Stage Tumors Surgery Chemo Tx Radiation

0 Cis TM or lumpectomy Tamoxifen For lumpectomy

I Tumors are < 2 cm BCT or MRM Considered for all For BCT
in diameter & invasive tumors
confined to breast

II Tumors are < 5 cm, BCT or MRM Regimen depends For BCT
or smaller with on tumor size &
mobile axillary nodal status
lymph node
involvement

TM-Total BCT- breast

Mastectomy conservation
treatment
IIIa Tumors are > 5 MRM Post-op & To chest wall
cm, possible & possibly
accompanied pre-op axillae after
by enlarged MRM
axilllary lymph
nodes fixed to
one another or
to adjacent
tissue
IIIb More advanced MRM Post-op & To chest wall &
lesions w/ possibly pre-op possibly axillae
sattelite nodules, after MRM
fixation to the
skin or chest
wall, ulceration,
edema, or w/

IV All tumors w/ Possibly To control To control

distant mets lumpectomy or progression progression
mRM and/or palliation and/or palliation
Treatment:
A.Medical Mgt.
1.)Chemotherapy : combination therapy
ØDoxorubicin (Adriamycin)
ØCyclophosphamide (Cytoxan)
ØMethotrexate
Ø5-fluorouracil
2.) Hormonal therapy:
üAndrogens: fluorymesterone (Halotestin)
üEstrogens: diethylstilbestrol ( DES)
üAntihormonal agents: Tamoxifen
3. Radiation therapy
- typically begins about 6 wks after the surgery to allow the incision to heal
Treatment:
B. Surgical mgt.

1.Breast-conserving procedures 6. Breast Reconstruction

oLumpectomy oTissue Expanders
oWide excision oTransverse Rectus Abdominis Muscle
oPartial mastectomy Flap
oSegmental mastectomy oLatissimus Dorsi Muscle Free Flap
oQuadrantectomy oNipple-Areola Reconstruction
2. Axillary lymph node dissection
3. Total Mastectomy
4. Modified Radical Mastectomy
5. Radical Mastectomy
Nursing management
Diagnostic Phase:
1.Minimize uncertainty
2.Prevent disease advancement
3.Protect emotional well-being
4.Establish trusting communication
Adjuvant Therapy Phase:
1.Develop a supportive network
2.Minimize adverse physical outcomes
3.Manage stress
4.Understand family members’ responses
Ongoing Recovery Phase:
1.Maintain association with professionals
2.Maintain positive outlook
3.Redefine self and partner
4.Cultivate ongoing support
Preoperative Nursing Intervention:
1.Explain breast CA, correct misconceptions, and treatment options.
2.Reduce fear
3.Reduce anxiety
4.Improve coping ability
5.Promote decision-making ability
 Postoperative Nursing Intervention:
1.Relieve pain and discomfort
2.Maintain skin integrity
3.Prevent infection, injury
4.Promote positive adjustment & coping
5.Monitor drainage; monitor bleeding