LESSON PLAN

ON
BREAST CANCER

SUBMITTED TO, SUBMITTED BY,

PRINCIPAL MA’AM MS. MANISHA A. DAVID
ASSISSTANT PROFESSOR
SINPS
Subject Medical Surgical Nursing
 Oncology
Unit
Breast cancer
Topic
B.Sc. Nursing IV Sem.
Group
Class room
Place
08.11.2023, 50 min.
Date & time
Lecture cum discussion
Teaching method

AV aids / instructional aids Power Point Tiles, Charts, Black Board

Regarding cancer and also know anatomy and physiology of female reproductive system.
Student Pre requisite

At the end of the class students will acquire adequate knowledge regarding breast cancer, its causes,
General Objective types, pathophysiology, clinical manifestations, diagnostic evaluation, management (medical, surgical,
nursing).
At the end of the session, the learner will be able to
 describe the anatomy and physiology of breast
 define breast cancer
 list out the aetiology of breast cancer
Specific objective  discuss the pathophysiology of breast cancer
 describe the clinical features of breast cancer
 enumerate the diagnostic evaluation of breast cancer
 explain the collaborate management of breast cancer
 describe the nursing management of patient with breast cancer
Review of previous class Ask questions from students about previous class and clear doubts.
Introduction  Breast cancer caused 685 000 deaths globally in 2020.
  Roughly half of all breast cancers occur in women with no specific risk factors other than sex and
age.
 Breast cancer occurs in every country in the world.
 Approximately 0.5–1% of breast cancers occur in men.
S. No Time Specific Content Teaching learning Evaluation
objective activity
05 min. describe the ANATOMY AND PHYSIOLOGY Teaching Activity: What is anatomy
1 anatomy and  Parts, Shape & position of the Gland To explain anatomy & and physiology of
physiology of physiology of breast with breast?
 It is conical in shape.
breast. the help of PPT.
 It lies in superficial fascia of the front of chest.
 It has a base, apex and tail.
 Its base extends from 2nd to 6th ribs. Students Activity:
Students are listening
 It extends from the sternum to the midaxillary
line laterally.
 It has no capsule.
SHAPE AND POSITION OF FEMALE BREAST
 2/3 of its base lies on the pectoralis major
muscle, while its inferolateral 1/3lieson:
 Serratus anterior
 External oblique muscles.
 Its superolateral part sends a process into the
axilla called the axillary tailor axillary process.
Nipple:
 It is a conical eminence that projects forwards
from the anterior surface of the breast.
 The nipple lies opposite 4th inter costal space.
 It carries 15-20 narrow pores of the lactiferous
ducts.
Areola:
 It is a dark pink brownish circular area of skin
that surrounds the nipple.
 The subcutaneous tissues of nipple & areola
are devoid of devoid of fat.
SHAPE AND POSITION OF FEMALE BREAST
 It is non capsulated gland.
 It consists of lobes and lobules which are
embedded in the subcutaneous fatty tissue of
superficial fascia.
 It has fibrous strands (ligaments of cooper)
which connect the skin with deep fascia of
pectoralis major.
 It is separated from the deep fascia covering
the underlying muscles by a layer of loose
areolar tissue which forms the retromammary
space.
STRUCTUREOFMAMMARYGLAND
 It is formed of 15-20 lobes.
 Each lobe is formed of a number of lobules.
 The lobes and lobules are separated by
interlobar and interlobular fibrous & fatty
tissue, called ligaments of Cooper.
 These ligaments give the breasts support by
connecting the skin of the breasts to the
pectoralis muscles below them.
 It has from15-20 lactiferous ducts which open
by the same number of openings on the
 summit of the nipple.
ARTERIALSUPPLY
 Perforating branches of internal thoracic
(internal mammary) artery.
 Mammary branches of lateral thoracic artery.
 Mammary branches of Intercostal arteries.
VENOUS SUPPLY
 Veins are corresponding to the arteries.
 Circular venous plexus are found at the base of
nipple.
 Finally, veins of this plexus drain into
axillary& internal thoracic veins.
2 05 min Define breast DEFINITION Teaching Activity:
cancer It refers to a group of malignant diseases that To define breast cancer
commonly occur in the female breast and infrequently with the help of PPT.
in the male breast. It originates from breast tissue,
most commonly from the inner lining of milk ducts or Students Activity:
the lobules that supplies the ducts with milk. Students are listening
05 min List out the  ETIOLOGY Teacher Activity: What are the
3 aetiology of  Gender (female) and increasing age. Enlist the aetiology and aetiology and risk
Breast cancer  Previous breast cancer: The risk of risk factor of cervical factor of cervical
developing cancer in the same or opposite cancer. cancer
breast is significantly increased. Family
history: Having first-degree relative with Learner’s Activity:
breast cancer (mother, sister, daughter) Students are listening &
increases the risk having two first degree discussion
relatives increases the risk Genetic mutations
(BRCA1 or BRCA2) account for majority of
 inherited breast cancers.
 Hormonal factors: early menarche (before12
years of age), nulliparity, first birth after 30
years of age, late menopause (after 55years of
age), and hormone therapy (formerly referred
to as hormone replacement therapy).
 Other factors may include exposure to
 ionizing radiation during adolescence
and
 early adulthood obesity
 alcohol intake
 high-fat diet
4 05 min Discuss the PATHOPHYSIOLOGY Teacher Activity:
pathophysiolog Due to etiological factors To explain
y of breast pathophysiology of breast
cancer. PTEN protein turns off the PI3K/AKT pathway cancer.

Protective pathways like PI3K/AKT, RAS/MEK/ERK

are mutated that turns the cells permanently on Learner’s Activity:
Students are listening &
Loss of apoptosis discussion

Accumulation of unwanted cells in the breast tissue

Development of breast cancer

5 05 min Describe the CLINICAL FEATURES Teacher Activity:

clinical features Generally, lesions are non-tender, fixed, and hard with Enlist the clinical
of breast cancer irregular borders; most occur in the upper outer manifestation of breast
 and its stages. quadrant. cancer.
Some women have no symptoms and no palpable
lump but have an abnormal mammogram. Learner’s Activity:
Advanced signs may include skin dimpling, nipple Students are listening &
retraction, or skin ulceration. discussion
Stage0: non-invasive carcinoma or carcinoma in situ
Stages I and II: early
Stage III: advanced; tumour >2cmacross and spread to
underarm LNs or is extensive in under arm LNs or
spread to LNs near breast bone or other tissue near
breast
Stage IV: spread beyond breast and underarm LNs to
other body parts
6 05 min To explain the DIAGNOSTIC EVALUATION Teacher Activity:
diagnostic History collection Enlist the diagnostic
evaluation of  Gender (female) and increasing age evaluation of breast
breast cancer  Previous breast cancer: The risk of cancer.
developing cancer in the same or opposite
breast is significantly increased Learner’s Activity:
 Family history: Having first-degree relative Students are listening &
with breast cancer (mother, sister, daughter) discussion
increases the risk twofold; having two first-
degree relatives increases the risk fivefold
these histories conclude that breast cancer.
Physical examination
 skin dimpling, nipple retraction, or skin
ulceration.
 Finding assessed that breast cancer Breast
exam
  BSE is an option for women starting in their
20s.
 Any changes detected should be reported to a
medical expert.
Mammograms
 A technologist will position your breast for the
test. The breast is pressed between 2 plates to
flatten and spread the tissue. The pressure lasts
only a few seconds while the picture is taken.
The breast and plates are repositioned and then
another picture is taken. The whole process
takes about 20 minutes.
 Breast ultrasound Uses sound waves to outline
a part of the body. The sound wave echoes are
picked up by a computer to create a picture on
a computer screen. Used to investigate areas of
concerns found by a mammogram.
Biopsy
 A biopsy is done when other tests show that
you might have breast cancer.
 It confirms if a mass is cancerous or not. Mass
is removed and studied.
7 15 min To elaborate the COLLABRATIVE MANAGEMENT Teacher Activity:
collaborative Medical management: Radiation therapy It can be Explain the collaborate
management of administered through an external beam and via management of breast
breast cancer. iridium implants. cancer
External beam radiation is administered 5 days a
Learner’s Activity:
week by a cobalt machine or linear accelerator with
Students are listening &
use of approximately 5000 rad over 5weeks.
 Chemotherapy discussion
CA (cyclophosphomide+adriamycin)
CAT (cyclophosphomide+adriamycin+taxane)
Hormonal therapy
E.g.: Tab. Tamoxifen (Nolvadex)
SURGICALMANAGEMENT 
Breast conservation surgery (Lumpectomy)
Tumour and surrounding breast tissue are removed.
Muscles, skin and lympnodes left intact.
Simple mastectomy: removing the lobules, ducts,
fatty tissue, nipple, areola, and some skin.
Modified radical mastectomy: simple mastectomy
combined with the removal of the axillary lympnodes.
Radical mastectomy: a simple mastectomy
combined with removing the lympnodes and muscles
of the chest wall.
8 05 min. Enlist the NURSINGMANAGEMENT: Teacher Activity:
nursing Assess the patient previous experiences and Explain the nursing
management of expectation of nausea and vomiting, including cause management of breast
breast cancer and intervention. cancer.
Adjust diet before and after drug administration
according to patient preference and tolerance. Learner’s Activity:
Prevent unpleast sight, Odor and sound in Students are listening &
environment. discussion
Ensure adequate fluid hydration, before during and
after drug administration, assess intake and output
Provide pain relief measure, if necessary.
Assess other contribution factor to nausea and
vomiting such as other symptom, radiation therapy,
 medication.
Assess pain and discomfort characteristic use pain
scale.
Assess other factor contributing to patient pain: fear,
fatigue, anger.
Administer analgesic to promote optimum pain relief.
Assess patient behavioural responses to pain and pain
experiences. Teach patient new strategies to
relieve pain and discomfort.
Summary: Breast cancer is a disease in which abnormal breast cells grow out of control and form tumours. If left unchecked, the tumours can
spread throughout the body and become fatal. Breast cancer cells begin inside the milk ducts and/or the milk-producing lobules of the breast.
The earliest form (in situ) is not life-threatening. Cancer cells can spread into nearby breast tissue (invasion). This creates tumours that cause
lumps or thickening. Invasive cancers can spread to nearby lymph nodes or other organs (metastasize). Metastasis can be fatal. Treatment is
based on the person, the type of cancer and its spread. Treatment combines surgery, radiation therapy and medications.

Conclusion: Breast cancer is the most common type of tumour in women in most parts of the world. Although stabilized in Western countries,
its incidence is increasing in other continents. Prevention of breast cancer is difficult because the causes are not well known.
Evaluation:
Q1: - Which of the following techniques have been used to screen breast cancer??

a. breast self-examination
b. mammography
c. clinical breast examination
d. all of these

Q2: - Which is the most common form of breast cancer?

a) Invasive ductal carcinoma

b) Ductal carcinoma in situ
 c) Infiltrating (invasive lobular carcinoma)
d) None of the above

Q3: - What is the risk factor of breast cancer?

a) Bearing children after 30
b) Consumption of alcohol
c) Being overweight after menopause
d) All of the above

Assignment: Assignment on breast self-examination and mammography.

Bibliography:
 Lewis (2018). Text book of medical surgical nursing, Elsiever publication, Pg.no:1141to1152 2.
 Brunner & Suddarth’s, (2008). Text book of medical surgical nursing, 11th edition, volume II, Lippincott Williams & William
publication, Pg. No: 386to390
 BT Basvanthappa, medical surgical nursing, 2nd edition, Jaypee publication new Delhi, pg.no 436 to 443