Case Presentation

On Breast Cancer
By Ms. Manasi A. Chaskar.
F.Y.M.Sc. Nursing
 Learning objectives
1. To know the meaning of breast cancer & its types.
2. Discuss the anatomy & physiology of mammary gland.
3. Describe the classifications of breast cancer.
4. Discuss the etiology & risk factors of breast cancer.
5. Explain pathophysiology of breast cancer.
6. Identify the symptoms of breast cancer.
7. Know various diagnostic findings for detecting breast
cancer.
8. Discuss various treatment strategies for treating breast
cancer
9. Demonstrate breast self examination. Discuss health
education for post operative and post chemo recepient
patient.
 What Do You Mean By tumor?

An abnormal mass of tissue that forms when cells

grow and divide more than they should or do not die
when they should. Tumors may be benign (not
cancer) or malignant (cancer).
1)Benign tumors: Benign tumors may grow large
but do not spread into, or invade, nearby tissues or
other parts of the body.
2)Malignant tumors: Malignant tumors can spread
into, or invade, nearby tissues. They can also spread
to other parts of the body through the blood and
lymph systems. Also called neoplasm.
 What Do You Mean By Breast
Cancer?
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 milk-producing 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.
Anatomy Of Mammary Gland
ARTERIAL SUPPLY:
1.Perforating branches of internal thoracic
(internal mammary) artery.
2.Mammary branches of lateral thoracic artery.
3.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.
 Physiology Of Mammary Gland
Functions of Female Breast:
• lactation
• During pregnancy, estrogen and progesterone stimulate the breast and
causes the enlargements of the ducts and glands. This ultimately
increases the size of the breasts. For a few days after child birth, the
breasts will produce a fluid called colostrum. This is yellowish substance
that is rich in protein and lactose but has very little fat.
• Following birth, the anterior pituitary gland will stimulate the production
of the milk usually by the third day after child birth. This milk has a much
higher concentrations of fats and carbohydrates than colostrum.
• The process of suckling stimulates the nerves in the breasts to send an
electrical signal to the hypothalamus. The hypothalamus then stimulates
the posterior pituitary gland to release oxytocin.
• Oxytocin travels to the breasts and causes the muscles to contract, which
squeezes the breast milk into the ducts and out of the nipple.
 Do You Know About
Lymphatic System And
Lymphatic Drainage?
SR. NO. BOOK PICTURE ( ETIOLOGY) PATIENT PICTURE

1. Genetic Abnormality Not known ( proper history not known by informant)

2. Ageing process Yes; age >70 years

3. Gender: most commonly Females Yes; female
4. Race: most common in whites No
5. Age: increases as woman get older Yes; old age ( >70 years)
6. Family history: mother or sisters No
7. Menstrual history: early menarche or late No
menopause
8. Child birth: child bearing after age of 30 years, or No
null parity
9. Obesity Yes; overweight as BMI-26.8kg/m2
10. Diet: fat, alcohol Yes ( diet including more fats)
11. Lack of physical activity, stress Yes; lack of exercise, loneliness due to loss of spouse

12. Radiation exposure No

13. History of cancer: breast, cervix, uterus No
14. Hormones: estrogen in hormonal replacement No
therapy and birth control pills
15. Genetics: genetic inherited disorders No
Pathophysiology
Classification of Breast Cancer:
1. Histopathology: This is based upon characteristics seen
upon light microscopy of biopsy specimens
2. Grade: This focuses on the appearance of the breast
cancer cell comparing with normal breast tissues
3. Stage: TNM (tumor, node, metastasis) system
4. Receptor status: According to estrogen progesterone
receptor- DNA-based
Signs & Symptoms
Of Breast Cancer
SR. NO. BOOK PICTURES PATIENT PICTURES

1. New lump in the breast or underarm (armpit) Present, lump in left breast 2.4*2*1.6cm in size,
approximately 4.5 cm away from nipple.

2. Thickening or swelling of part of the breast Absent

3. Irritation or dimpling of breast skin Present, Irritation & Itching

4. Redness or flaky skin in the nipple area or the Absent

breast

5. Pulling in of the nipple or pain in the nipple area Absent

6. Nipple discharge other than breast milk, including Absent

blood

7. Any change in the size or the shape of the breast Lump observed ; change in shape, tenderness

8. Pain in any area of the breast Absent

9. Peau d'orange Appearance Absent

Clinical Breast Examination
Breast Ultrasound
PET scan
BIOPSY
 Treatment Modalities Of Breast Cancer
Its treatment depends on the stage of cancer. It may
consist of chemotherapy, radiation, hormone therapy
and surgery.
AIMS OF TREATMENT :
• To achieve possible cure
• Control of local disease in breast and axilla
• Breast conservation; Breast form and function
• Prevention of distant metastasis
• To prevent local recurrence
Surgical Management of Breast Cancer
Surgical Principles:
1. Establish a diagnosis
2. Completely eradicate the primary tumor
3. Determine if regional nodes are involved with
metastasis
4. Wide excision with radiation therapy for local
tumors
5. Mastectomy recommended for a multicentric/larger
tumors.
6. Removal of axillary nodes is necessary for accurate
staging.
SIMPLE MASTECTOMY
MODIFIED RADICAL MSTECTOMY
Breast-conserving surgery
Sentinel Lymph Node Biopsy
(SLNB)
Axillary Lymph Node Dissection
Post Operative Nursing Interventions
• Reliving pain and discomfort
• Many patients tolerate the breast surgery quite well and have minimal pain
during the postoperative periods.
• Analgesic medication, warm bath or relaxation and distraction methods .
• Managing post operative sensation; Common sensation such as tenderness ,
numbness , tightness , , and pulling.
• Phantom sensation ( feeling post mastectomy that breast \ and or nipple are
still present).May persist for 2 years or longer. Reassure the patient and these
sensations are not indication of problem.
• Promoting positive body image.
• Emotional distress patient need (Conversation treatment) or Breast
reconstructions; Temporary breast form to place in her bra.
• Promoting positive adjustment and coping. Identifying supporting system
and providing information.
• Anxiety related to treatment (e.g. chemotherapy)
• Ineffective coping need consultation of mental health practitioner
 Radiation Therapy
• Radiation therapy works by damaging the DNA within cancer
cells and destroying their ability to reproduce. When the
damaged cancer cells are destroyed by radiation, the body
naturally eliminates them. Normal cells can be affected by
radiation, but they are able to repair themselves.
• Radiation therapy is the use of high-energy ionizing rays to
destroy a cancer cell's ability to grow and multiply.
• The goal of radiation therapy is to deliver a precisely
measured dose of irradiation to a defined tumor volume with
minimal damage to surrounding healthy tissue.
• This results in eradication of tumor, high quality of life,
prolongation of survival, and allows for effective palliation or
prevention of symptoms of cancer, with minimal morbidity.
Nursing Management Patient with Radiation Therapy
1. Teaching is a primary responsibility of nursing care for radiation patients. e.g. What is
radiation therapy, purpose, duration of therapy, possible side effects and its management.
2. Monitor and assess the patient’s pain level using a standard 0-to-10 pain scale. Note what pain
medications the patient takes and whether these are effective.
3. If appropriate, refer patients with fatigue for physical therapy, which can ease fatigue and
improve stamina.
4. Obtain a complete list of the patient’s medications and monitor for drug interactions. Stress
the importance of informing all healthcare providers of medication changes.
5. PROTECTING THE SKIN AND ORAL MUCOSA •The nurse assesses the patient’s skin, nutritional
status, and general feeling of well-being. •The skin and oral mucosa are assessed frequently for
changes (particularly if radiation therapy is directed to these areas). • The skin is protected from
irritation, and the patient is instructed to avoid using ointments, lotions, or powders on the area.
6. PROTECTING THE SKIN AND ORAL MUCOSA •Weigh patients weekly on the same scale. If
appropriate, refer them to a dietitian. • Be aware that patients who have difficulty swallowing
and maintaining adequate nutrition and hydration may need a percutaneous endoscopic
gastrostomy tube.
7. PROTECTING THE SKIN AND ORAL MUCOSA •A dehydrated patient may require I.V. fluids.
Teach the patient to report dehydration signs and symptoms, such as weakness, dizziness, and
decreased urine output
 CHEMOTHERAPY
Chemotherapy-is the use of chemicals to treat disease. Paul
Erlich, considered to be the father of chemotherapy,
Chemotherapy is the use of antineoplastic drugs to promote tumor
cell destruction by interfering with cellular function and
reproduction. It includes the use of various chemotherapeutic
agents and hormones.
Chemotherapy is a term used to describe any treatments that
utilizes the introduction of chemical agents to an organism to help
control, stop and or terminate the rapid growth of cells. There are
60 types of chemotherapy currently available and new ones being
developed all the time.
The drugs enter the bloodstream and reach all parts of the body
Cytotoxic drugs destroy cancer cells by damaging them so that
they can’t divide and grow. The drugs can also affect normal cells.
Types of chemotherapeutic agents: Drugs acting directly on
cells ( cytotoxic drugs) 1. Alkylating agents: a) Nitrogen
mustards (Cyclophosphamide, melphalan) b) Ethylenimine
(Thio-TEPA) c) Alkyl sulfonates (Busulphan) d) Nitrosoureas
(carmustin) e) Triazine (Decarbazine) f) Miscellaneous
(Hydroxyurea,Procarbzine)
Drugs altering hormones : 1.Glucocorticoids (Prednisolone)
2.Estrogen (Diethylstilbestrol) 3.Antiestrogen (Tamoxifen)
4.Androgens (Testosterone) 5.Progestins (Hydroxyprogestrone)
Routes of administration of Chemotherapeutic agents: A. Oral,
capsule, tablet, or liquid B. I.V, push (bolus) or infusion over a
specified time period C. Intramuscular D.
Intrathecal/intraventricular given by injection via an Ommaya
reservoir or by lumbar puncture E. Intra-arterial F. Intracavitary
”such as peritoneal cavity G. Intravesical into uterus or bladder
H. Topical
Nursing Management in Chemotherapy

• Assessing fluid and electrolyte status

• Management of Extravasations
Nursing Diagnosis
Health Education
Any Questions??????
 Pilates and dance to patients with breast cancer
undergoing treatment: study protocol for a
randomized clinical trial
The purpose of this study is to provide a Pilates solo and a belly dance protocol (three
times per week/16 weeks) for women undergoing breast cancer treatment and compare
its effectiveness with that in the control group.
The participants will be allocated to either the intervention arm or a control group. The
Pilates solo and belly dance classes will be divided into three stages: warmup and
stretching, the main stage, and relaxation.
Measurements of the study outcomes will take place at baseline; postintervention; and
6, 12, and 24 months after the end of the intervention. The data collection for both
groups will occur with a paper questionnaire and tests covering general and clinical
information. The primary outcome will be quality of life, and secondary outcomes will be
physical aspects such as cardiorespiratory fitness (6-min walk test and cycle ergometer),
lymphedema (sum of arm circumference), physical activity, disabilities of the arm , range
of motion (goniometer test), muscular strength (dynamometer test) and flexibility (sit
and reach test), and psychological aspects such as depressive symptoms (Beck
Depression Inventory), body image (Body Image After Breast Cancer Questionnaire), self-
esteem (Rosenberg), fatigue (FACT-F), pain (VAS), sexual function (FSFI), and sleep quality
(Pittsburgh Sleep Quality Index).
Pilates solo and belly dancing are two types of physical activity
that involve mental and physical concentration, music, upper
limb movements, femininity, and social involvement. An
intervention with these two physical activities could offer options
of supportive care to women with breast cancer undergoing
treatment, with the aim being to improve physical and
psychological quality of life.
 Eurythmy therapy versus slow movement fitness in the
treatment of fatigue in metastatic breast cancer patients:
study protocol for a randomized controlled trial
Cancer-related fatigue (CRF) is the most taxing symptom for many breast cancer patients during
and after therapy. The aim of this study is to assess the effect on fatigue of eurythmy therapy
(ERYT) compared to slow movement fitness (CoordiFit) in metastatic breast cancer patients.
The ERYT/CoordiFit study is a randomized controlled, open-label, two-arm, multi-
center Swiss clinical trial. A sample of 196 patients presenting with CRF will be
recruited by oncologists from the departments of clinical oncology at each local study
site. All participants will be randomly allocated to the intervention or control group in
a 1:1 ratio. The control group is an active control intervention (CoordiFit) in order to
control for potential non-intended effects such as therapist-patient interaction and
participation in a program. Both ERYT and CoordiFit exercises are easy to learn, and
the training sessions will follow the same frequency and duration schedule, i.e., 13
standardized therapy sessions of 45 min (once a week for 6 weeks and then once
every second week) during the total intervention period of 20 weeks. The primary
endpoint of the study is the change from baseline over the whole intervention period
(i.e., including measurements at baseline, weeks 8, 14, and 20) in the Functional
Assessment of Chronic Illness Therapy - Fatigue (FACIT-F) subscale score.
This study is the first-known randomized clinical trial assessing
eurythmy therapy in the treatment of fatigue in metastatic
breast cancer patients. Given the distress that fatigue causes
patients, it is important to validate treatment options. If
eurythmy therapy proves beneficial in CRF as part of this
randomized controlled clinical trial, the study may be very
impactful with implications not only for metastatic breast cancer
patients but also for other cancer patients, health care
personnel, scientists, and funding and regulatory bodies.
Summary
Conclusion