short -
• should put a towel on pillow to collect hairs that are
shed.
• She should be informed that the side effects will be
managed by the physician
• During follow up clinic where medications would be
prescribed to alleviate the problems.
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34. • EDUCATION ON SIDE EFFECTS OF CHEMOTHERAPY
• Fever and infections are likely to occur due to
suppression of the bone marrow and she should
report fever and chills to physician.
• Nutrition - patient should take plenty of water,
eat small and light meal and avoid unpleasant
environment.
• Patient should see a dietician if side effects
affects her nutrition
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35. EDUCATION ON SIDE EFFECTS OF CHEMOTHERAPY
• Drink plenty of water, take stool softeners,
exercise to reduce constipation and take
high fibre diet.
• For Diarrheoa provide - fluid replacement
and apply soothing cream at the anus and
buttocks.
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36. • EDUCATION ON SIDE EFFECTS OF CHEMOTHERAPY
• or Mouth sores (mucositis)-Rinse mouth with
mouth wash that are non-irritating
• For Neuropathy - she should wear soft loose
padded shoes, wash feet & nails frequently &
massage
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37. SURGERY
• Types of breast surgery includes:
1. Lumpectomy- Lump alone or with lymph node is
removed
2. Simple mastectomy-breast tissues are removed
but lymph nodes may be kept intact
3. Radical mastectomy-breast tissues, nipples,
underlying muscles and lymph nodes are removed
4. Modified radical mastectomy-breast tissues and
lymph nodes are removed but muscles are left
intact
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38. PRE-OPERATIVE MANAGEMENT
• PSYCHOLOGICAL
• PHYSICAL
• PHYSIOLOGICAL
• SOCIO-ECONOMIC
• SPIRITUAL
• DISCUSSION
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39. POST OPERATIVE CARE
• NUTRTION
• WOUND CARE
• PAIN RELIEVE
• PERSONAL HYGIENE
• OBSERVATION
• EDUCATION
• PSYCHOLOGICAL (BODY IMMAGE & STIGMA)
• OTHERS
• RESTORATION OF BREAST SHAPE (Breast
prosthesis AND Breast reconstruction)
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40. COPING WITH CANCER
• Educate client on the condition and
its management.
• Provide information on side effects of
treatment and its management.
• Reassure patient and family of
competence of health team.
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41. • Provide atmosphere for patient to
express anxiety and fears.
• Provide emotional support for patient
and family.
• Involve family /spouse in management
of patient.
• Provide physical support for pain and
symptoms of side effects of treatments
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42. • Assist and provide support for client to
go through grieving and loss and
development of coping strategies.
• Provide needed information on joining
cancer associations available counseling
services and materials on coping with
cancer eg. Books etc.
• Refer patient and family for spiritual
support from religious leaders.
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43. • Discuss sexual and reproductive changes
and information on how to enjoy sex life.
• Provide information on how to cope with
financial stress through fund raising
activities, donations, volunteers.
• Introduce patient to cancer survivors to
share their experience.
• Encourage patient to seek professional
advice and follow up.
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44. Prevention of breast cancer
• DISCUSSION
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45. REFERENCES
Bloom, A. & S.R., Toohey’s Medicine for Nurses, London: Churchill
Livingstone.
Bucher et al. (2005). Medical-Surgical Nursing, assessment and management
of clinical problems (7th edition). Mosby Elsevier. USA.
Brunner, L.S. & Suddarth, D. S. (2008). Textbook of medical and surgical
nursing. 11th ed. Philadelphia: J. B. Lippincott Co.
Daniels N. N. (2007). Contemporary Medical- Surgical Nursing (vol. 1 &2).
Thompson Corporation. USA.
Ignatavicius, D. (2002). Critical thinking study guide for medical-surgical
nursing. Critical thinking for collaborative care, 4th ed. St Louis: Saunders.
Watson, J.E., Watson’s Medical-Surgical Nursing and Related Philosophy,
London: Bailliere Tindall
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