BREAST CANCER

MR. POORAN SINGH BHATI

ASSISTANT PROFESSOR
MEDICAL SURGICAL NURSING
SMT. D.S.S.N.I
 INTRODUCTION
• Breast cancer is the most common malignant condition of breast.
• Breast cancer is an uncontrolled growth of breast cells.
• The term breast cancer refers to a malignant tumor that has developed from cells in
the breast.
• The most common form of cancer among women.
• The 2nd most common cause of cancer related mortality 1 of 8 women (12.2%).
• One third of women with breast cancer die
TYPES-
• Two types of breast cancer
1. Ductal carcinoma
2. Lobular carcinoma
3. Metastatic breast cancer
 ETIOLOGY & RISK FACTORS
• The exact cause of breast cancer is unknown.
• Age & gender
• Family history of breast cancer
• Personal history of breast cancer
• Certain breast changes.
• Reproductive & menstrual history.
• Atypical hyperplasia.
• Hormonal replacement therapy (Estrogen & progesterone)
• Oral contraceptive use
• Over weight or obese after menopause.
• Lack of physical activity.
• Alcohol abuse
 STAGES OF BREAST CANCER
• Stage-O- Non-invasive carcinoma or carcinoma in situ.
• Stage-I- The tumor is no larger than 2cm & cancer cells are confined to the breast.
• Stage-II- A tumor has started to spread to the lymph node or the tumor has >5cm in size.
• Stage-III- The tumor has exceeded 5cm & has spread into the lymph nodes in a more extensive way than in a
stage-II.
• Stage-IV- The cancer has metastasized & spread to other organs of the body.
TNM CLASSIFICATION-
• T1- Tumor size <2cm
• T2- Tumor size 2-5cm
• T3- Tumor size >5cm
• T4- Tumor extends to skin or chest wall.
• No- No lymph node metastasis
• N1- Metastasis to Ipsilateral, movable, axillary lymph node.
• N2- Metastasis to Ipsilateral fixed axillary or internal mammary lymph node.
• N3- Metastasis to infraclavicular/supraclavicular lymph node or to axillary & internal mammary lymph node.
• Mo- No distant metastasis
 CLINICAL MANIFESTATION
• A lump or thickening in or near the breast or in the underarm area.
• A change in the size or shape of the breast.
• The skin of breast, areola or nipple may be scaly, red or swollen.
• Skin irritation or dimpling.
• Breast pain.
• Nipple pain or tenderness.
• A nipple turned inward into the breast.
• Unilateral nipple discharge other than breast milk.
• Enlarged axillary or supraclavicular lymph nodes.
• Change in nipple position.
 DIAGNOSTIC EVALUATION
• History collection.
• Physical examination.
• Clinical breast examination
• Ultrasonography
• MRI
• Fine needle aspiration & cytology (FNAC)
• Core biopsy
• Excision biopsy
• Mammography- It is a special type of low powered x-ray technique that captures a
pictures of the internal structure of the breast.
• PET Scan
• CT Scan
 MANAGEMENT
RADIATION THERAPY-
• It involves medical use of Ionizing radiation used in cancer treatment.
• It can be used as a curative, palliative care.
• Ionizing radiation work by damaging the DNA of cancerous tissues leading to cellular
death.
• External beam radiation therapy.
• Brachytherapy.
• Radio Isotope therapy.
CHEMOTHERAPY-
• Treatment of cancer with one or more cytotoxic antineoplastic drugs.
• It is often used in conjugation with radiation therapy or surgery.
• Chemotherapy agents act by killing cells that divide rapidly one of the main properties of
cancerous cells.
 MANAGEMENT
SURGICAL MANAGEMENT-
• Radical Mastectomy-
• Excision of complete breast tissue, pectoral muscle, axillary lymph node &
associated skin & subcutaneous tissues.
• Modified Redical Mastectomy (MRM)-
• Excision of entire breast tissue, fascia over the chest muscle, axillary lymph nodes
& pectoral muscles remain intact.
• Simple/total Mastectomy-
• It involves surgical removal of entire breast tissue but lymphatic tissue & pectoral
muscles are pressured.
• It involves a low to moderate risk of lymphedema due to post operative radiation
therapy.
 MANAGEMENT
BREAST CONSERVING SURGERY-
• Lumpectomy- Surgical removal of lump, margin of normal tissue surrounding lump. It may include
sampling or removal of axillary lymph nodes.
• Segmental Mastectomy- Excision of mass along with some portion of breast tissues.
• Quatrectomy- Excision of affected quadrant of the breast tissues.
CRYO-SURGERY- In this surgery uses extreme cold to freeze & kill cancer cells.
BREAST RECONSTRUCTIVE SURGERY-
• It is the rebuilding of the breast after mastectomy & sometimes lumpectomy.
• It is done to hence body image & to provide symmetry of breast.
• Breast reconstruction is done by accomplishing as prosthesis implants, tissue expansion or flap procedure.
• Silicone implants (Prosthetic clavical)
• Lattissimus dorsi myocutaneous flap
• Transverse rectus abdominus myocutaneous flap
• Gluteal free flap.
HORMONAL THERAPY- Aromatase inhibitors (Letrozole, Anastrozole) use for treatment of breast
cancer.
MANAGEMENT
• Exercise after Mastectomy-
• Chest wall stretch
• Shoulder stretch
• Wall hand climbing
• Rope turning.
• Pulley tugging
• Rod or broomstick lifting.
Wall hand climbing
Pulley tugging Rod or Broomstick lifting