I N T R O D U C T I O N

We acquire the strength of what we have overcome.

- Ralph Waldo Emerson
So many women you know may have had breast cancer
friends and neighbors, coworkers, relatives. It seems as if
every time you turn around, breast cancer is being talked
about in the newspaper or on TV. You may be fearful of
developing breast cancer for the first time or of receiving a
diagnosis after a mammogram or other testing. If youve had
breast cancer, you may be fearful of a possible recurrence or
even of the possibility that breast cancer could take your
life.
Breast cancer is an uncontrolled growth of breast cells.
To better understand breast cancer, it helps to understand how
any cancer can develop.
Cancer develops when cells in a part of the body begin to
grow out of control. Although there are many kinds of cancer,
they all start because of out-of-control growth of abnormal
cells. Normal body cells grow, divide, and die in an orderly
fashion. During the early years of a person's life, normal
cells divide more rapidly until the person becomes an adult.
After that, cells in most parts of the body divide only to
replace worn-out or dying cells and to repair injuries.
Because cancer cells continue to grow and divide, they
are different from normal cells. Instead of dying, they
outlive normal cells and continue to form new abnormal cells.
Cancer cells develop because of damage to DNA. This substance
is in every cell and directs all its activities. Most of the
time when DNA becomes damaged the body is able to repair it.
In cancer cells, the damaged DNA is not repaired. People can
inherit damaged DNA, which accounts for inherited cancers.
Many times though, a persons DNA becomes damaged by exposure
to something in the environment, like smoking. Cancer cells
can invade nearby healthy breast tissue and make their way
into the underarm lymph nodes, small organs that filter out
foreign substances in the body. If cancer cells get into the
lymph nodes, they then have a pathway into other parts of the
body. The breast cancers stage refers to how far the cancer
cells have spread beyond the original tumor, A tumor can be
benign (not dangerous to health) or malignant (has the
potential to be dangerous).
The term breast cancer refers to a malignant tumor that
has developed from cells in the breast. Usually breast cancer
either begins in the cells of the lobules, which are the milkproducing glands, or the ducts, the passages that drain milk
from the lobules to the nipple. Less commonly, breast cancer
can begin in the stromal tissues, which include the fatty and
fibrous connective tissues of the breast.
Breast cancer is always caused by a genetic abnormality
(a mistake in the genetic material). However, only 5-10% of
cancers are due to an abnormality inherited from your mother
or father. About 90% of breast cancers are due to genetic
1

abnormalities that happen as a result of the aging process and

the wear and tear of life in general.
Breast cancer is the second leading cause of cancer death
in women, exceeded only by lung cancer. The chance that breast
cancer will be responsible for a woman's death is about 1 in
35(about 3%). In 2008, about 40,480 women will die from breast
cancer in the United States. Death rates from breast cancer
have been declining since about 1990, with larger decreases in
women younger than 50. These decreases are believed to be the
result of earlier detection through screening and increased
awareness, as well as improved treatment.
The risk of developing most types of cancer can be
reduced by changes in a person's lifestyle, for example, by
quitting smoking and eating a better diet. The sooner a cancer
is found and treatment begins, the better are the chances for
living for many years.
We have chosen the case because we want to broaden our
knowledge about Breast Cancer regarding to the nursing
interventions and medical management. Cancer is the second
leading cause of death and is a common case in the Surgical
Ward of Baguio General Hospital and medical Center (BGHMC)
that also prompted the group to research on the disease. The
risk of developing most types of cancer can be reduced by
changes in a person's lifestyle, for example, by quitting
smoking and eating a better diet. The sooner a cancer is found
and treatment begins, the better are the chances for living
for many years.

P A T I E N T S
Biographical

P R O F I L E

Data

Patient X is 53 y/o, female, currently residing at

Urdaneta City, Pangasinan was born on May 28, 1956 at Dagupan
City, Benguet. She is married and was blessed with four
children. She is currently living with her sister and her
daughter here in Baguio due to her chemotherapy sessions at
Baguio General Hospital and Medical Center.
She is currently a housewife, managing the family and her
only daughter. At present, source of income comes from her
husband working as a Computer Technician on a company.
She was admitted last September 2008 at Baguio General
Hospital and Medical Center (BGHMC) form MRM (modified Radical
Mastectomy) with complaints of having pain in her right breast
last December 2007.
She attained a High school degree having the knowledge
and ability to read and write. As for hobbies and interests,
she certainly entertains herself by reading, cleaning and
doing household chores and taking care of her family. She
verbalized that the greatest gift from her is her only
children.

Present
2 months
noted a mass
There
was
Consultation
admission.

Past

Illness

Prior to Admission, patient complained, patient

before the incision area of the right breast.
associated
tenderness
but
no
discharged.
was sought and surgery was scheduled, hence

Medical

History

Patient X has no previous history of allergies. She had

stated that she had previous records of hospitalization and
operations. Last Operations were performed on September 2008.
She underwent MRM (Modified Radical Mastectomy) and Status
post a 6 cycle of Chemotherapy because of presence of tumor on
her right breast. She has also a history of Hypertension.

Family

Medical

History

Patient X verbalized that she is the only one in the

family that had cancer. She has stated that there were Family
Medical Diseases known in their neither family nor hereditary
sickness such as hypertension and most commonly in cancer. She
declared that she had cancer due to an unhealthy lifestyle
established during her younger years. Her aunt had breast
cancer and survived and her cousin died due to cancer.
3

Social/Environmental

History

Patient X is married and with four children. They are

living in a bungalow type of house made of cement and wood
just. Purchase of mineral water is their source of drinking
water in the area. She also Garbage is collected on their area
daily. She is fond of eating vegetables and fruits, less meat,
and fish, and very selective on food. She dislikes and avoids
eating salty foods; she is not very fond of eating sweets. She
also stated that promotes drinking water, hydrating herself by
drinking lots of water approximately 8-10 glasses a day, as
she knows that it would be a benefit to her health. She also
stated that she is a non-alcoholic and non-smoker.

Gynecological

History

The patient was pregnant four times and delivered a

four healthy children via Normal Spontaneous Delivery. During
her pregnancy, she has a regular pre-natal check-up every
month. She has a normal menstrual cycle (ranging from 3 to 4
days every month). She has not undergone any abortion. She has
no history of reproductive abnormalities.

P H Y S I C A L
13

A.

AREAS

A S S E S S M E N T
OF

Psychosocial

ASSESSMENT

Status

Patient X is 53 y/o, female; currently residing at

Urdaneta City, Pangasinan was born on March 18, 1956 at Baguio
City, Benguet. She attained a High school degree having the
knowledge and ability to read and write.
As for now, she is currently a housewife, managing the
family and her only daughter. At present, source of income
comes from her husband working as a Computer Technician on a
company. As for hobbies and interests, she certainly
entertains herself by reading, cleaning and doing household
chores and taking care of her family. She verbalized that the
greatest gift from her is her only children.
Under Erik Eriksons psychosocial development theory, the
patient is under the stage of Generativity Versus Stagnation.
She seems to have a good outlook in life.
She was attentive in conversing with the health team
members. She was cooperative to the nursing and medical
interventions. She deals well with her watcher and visitors.
They seem to have good relationship.

B.

Mental

Status and
Status

Emotional

The patient was conversant and was slightly oriented to

date time, place, and people and to her present condition.
During the duty, there were no observed mood swings and
emotional changes. Her positive attitude was consistent all
throughout. She answers questions and follow instructions
appropriately.

C.

Environmental

Status

The patient was admitted to Baguio General Hospital and

Medical Center in Surgery East Ward of the Female Division on
Bed 16. The ward has adequate lighting, good ventilation and
warm temperature. It was maintained clean at all times by the
cooperation of the Hospital Janitor, Staff Nurses and Watchers
of each patient. The bed has no side rails. There are clean
blankets and pillows for the patients use. There was a
regular garbage collection in the hospital where in there is
proper regulation. The garbage bins are placed on the hallway
of the ward which is managed by the Hospital Janitor.
5

D.

Sensory

Status

1. Visual Status

The patients pupils are equally rounded. There are no

reduced accommodation to light changes when the penlight was
directed to the eyes. Based on her age, she has diminished
visual acuity nor reduction in visual field. She does not have
difficulties in seeing far away objects and recognizing
people, and does wear corrective devices such as eye glasses
if needed. She has the capability to read due to good visual
acuity.

2. Auditory Status

She has no difficulties in hearing soft voices upon

seeing her conversing with her watcher in a whispering manner.
She was able to determine from what direction the sound of the
voices were coming from as observed when she turned her head
towards the direction of the person she was talking to. There
was no impacted cerumen upon inspection. The ears are
symmetrical and in lined with the outer cantus of the eyes.

3. Olfactory Status

Air is felt in the nose when she exhaled. Nasal mucosa is

intact, smooth and moist pink upon inspection. She was able to
discriminate foul odor as noted when she complained about the
bad smell of the comfort room.

4. Gustatory Status

She is able to determine between different tastes such as

sour, sweet, bitter, and salty. She could also taste any
flavor or dish served to her.

5. Tactile Status

She was able to perceive hotness. She was also able to

perceive cold as noted when she asked the student nurse why
the thermometer is cold. Pain was noted when she grimaced upon
the administration of intravenous medications.

6. Language Perception and Formation

The patient is fluent in Ilocano, Tagalog and in English.

She can understand Ilocano, Tagalog and English language but
fairly understandsother dialects. She verbalizes her needs.

E.

Motor

Status

Patient can move all her extremities very well. She has
no limited movement from her bed and can barely stand on her
own. She could ambulate around the ward and walks to the
comfort room to refresh herself without no assistance.

F.

Nutritional

Status

During her hospitalization, The doctor advised her to

take in foods that would boost her immune system, eating a
balanced meal composing largely on fruits and vegetables and
small amount of meat. She has a good appetite. Upon palpation,
there is no abdominal tenderness.

G.

Elimination

Status

During hospitalization, her urination ranges from 3-4

times per day only. This must have been because she takes
water at all.
On the days that we handled her, she had not defecated
during our 3-11 shift. She described her stool as brownish and
depending on the foods colors that she intake in.

H.

Fluid

and

Electrolyte

status

Before the hospitalization, Mrs. X drinks large amounts

of water just about 8-10 glasses of water a day. She drinks
water every after meal, as she knows that it would be a
benefit to her health.
During her hospitalization, she did drink much water.
There was insertion of IV administration of D5LRS 1000 Liters
regulated at 21 drops per minute (gtts/min).

I.

Circulatory

Status

Her pulse rate ranges from 62-95 beats per minute which
is within the normal limits. However, her blood pressure
ranges from 100/60- 130/70 which also her normal BP. She has a
7

history of
hypertension. Her capillary refill is about 2-3
seconds which is normal.

J.

Respiratory

Status

Her respiration ranges from 16-22 breaths per minutes.

She has no episodes of difficulty in breathing.

K.

Temperature

Status

During her first day of hospitalization, she has no

fever. Her temperature ranges from 36.9 37.2 degrees
centigrade which is within normal range.

L.

Integumentary

Status

Skin was moist. Lips and buccal mucosa were not dry.
There is normal Skin turgor which goes back normally. There
were noted incision on the left breast due to her mastectomy
operation last 2008 at Cagayan de Oro.

M.

Comfort

and

Rest

Status

During our shift, she was comfortable in sleeping but

there are episodes where she cannot sleep due to ward
setting. The lights are on and the Noise surrounding the ward
could irritate her disturbance of sleeping.

L A B O R A T O R Y

F I N D I N G S

H e m a t o l o g y
N a m e : x
W a r d : s u r g

A g e : 3 6 / f
T i m e : 9 : 1 5
R E F .
Hemoglobin
1 0 2
F
1 2 0
Hematocrit
0 . 3 0
F
0 .
WBC Count
5 . 0 - 1 0 . 0 x
D I F F E R E N T I A L
C O U N T
Neutrophils
0 . 5 0 - 0 . 7 0
Lymphocytes
0 . 2 0 - 0 . 4 0
Midcell
0 . 0 3 - 0 . 0 9
Eosinophil
0 . 0 0 - 0 . 0 7
Monocyte
0 . 0 0 - 0 . 0 7
Band
0 . 0 0 - 0 . 0 5
T O T A L
1 . 0 0
Red Cell Count
F
4 . 0 4
- 5

A N D

R e s u l t

a m
R A N G E
l / l
- 1 6 0
3 7 - 0 . 4 7 l
1 0 g / L

I M P L I C A T I O N S
F o r m

/ l

H o s p : 3 9 1 0 5 3
L a b # :
W H 1 2 2
R E S U L T
7 8
0 . 2 3
2 1 . 1
0 . 8 4
0 . 1 5
0 . 0 1
1 . 0 0

. 4 8

1 0

1 2 / L

Platelet Count
LE Cell Prep.
Malarial Smear

1 5 0 - 4 0 0 x

1 0

g / l

M a r k e d l y

i n c r e a s e d

Bleeding Time
1 - 5
m i
Clotting Time
2 - 6
m i
Lee & white C.T
5 - 1 0
m
P R O T H R O M B I N
T I M E
(
Patient
1 0 - 1 4
Control
1 0 . 8 - 1
INR
% Activity
P A R T I A L
P R O T H R O M B I
Patient
2 6 - 3 6
Control
2 9 . 6 - 3
E R Y T H R O C Y T E
S E D I M E
Wintrobe Method
F 0 - 2 0 m
Westergren Method
A d u l t
Retailocyte Count
0 . 5 - 1 .

n
n
i
P
s
3
N
s
7
N
m
0
5

u
u
n
T
e
.

e
.
T
/
%

t
t
u
)
c
8

e s
e s
t e s

T
c
6
A
H
1

I M E
o n d
s e
T I O
r
0
m

o n d s
s e c o n d s
( P T T )
s
c o n d s
N
R A T E
m / H r

R E M A R K S :
Midcells may include less frequently occurring and rare correlating to monotype, eosinophils, basophils,
blast and other precursor.
Blood Type: O
10

Rh: Positive

I M P L I C A T I O N :
Chemotherapy affects production of white blood cells in the bone marrow. Normally white blood cells help
fight off infection. After chemotherapy, if your white blood cells are low, you are more likely to get
infections. Any infection can also worsen more quickly a trivial infection could become life threatening
within hours if it isnt treated.
When your white blood cell count is at its lowest you can feel very tired (fatigued). Some people also
say they feel depressed. This can be really hard to deal with and make you wonder if you really want to go on
with your treatment. Try to hang in there. Things should improve and you will start to feel better again
before your next treatment, as your blood counts rise. Unfortunately, they'll go down again after each
treatment. But once your treatment is finished your blood cell counts will remain at normal levels.

11

A N A T O M Y
T h e

A N D

P H Y S I O L O G Y

B r e a s t s

In order to understand breast cancer, it helps to have

some basic knowledge about the normal structure of the
breasts. The female breast is made up mainly of lobules (milkproducing glands), ducts (tiny tubes that carry the milk from
the lobules to the nipple), and stroma (fatty tissue and
connective tissue surrounding the ducts and lobules, blood
vessels, and lymphatic vessels).

Most breast cancers begin in the cells that line the

ducts (ductal cancers). Some begin in the cells that line the
lobules (lobular cancers), while a small number start in other
tissues.

T h e

L y m p h a t i c

s y s t e m

The lymph system is important to understand because it is

one of the ways in which breast cancers can spread. This
system has several parts. Lymph nodes are small, bean-shaped
collections of immune system cells (cells that are important
in fighting infections) that are connected by lymphatic
vessels. Lymphatic vessels are like small veins, except that
they carry a clear fluid called lymph (instead of blood) away
from the breast. Lymph contains tissue fluid and waste
products, as well as immune system cells.
Breast cancer cells can enter lymphatic vessels and begin
to grow in lymph nodes. Most lymphatic vessels in the breast
connect to lymph nodes under the arm (axillary nodes).
Some lymphatic vessels connect to lymph nodes inside the chest
(internal mammary nodes) and those either above or below the
collarbone (supraclavicular or infraclavicular nodes).

12

Knowing if the cancer cells have spread to lymph nodes is

important because if it has, there is a higher chance that the
cells could have also gotten into the bloodstream and spread
(metastasized) to other sites in the body.
The more lymph nodes that have breast cancer, the more
likely it is that the cancer may be found in other organs as
well. This is important to know because it could affect your
treatment plan. Still, not all women with cancer cells in
their lymph nodes develop metastases, and in some cases a
woman can have negative lymph nodes and later develop
metastases.

F i b r o c y s t i c

c h a n g e s

Most lumps turn out to be fibrocystic changes. The term

"fibrocystic" refers to fibrosis and cysts. Fibrosis is the
formation of fibrous (scar-like) tissue, and cysts are fluidfilled sacs.
Fibrocystic changes can cause breast swelling and pain.
This often happens just before a woman's menstrual period is
about to begin. Her breasts may feel lumpy and, sometimes, she
may notice a clear or slightly cloudy nipple discharge.

B e n i g n

B r e a s t

L u m p s

Benign
breast
tumors
such
as
fibroadenomas
or
intraductal papillomas are abnormal growths, but they are not
cancerous and do not spread outside of the breast to other
organs.They are not life threatening. Still, some benign
breast conditions are important because women with these
conditions have a higher risk of developing breast cancer.

13

P A T H O P H Y S I O L O G Y
Predisposing
Factors:

O F

T H E

D I S E A S E
Precipitating Factors:

ETIOLOGY:

exposure to radiation and

certain chemicals
having a sibling with
leukemia
HTLV-1 virus
genetic abnormalities
chromosomal
translocations

Unknown

Age
Gender

Somatic mutations in
the DNA

Activate oncogene/
deactivate tumorsupppresor gene

Malignant transformation
of lymphoid stem cells

Uncontrolled proliferation
of lymphoblast in the bone
marrow
Diagnostic
Test:

Lymphoblast replace the

normal marrow elements

BM aspiration
Decreased production
of normal blood cells

14

s/sx:
bone pain
joint pain
Treatment:
Remission Induction
Therapy
Consolidation and
Maintenance
Therapy
BM Transplantation
CNS prophylaxis

Treatment:
Analgesic

P A T H O P H Y S I O L O G Y
D I S E A S E

O F

T H E

Breast cancer may be classified pathologically as

noninvasive (in situ) or invasive (infiltrating). The
noninvasive carcinomas are generally thought to be antecedents
of invasive carcinoma.
Intraductal carcinoma (ductal carcinoma in situ) is the
most common noninvasive carcinoma among elderly women. It is
generally multicentric, and <= 20% recur locally after partial
mastectomy. Axillary lymph nodes are involved in < 2% of
cases. Lobular carcinoma in situ, often multicentric and
involving both breasts, is rare after menopause.
Of the invasive carcinomas, invasive ductal carcinoma is
the most common among women of all ages, comprising about 70%
of all cases. The incidence of mucinous (colloid) carcinoma, a
slow-growing tumor in elderly women, increases with age. The
incidence of medullary carcinoma, which is often bilateral,
decreases with age. Inflammatory carcinoma of the breast, a
very
aggressive
tumor,
is
equally
prevalent
among
premenopausal and postmenopausal women.
Paget's disease of the nipple represents spread of a
ductal carcinoma to the skin of the nipple; it is usually
associated with intraductal carcinoma and less so with
invasive carcinoma. A palpable breast lump is present in 50%
of cases.
Although many risk factors may increase your chance of
developing breast cancer, it is not yet known exactly how some
of these risk factors cause cells to become cancerous.
Hormones seem to play a role in many cases of breast cancer,
but just how this happens is not fully understood.
Certain changes in DNA can cause normal breast cells to
become cancerous. DNA is the chemical in each of our cells
that makes up our genes -- the instructions for how our cells
function. We usually resemble our parents because they are the
source of our DNA. However, DNA affects more than how we look.
Some genes contain instructions for controlling when our cells
grow, divide, and die. Certain genes that speed up cell
division are called oncogenes. Others that slow down cell
division, or cause cells to die at the right time, are called
tumor suppressor genes. Cancers can be caused by DNA mutations
(changes) that "turn on" oncogenes or "turn off" tumor
suppressor genes.

Inherited gene mutations

Certain inherited DNA changes can increase the risk for
developing cancer and are responsible for the cancers that run
in some families. Mutations in these genes can be inherited
from parents. When they are mutated, they no longer suppress
abnormal growth, and cancer is more likely to develop. Women
have already begun to benefit from advances in understanding
the genetic basis of breast cancer. These women can then take
steps to reduce their risk of developing breast cancers
15

and to monitor changes in their breasts carefully to find

cancer at an earlier, more treatable
stage.

Acquired gene mutations

Most DNA mutations related to breast cancer, however,
occur in single breast cells during a woman's life rather than
having been inherited. These acquired mutations of oncogenes
and/or tumor suppressor genes may result from other factors,
such as radiation or cancer(22 of 121) causing chemicals. But
so far, the causes of most acquired mutations that could lead
to breast cancer remain unknown. Most breast cancers have
several gene mutations that are acquired.

16

N U R S I N G
C A R E
A N D
M A N A G E M E N T
LIST

OF

IDENTIFIED

ACTUAL

PROBLEMS

PROBLEMS

1. hair loss leading to disturbed body image

2. easy bruising or bleeding (due to low blood platelet
counts)
3. fatigue (due to low red blood cell counts and other
reasons)
4. loss of appetite
POTENTIAL

PROBLEMS

1. nausea and vomiting

2. increased chance of infections (due to low white blood
cell counts)
3. mouth sores

PRIORITIZED

PROBLEMS

1. Fatigue (due to low red blood cell counts and other

reasons)
Fatigue is a common health complaint. It is, however, one
of the hardest terms to define, and a symptom of many
different conditions.
Fatigue, also known as weariness, tiredness, exhaustion,
or lethargy, is generally defined as a feeling of lack of
energy. Fatigue is not the same as drowsiness, but the
desire to sleep may accompany fatigue. Apathy is a
feeling of indifference that may accompany fatigue or
exist independently.
2. Hair Loss Leading Disturbed Body Image
Some medicines can cause hair loss. This type of hair
loss improves when you stop taking the medicine.
Medicines that can cause hair loss include blood thinners
(also called anticoagulants), medicines used for gout,
medicines used in chemotherapy to treat cancer, vitamin A
(if too much is taken), birth control pills and
antidepressants.
Body image is the attitude a person has about the actual
or perceived structure or function of all or part of his
or her body. This attitude is dynamic and is altered
through interaction with other persons and situations and
17

influenced by age and developmental level. As an

important part of ones self-concept, body image
disturbance can have profound impact on how individuals
view their overall selves.
3. loss of appetite
A decreased appetite is when you have a reduced desire to
eat. This occurs despite the body's basic caloric
(energy) needs.
Any illness can affect a previously hearty appetite. If
the illness is treatable, the appetite should return when
the condition is cured.
Loss of appetite can cause unintentional weight loss.
Depression in the elderly is a common cause of weight
loss that is not explained by other factors.

18

N U R S I N G

C A R E

P L A N S

ACTUAL
ASSESSMENT

EXPLANATION OF
THE PROBLEM

PLANNING

S> Medyo
nanghihina pa ako
O> Appears weak
Slow
Movements
noted
Good Skin
Turgor
Coherent and
Conversant
Needs
assistance in
performing
ADLs
A> Activity
Intolerance
Related to
Weakness

The length of
Chemotherapy
treatment depends
on whether the
cancer shrinks,
how much it
shrinks, and how a
woman tolerates
length of
treatment. Some of
the most common
possible side
effect is fatigue
(due to low red
blood cell counts
and other reasons)

STO> After 8 hours

of Nursing
Intervention the
patient will be
able to identify
techniques to
enhance activity
tolerance such as:
- gradual increase
in activity level
as tolerated
- rest in between
activities
LTO> After 8 days
of Nursing
Intervention, the
patient will be
able to report an
increase in

IMPLEMENATION
DX> Monitor Vital
Signs and Record
Assess
Ability to
ambulate
Assess
capillary
Refill
Assess skin
turgor.
TX> Promote
Adequate Rest

Assist with
activities
Anticipate
Needs
EDX> Encourage
19

RATIONALE

EVALUATION

For baseline
data.
To determine
activity
intolerance
To determine
circulatory
problems.
To determine
hydration.
To enhance
ability to
participate
with
activities
To protect
client from
injury
To promote
wellness

STO> Goal is met

if the patient
will be able to
identify
techniques to
enhance activity
tolerance such as:
- gradual increase
in activity level
as tolerated
- rest in between
activities
LTO> Goal is met
if the patient
will be able to
report an increase
in activity
intolerance.

activity
intolerance.

expression of
feelings
Suggest Use
of Relaxation
Techniques
such as
visualization
and guided
imagery.

20

To determine
contributing
factors
To Enhance
Ability to
participate
in activities

ASSESSMENT

EXPLANATION
OF THE
PROBLEM

PLANNING

IMPLEMENATION

S> Nakakahiya
makakalbo ako
O>
Coherent and
Conversant
Submits self
to Nursing
Procedure and
Care done
A> Disturbed
Body Image
realted to
illness
treatment.

The length of
Chemotherapy
treatment depends
on whether the
cancer shrinks,
how much it
shrinks, and how a
woman tolerates
length of
treatment. Some of
the most common
possible side
effect is hair
loss.

STO> After 8
hours of Nursing
Intervention the
patient will be
able to verbalize
understanding of
body changes

DX> Monitor vital

signs and record
Determine
patients
perception of
cancer and
cancer
treatments.
TX> Ask for
patient for verbal
feedback, and
correct
misconception
about individuals
type of cancer and
treatment.
Provide
anticipatory
guidance with
patient
regarding
treatment
Protocol,
length of

LTO> After 1 day

of Nursing
Intervention, the
patient will be
able to verbalize
acceptance of
self in situation
in the effects of
therapeutic
regimen.

21

RATIONALE

For baseline
data
Aids in
identification
of ideas,
attitudes and
fears,
misconception
Misconceptions
about cancer may
be more
disturbing than
facts and can
interfere with
treatments/
delay healing.
Accurate and
concise
information
helps dispel
fears and
anxiety, helps
clarify the
expected

EVALUATION

STO> Goal is met

if patient will
be able to
verbalize
understanding of
body changes.
LTO> Goal is met
if patient will
be able to
verbalize
acceptance of
self in situation
in the effects of
therapeutic
regimen.

therapy and
possible side
effects
EDX> Refer to
community
resources as
indicated.
Review
specific
medication
regimen and
use of OTC
drugs.

22

routine.

Promotes
competent selfcare and optimal
independence.
Enhances ability
to manage selfcare and avoid
potential
complications,
drug reactions.

ASSESSMENT

EXPLANATION
OF THE
PROBLEM

S>
O> Coherent and
Conversant
Submits self
to Nursing
Procedure and
Care done
A> Risk for
Infection
related to
inadequate
secondary
defenses and
immunosuppress
ion secondary
to doselimiting side
effect of
chemotherapy.

This can often

have a major
effect on the
immune system and
may reduce the
body's defenses
against infection
for some months,
both during and
after treatment.
This is because
chemotherapy
reduces the
production of
white blood cells
by the bone
marrow. People
having
chemotherapy are
particularly at
risk of picking up
infections between
714 days after
the chemotherapy,

PLANNING

IMPLEMENATION

STO> After 8
hours of Nursing
Intervention the
patient will be
able to verbalize
understanding of

DX> Monitor Vital

Signs and record.
Monitor
Temperature

Having cancer or
treatment for cancer
can weaken your
immune system. This
makes it more likely
that you will pick
up an infection and
develop a fever.

LTO> After 1 day

of Nursing
Intervention, the
patient will be
able to
demonstrate proper
aseptic techniques
preventing further
infection such as
proper hand
23

TX> Assess all

systems for signs
and symptoms of
infection on a
continual basis.

Promote
adequate
rest/
exercise
periods

RATIONALE

For baseline
Data.
Temperature
elevation may
occur because
of various
factors such
as
chemotherapy
side effects.
Early
recognition
and
intervention
may prevent
progression
to more
serious
situation.
Limits
fatigue, yet
encourages
sufficient
movement to

EVALUATION

STO> Goal is met

if patient will
be able to
verbalize
understanding of
Having cancer or
treatment for cancer
can weaken your
immune system. This
makes it more likely
that you will pick
up an infection and
develop a fever.

LTO> Goal is met

if patient will be
able to
demonstrate proper
aseptic techniques
preventing further
infection such as
proper hand
washing.

when the level of

white blood cells
will be at its
lowest (this time
is known as the
nadir). This time
can vary slightly
depending upon the
chemotherapy drug,
or combination of
drugs, used.

washing.
Avoid/ limit
invasive
procedures.
Adhere to
aseptic
techniques.

EDX> Promote good

handwashing
procedures by
staff and
visitors.
Emphasize
personal
hygiene

Stress
importance of
good oral
hygiene

24

prevent
stasis
complications
Reduces risk
of
contamination
, limits
portal of
entry for
infectious
agents.
Protects
patients from
sources of
infection.
Limits
potential
sources of
infection
and/ or
secondary
overgrowth.
Development
of stomatitis
increases
risk of

infection/
secondary
overgrowth.

25

D R U G

S T U D Y

26

Generic name/brand name/

classification

Action and Indication

Route/Dosage/Date prescribe

Dosage

tamoxifen citrate

Therapeutic actions

(ta mox' i fen)

Apo-Tamox (CAN),
Nolvadex, Novo-Tamoxifen
(CAN), Tamofen (CAN),
Tamone (CAN)

Potent antiestrogenic effects:

competes with estrogen for binding
Adult
sites in target tissues, such as the
Breast cancer:
breast.

Pregnancy Category D
Drug class

Antiestrogen

Nursing consideration

Take the drug

twice a day, in
the morning and
evening.

The following
side effects may
occur: bone pain;
hot flashes
(staying in cool
temperatures may
help); nausea,
vomiting (small,
frequent meals
may help); weight
gain; menstrual
irregularities;
dizziness,
headache, lightheadedness (use
caution if
driving or
performing tasks
that require
alertness).

This drug can

cause serious
fetal harm and
must not be taken
during pregnancy.
Contraceptive
measures should
be used. If you
become pregnant
or decide that
you would like to
become pregnant,
consult with your
health care
provider

Available Forms: Tablets--10,

20 mg

Indications
Adjunct with cytotoxic
chemotherapy following radical
or modified radical mastectomy
to delay recurrence of
surgically curable breast
cancer in postmenopausal women
or women >50 y with positive
axillary nodes
Treatment of advanced,
metastatic breast cancer in
women and men; alternative to
oophorectomy or ovarian
radiation in premenopausal
women
Preventative therapy for women
at high risk for breast cancer
Unlabeled uses: treatment of
mastalgia; useful for
decreasing size and pain of
gynecomastia; treatment of
pancreatic, endometrial, and
hepatocellular carcinoma

27

20---40 mg/d PO for 5 y.

Reduction in breast cancer
incidence:
20 mg/d PO for 5 y.
Pharmacokinetics
Route
Oral

Onset
Varies

Peak
4---7 h

Metabolism: Hepatic, T1/2:

7---14 d
Distribution: Crosses
placenta; enters breast
milk
Excretion: Feces

S U M M A R Y

O F

F I N D I N G S

Vital Signs were assessed and properly documented. The

patient

was

on

IVF

of

D5NSS

1L,

it

was

regulated

and

monitored. IVF flow rate and patency on site were checked. The
significant others was encouraged to converse with the patient
and instructed to maintain bed rest. The significant others
was endorsed to increase fluid intake. The diet as tolerated
was

encouraged

promoting

vegetables

and

fruits

in

giving

vitamins and minerals that could support the bodys defenses.

Medications were prepared to the patient Treatment for these
symptoms are a standard fluid rehydration therapy in order to
maintain
reversed,

blood
death

pressure.
may

If

follow.

circulatory
Rapport

was

failure

is

not

established

and

integrated with the significant others. Safety was ensured

with the close monitoring on the patient.

28

C O N C L U S I O N

If a newly diagnosed Breast cancer patient asked you to

define cancer, could you tell her that she has still hope? We
all have heard the word "cancer" many times, however very few
people understand the disease and how it develops.
Cancer is a complex group of over 100 different types of
cancer. Cancer can affect just about every organ in the human
body.
All cancers are different, and require different
treatment. What may be effective for prostate cancer, probably
will not be for bladder cancer. Diagnosing cancer will vary as
well, depending on the organ affected.
End-of-Life Issues
Palliative care, which provides physical, emotional, and
spiritual relief, must be provided with attempts for curative
therapy and becomes the exclusive goal when cure cannot be
expected at all stages of breast cancer, treatment needs to be
modified for life expectancy. For patients with metastatic
disease for which cure is not attainable, the physician should
clarify the goals of care through frequent, clear discussions
with the patient and, when appropriate, the family.
All should recognize that cognitive impairment alone does
not exclude the patient from participating in decision making,
because some patients with impaired cognition are able to
understand, explain the consequences of, and voice an opinion
about certain treatment options. Pain from bony metastases
should be treated as described above with nonsteroidal antiinflammatory
drugs,
pamidronate,
local
radiation,
and
strontium 89 rather than with opioids if possible. Palliative
chemotherapy may be useful when the tumor invades vital
organs.

29

R E C O M M E N D A T I O N

Health care providers should:

a. Should continuously monitor the vital signs of the
patient.
b. Observe the patient to avoid development of
complications.
c. Promote safety of the patient.
d. Educate patient and significant others about the disease,
and
e. Explain the procedure done to the patient. The evaluation
and diagnosis of Breast Cancer is based on the presenting
symptoms and history combined with a focused physical
assessment, imaging studies, and possibly a functional
study of the breast.
Significant others should:
a. Actively cooperate in the rendering of care for the
patient.
b. Be sensitive to the needs.
c. In addition, every effort is made to retrieve and analyze
breast has passed spontaneously or retrieved through
aggressive interventions.
d. Cooperate with the health care providers in the
implementation of her Health Care programs.

30

A P P E N D I C E S

S t a g e s
Stage
Stage
0
Stage
I

Stage
IIA

Stage
IIB

Stage
IIIA

Stage
IIIB

o f

B r e a s t

C a n c e r

Definition
Cancer cells remain inside the breast duct, without
invasion into normal adjacent breast tissue.
Cancer is 2 centimeters or less and is confined to the
breast (lymph nodes are clear).
No tumor can be found in the breast, but cancer cells
are found in the axillary lymph nodes (the lymph nodes
under the arm)
OR
the tumor measures 2 centimeters or smaller and has
spread to the axillary lymph nodes
OR
the tumor is larger than 2 but no larger than 5
centimeters and has not spread to the axillary lymph
nodes.
The tumor is larger than 2 but no larger than 5
centimeters and has spread to the axillary lymph nodes
OR
the tumor is larger than 5 centimeters but has not
spread to the axillary lymph nodes.
No tumor is found in the breast. Cancer is found in
axillary lymph nodes that are sticking together or to
other structures, or cancer may be found in lymph nodes
near the breastbone
OR
the tumor is any size. Cancer has spread to the
axillary lymph nodes, which are sticking together or to
other structures, or cancer may be found in lymph nodes
near the breastbone.
The tumor may be any size and has spread to the chest
wall and/or skin of the breast
AND
may have spread to axillary lymph nodes that are
clumped together or sticking to other structures, or
cancer may have spread to lymph nodes near the
breastbone.

Inflammatory breast cancer is considered at least stage

IIIB.
There may either be no sign of cancer in the breast or
a tumor may be any size and may have spread to the
chest wall and/or the skin of the breast
AND
Stage
the cancer has spread to lymph nodes either above or
IIIC
below the collarbone
AND
the cancer may have spread to axillary lymph nodes or
to lymph nodes near the breastbone.
Stage The cancer has spread or metastasized to other
IV
parts of the body.

31

B r e a s t

C a n c e r

R i s k

F a c t o r s

A risk factor is anything that increases your risk of

developing breast cancer. Many of the most important risk
factors for breast cancer are beyond your control, such as
age, family history, and medical history. However, there are
some risk factors you can control, such as weight, physical
activity, and alcohol consumption.
Be sure to talk with your doctor about all of your
possible risk factors for breast cancer. There may be steps
you can take to lower your risk of breast cancer, and your
doctor can help you come up with a plan. Your doctor also
needs to be aware of any other risk factors beyond your
control, so that he or she has an accurate understanding of
your level of breast cancer risk. This can influence
recommendations about breast cancer screening what tests to
have and when to start having them.

I.

Risk

factors

you

can

control

Weight. Being overweight is associated with increased risk of

breast cancer, especially for women after menopause. Fat
tissue is the bodys main source of estrogen after menopause,
when the ovaries stop producing the hormone. Having more fat
tissue means having higher estrogen levels, which can increase
breast cancer risk.
Diet. Diet is a suspected risk factor for many types of
cancer, including breast cancer, but studies have yet to show
for sure which types of foods increase risk. Its a good idea
to restrict sources of red meat and other animal fats
(including dairy fat in cheese, milk, and ice cream), because
they may contain hormones, other growth factors, antibiotics,
and pesticides. Some researchers believe that eating too much
cholesterol and other fats are risk factors for cancer, and
studies show that eating a lot of red and/or processed meats
is associated with a higher risk of breast cancer. A low-fat
diet rich in fruits and vegetables is generally recommended.
For more information, visit our page on healthy eating to
reduce cancer risk in the Nutrition section.
Exercise. Evidence is growing that exercise can reduce breast
cancer risk. The American Cancer Society recommends engaging
in 45-60 minutes of physical exercise 5 or more days a week.
Alcohol consumption. Studies have shown that breast cancer
risk increases with the amount of alcohol a woman drinks.
Alcohol can limit your livers ability to control blood levels
of the hormone estrogen, which in turn can increase risk.
Smoking. Smoking is associated with a small increase in breast
cancer risk.
Exposure to estrogen. Because the female hormone estrogen
stimulates breast cell growth, exposure to estrogen over long
periods of time, without any breaks, can increase the risk of
breast cancer. Some of these risk factors are under your
control, such as:

32

taking combined hormone replacement therapy (estrogen and

progesterone; HRT) for several years or more, or taking
estrogen alone for more than 10 years

being overweight

regularly drinking alcohol

Recent oral contraceptive use. Using oral contraceptives

(birth control pills) appears to slightly increase a womans
risk for breast cancer, but only for a limited period of time.
Women who stopped using oral contraceptives more than 10 years
ago do not appear to have any increased breast cancer risk.
Stress and anxiety. There is no clear proof that stress and
anxiety can increase breast cancer risk. However, anything you
can do to reduce your stress and to enhance your comfort, joy,
and satisfaction can have a major effect on your quality of
life. So-called mindful measures (such as meditation, yoga,
visualization exercises, and prayer) may be valuable additions
to your daily or weekly routine. Some research suggests that
these practices can strengthen the immune system.

I I . R i s k
f a c t o r s
c o n t r o l

y o u

c a n t

Gender. Being a woman is the most significant risk factor for

developing breast cancer. Although men can get breast cancer,
too, womens breast cells are constantly changing and growing,
mainly due to the activity of the female hormones estrogen and
progesterone. This activity puts them at much greater risk for
breast cancer.
Age. Simply growing older is the second biggest risk factor
for breast cancer. From age 30 to 39, the risk is 1 in 233, or
.43%. That jumps to 1 in 27, or almost 4%, by the time you are
in your 60s.
Family history of breast cancer. If you have a first-degree
relative (mother, daughter, sister) who has had breast cancer,
or you have multiple relatives affected by breast or ovarian
cancer (especially before they turned age 50), you could be at
higher risk of getting breast cancer.
Personal history of breast cancer. If you have already been
diagnosed with breast cancer, your risk of developing it
again, either in the same breast or the other breast, is
higher than if you never had the disease.
Race. White women are slightly more likely to develop breast
cancer than are African American women. Asian, Hispanic, and
Native American women have a lower risk of developing and
dying from breast cancer.
Radiation therapy to the chest. Having radiation therapy to
the chest area as a child or young adult as treatment for
another cancer significantly increases breast cancer risk. The
increase in risk seems to be highest if the radiation was
given while the breasts were still developing (during the teen
years).

33

Breast cellular changes. Unusual changes in breast cells found

during a breast biopsy (removal of suspicious tissue for
examination under a microscope) can be a risk factor for
developing breast cancer. These changes include overgrowth of
cells (called hyperplasia) or abnormal (atypical) appearance.
Exposure to estrogen. Because the female hormone estrogen
stimulates breast cell growth, exposure to estrogen over long
periods of time, without any breaks, can increase the risk of
breast cancer. Some of these risk factors are not under your
control, such as:

starting menstruation (monthly periods) at a young age

(before age 12)

going through menopause (end of monthly cycles) at a late

age (after 55)

exposure to estrogens in the environment (such as

hormones in meat or pesticides such as DDT, which produce
estrogen-like substances when broken down by the body)

Pregnancy and breastfeeding. Pregnancy and breastfeeding

reduce the overall number of menstrual cycles in a womans
lifetime, and this appears to reduce future breast cancer
risk. Women who have never had a full-term pregnancy, or had
their first full-term pregnancy after age 30, have an
increased risk of breast cancer. For women who do have
children, breastfeeding may slightly lower their breast cancer
risk, especially if they continue breastfeeding for 1 1/2 to 2
years. For many women, however, breastfeeding for this long is
neither possible nor practical.
DES
exposure.
Women
who
took
a
medication
called
diethylstilbestrol (DES), used to prevent miscarriage from the
1940s through the 1960s, have a slightly increased risk of
breast cancer. Women whose mothers took DES during pregnancy
may have a higher risk of breast cancer as well.
For more detailed information about risk factors for breast
cancer, visit our Lower Your Risk section.

S y m p t o m s

&

D i a g n o s i s

Breast cancer symptoms vary widely from lumps to

swelling to skin changes and many breast cancers have no
obvious symptoms at all. Symptoms that are similar to those of
breast cancer may be the result of non-cancerous conditions
like infection or a cyst.
Breast self-exam should be part of your monthly health care
routine, and you should visit your doctor if you experience
breast changes.

34

Mammogram. If you're over 40 or at a high risk for the

disease, you should also have an annual mammogram.
Physical Exam by a doctor. The earlier breast cancer is found
and diagnosed, the better your chances of beating it.
The actual process of diagnosis can take weeks and involve
many different kinds of tests. Waiting for results can feel
like a lifetime. The uncertainty stinks. But once you
understand your own unique big picture, you can make better
decisions. You and your doctors can formulate a treatment plan
tailored just for you.

R i s k

o f

D e v e l o p i n g
C a n c e r

B r e a s t

The term risk is used to refer to a number or

percentage that describes how likely a certain event is to
occur. When we talk about factors that can increase or
decrease the risk of developing breast cancer, either for the
first time or as a recurrence, we often talk about two
different types of risk: absolute risk and relative risk.

I .

A b s o l u t e

r i s k

Absolute risk is used to describe an individuals

likelihood of developing breast cancer. It is based on the
number of people who will develop breast cancer within a
certain time period. Absolute risk also can be stated as a
percentage.
The absolute risk of developing breast cancer during a
particular decade of life is lower than 1 in 8. The younger
you are, the lower the risk. For example:

From age 30 to 39, absolute risk is 1 in 233, or 0.43%. This

means that 1 in 233 women in this age group can expect to
develop breast cancer. Put another way, your odds of
developing breast cancer if you are in this age range are 1 in
233.

From age 40 to 49, absolute risk is 1 in 69, or 1.4%.

From age 50 to 59, absolute risk is 1 in 38, or 2.6%.

From age 60 to 69, absolute risk is 1 in 27, or 3.7%.

I I . R e l a t i v e

r i s k

Relative risk is a number or percentage that compares one

groups risk of developing breast cancer to anothers. This is
the type of risk frequently reported by research studies,
which
often
compare
groups
of
women
with
different
characteristics or behaviors to determine whether one group
has a higher or lower risk of breast cancer than the other
(either as a first-time diagnosis or recurrence).

E n d - o f - L i f e

I s s u e s

Palliative care, which provides physical, emotional, and

spiritual relief, must be provided with attempts for curative
35

therapy and becomes the exclusive goal when cure cannot be

expected. At all stages of breast cancer, treatment needs to
be modified for life expectancy.
For patients with metastatic disease for which cure is
not attainable, the physician should clarify the goals of care
through frequent, clear discussions with the patient and, when
appropriate, the family. All should recognize that cognitive
impairment
alone
does
not
exclude
the
patient
from
participating in decision making, because some patients with
impaired cognition are able to understand, explain the
consequences of, and voice an opinion about certain treatment
options.
Pain from bony metastases should be treated as described
above with nonsteroidal anti-inflammatory drugs, pamidronate,
local radiation, and strontium 89 rather than with opioids if
possible. Palliative chemotherapy may be useful when the tumor
invades vital organs.

Chemotherapy
Chemotherapy is treatment with cancer-killing drugs that may
be given intravenously (injected into a vein) or by mouth. The
drugs travel through the bloodstream to reach cancer cells in
most parts of the body. The chemotherapy is given in cycles,
with each period of treatment followed by a recovery period.
Treatment usually lasts for several months.
When is chemotherapy used?
There are several situations in which chemotherapy may be
recommended.
Adjuvant chemotherapy: Systemic therapy given to patients
after surgery who have no evidence of cancer spread is called
adjuvant therapy. When used as adjuvant therapy after
breast-conserving surgery or mastectomy, chemotherapy reduces
the risk of breast cancer coming back. Even in the early
stages of the disease, cancer cells may break away from the
primary breast tumor and spread through the bloodstream. These
cells don't cause symptoms, they don't show up on imaging
tests, and they can't be felt during a physical exam. But if
they are allowed to grow, they can establish new tumors in
other places in the body. The goal of adjuvant chemotherapy is
to kill undetected cells that have traveled from the breast.
Neoadjuvant chemotherapy: Chemotherapy given before surgery is
called neoadjuvant therapy. The major benefit of neoadjuvant
chemotherapy is that it can shrink large cancers so that they
are small enough to be removed by lumpectomy instead of
mastectomy. Another possible advantage of neoadjuvant
chemotherapy is that doctors can see how the cancer responds
to chemotherapy. If the tumor does not shrink, your doctor may
try different chemotherapy drugs.
So far, it's not clear that neoadjuvant chemotherapy improves
survival, but it seems to be at least as effective as adjuvant
therapy after surgery.

36

Chemotherapy for advanced breast cancer: Chemotherapy can also

be used as the main treatment for women whose cancer has
already spread outside the breast and underarm area at the
time it is diagnosed, or if it spreads after initial
treatments. The length of treatment depends on whether the
cancer shrinks, how much it shrinks, and how a woman tolerates
length of treatment. Some of the most common possible side
effects include:
hair loss
mouth sores
loss of appetite
nausea and vomiting
increased chance of infections (due to low white blood cell
counts)
easy bruising or bleeding (due to low blood platelet counts)
fatigue (due to low red blood cell counts and other reasons)

37

D E F I N I T I O N
Breast

cancer

O F

T E R M S

general

terms

It is important to understand some of the key words used to

describe breast cancer.
Carcinoma
This is a term used to describe a cancer that begins in
the lining layer (epithelial cells) of
organs such as the breast. Nearly all breast cancers are
carcinomas (either ductal carcinomas or lobular carcinomas).
Adenocarcinoma
Is a type of carcinoma that starts in glandular tissue
(tissue that makes and secretes a substance). The ducts and
lobules of the breast are glandular tissue (they make breast
milk), so cancers starting in these areas are sometimes called
adenocarcinomas.
Carcinoma in situ
This term is used for the early stage of cancer, when it
is confined to the layer of cells where it began. In breast
cancer, in situ means that the cancer cells remain confined to
ducts (ductal carcinoma in situ) or lobules (lobular carcinoma
in situ). They have not invaded into deeper
tissues in the breast or spread to other organs in the body,
and are sometimes referred to as non-invasive breast cancers.
Invasive (infiltrating) carcinoma
An invasive cancer is one that has already grown beyond
the layer of cells where it started(as opposed to carcinoma
in situ). Most breast cancers are invasive carcinomas either
invasive ductal carcinoma or invasive lobular carcinoma.
Sarcoma
Sarcomas are cancers that start from connective tissues
such as muscle tissue, fat tissue, or blood vessels. Sarcomas
of the breast are rare.
Triple-negative breast cancer
This term is used to describe breast cancers (usually
invasive ductal carcinomas) whose cells lack estrogen
receptors and progesterone receptors. Breast cancers with
these characteristics tend to occur more often in younger
women and in African-American women, and they tend to grow and
spread more quickly than most other types of breast cancer.
Because the tumor cells lack these receptors, neither hormone
therapy nor drugs that target HER2 are effective
against these cancers (although chemotherapy may be useful if
needed).
Mixed tumors
Mixed tumors are those that contain a variety of cell
types, such as invasive ductal cancer combined with invasive
lobular breast cancer. In this situation, the tumor is treated
as if it were an invasive ductal cancer.
Medullary carcinoma
This special type of infiltrating breast cancer has a
rather well defined boundary between tumor tissue and normal
tissue. It also has some other special features, including the
large size of the cancer cells and the presence of immune
38

system cells at the edges of the tumor. Medullary carcinoma

accounts for about 3% to 5% of breast cancers. The outlook
(prognosis) for this kind of breast cancer is generally better
than for the more common types of invasive breast cancer. Most
cancer specialists think that true medullary cancer is very
rare, and that cancers that are called medullary cancer should
be treated as the usual invasive ductal breast cancer.
Metaplastic carcinoma
Is a very rare type of invasive ductal cancer. These
tumors include cells that are normally not found in the
breast, such as cells that look like skin cells (squamous
cells) or cells that make bone. These tumors are treated like
invasive ductal cancer.
Mucinous carcinoma
Also known as colloid carcinoma, this rare type of
invasive breast cancer is formed by mucus-producing cancer
cells. The prognosis for mucinous carcinoma is usually better
than for the more common types of invasive breast cancer.
Paget disease of the nipple
This type of breast cancer starts in the breast ducts and
spreads to the skin of the nipple and then to the areola, the
dark circle around the nipple. It is rare, accounting for only
about 1% of all cases of breast cancer. The skin of the nipple
and areola often appears crusted, scaly, and red, with areas
of bleeding or oozing. The woman may notice burning or
itching.
Paget disease is almost always associated with either
ductal carcinoma in situ (DCIS) or, more often, with
infiltrating ductal carcinoma. If no lump can be felt in the
breast tissue and the biopsy shows DCIS but no invasive
cancer, the prognosis is excellent.
Tubular carcinoma
Tubular carcinomas are another special type of invasive
ductal breast carcinoma. They are called tubular because of
the way the cells are arranged when seen under the microscope.
Tubular carcinomas account for about 2% of all breast cancers
and tend to have a better prognosis than most other
infiltrating ductal or lobular carcinomas.
Papillary carcinoma
The cells of these cancers tend to be arranged in small,
finger-like projections when viewed under the microscope.
These cancers are most often considered to be a subtype of
ductal carcinoma in situ (DCIS), and are treated as such. In
rare cases they are invasive, in which case they are treated
like invasive ductal carcinoma, although the outlook is likely
to be better. These cancers tend to be diagnosed in older
women, and they make up no more than 1% or 2% of all breast
cancers.
Adenoid cystic carcinoma (adenocystic carcinoma)
These cancers have both glandular (adenoid) and cylinderlike (cystic) features when seen under the microscope. They
make up less than 1% of breast cancers. They rarely spread to
the lymph nodes or distant areas, and
they tend to have a very good prognosis.
Phyllodes tumor

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This very rare breast tumor develops in the stroma

(connective tissue) of the breast, in contrast to carcinomas,
which develop in the ducts or lobules. Other names for these
tumors include phylloides tumor and cystosarcoma phyllodes.
These tumors are usually benign but on rare occasions may be
malignant. Benign phyllodes tumors are treated by removing the
mass along with a margin of normal breast tissue. A malignant
phyllodes tumor is treated by removing it along with a wider
margin of normal tissue, or by mastectomy. While surgery is
often all that is needed, these cancers may not respond as
well to the other treatments used for invasive ductal or
lobular breast cancer.
Angiosarcoma
This is a form of cancer that starts from cells that line
blood vessels or lymph vessels. It rarely occurs in the
breasts. When it does, it is usually seen as a complication of
radiation to the breast. It tends to develop about 5 to 10
years after radiation treatment. However, this is an extremely
rare complication of breast radiation therapy.
Angiosarcoma can also occur in the arm of women who develop
lymphedema as a result of lymph node surgery or radiation
therapy to treat breast cancer. These cancers tend to grow
and spread quickly. Treatment is generally the same as for
other sarcomas.

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B I B L I O G R A P H Y

Huether, S.E., McCance K.L., (2004). Understanding Pathophysiology

3rd edition. USA: Mosby
Doenges, M E., Moorehouse, M.F., (2002).
Guidelines
for
individualizing
patient
Philadelphia USA: Davis company
Lee, E.C., Banasik, J., (2005).
Philippines: Elsevier Saunders

Nursing Care Plans:

cares
6th
edition.

Pathophysiology

3rd

edition.

Lemone, P., Burke, K., (2004). Medical-surgical Nursing: Critical

Thinking in Client Care 3rd edition. USA: Pearson
Schilling, J.A., Kelly, W.J., et al (2007). Nursing Drug Handbook
27th edition. Philippines: Lippincott William and Wilkins.
Smeltzer, S.C., Bare, B.G., Hinkle, J.L., and Cheever, K.H. (2008).
Brunner and Suddarths Textbook of Medical-Surgical Nursing 11 th
edition. Philippines: Lippincott Williams and Wilkins.

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