1.0 Breast Cancer

Breast Cancer

The most common cancer in FEMALES

Numerous etiologies implicated

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Breast Cancer is second only to lung cancer as cause of deaths in american women.

somatic cell genes

• Cancer involves the abnormal multiplication and spread of cells in the body.

• It is usually caused by mutations in________ that regulate cell growth.

• Almost every tissue in the body can produce cancer; some even generate many different types of cancer.

• However, cancer mostly occurs in cells that divide and reproduce more than other cells.

Lobules

Breast Cancer occurs when a mutation takes place in the cells that line the _______that manufacture milk or more commonly in the ducts that carry it to the nipple.

Breast Cancer

The area around the center of the breast is where most cancers occur.

It is fairly rare for cancers to form in the fat or non-glandular tissues of the breast.

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The causes of breast cancer are not completely understood and are not set in stone. But certain women are more susceptible of developing one form of cancer.

• Race

• Menstrual Cycle

• Estrogen

Risk Factors that cause Breast Cancer

• Factors that cannot be prevented

  • Gender

    Aging

    Genetic Risk Factors (inherited)

    Family History

    Personal History

  • -

  • -

  • -

• Oral contraceptives

• not having children

• not breastfeeding

• Hormone replacement therapy

Risk Factors that cause Breast Cancer

• Lifestyle Risks

  • -

  • -

  • -

  • -

  • Alcohol Use

    Obesity

    High Fat Diets

    Physical Inactivity

    Smoking

• Exposure to estrogen

• Radiation

• Electromagnetic fields

• Xenoestrogen

• Exposure to chemicals

Environmental Factors

Hormonal Replacement Therapy

Oral Contraceptives

Exogenous Estrogen

• -

• -

Hormonal replacement therapy

Exogenous Estrogen

• 30% increased risk with long term use

Oral Contraceptives

Exogenous Estrogen

• risk slight

  risk returns to normal once the use of OC’s has been discontinued

• Atpyical Hyperplasia

• Intraductal carcinoma in situ

• Intralobular carcinoma in situ

RISK FACTORS FRO BREAST CANCER

• Radiation exposure

• Breast disease

  • -

  • -

  • -

• Obesity

• Diet

  • Fat

  • Alcohol

BRCA 1

BRCA 2

P53, Rb1

Her-2/neu

c-erB2

c-myc

Genetics

BRCA 1 and 2

Ovarian Cancer

Prostate Cancer

Both of these genes code for DNA repair.

If a woman has a mutation on either one of these genes, the risk of her getting breast cancer increases from 10% to 80% in her lifetime.

Mutations in_____ or _____ account for 40-50% of all cases of inherited breast cancer.

These genes are also associated with _______ in women and _______ in men.

These genes can be inherited either from the mother or the father.

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PROTECTIVE FACTORS

1. Exercise

2. Breast feeding

3. Pregnancy before 30 yo

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Upper outer quadrant

NON-tender

Skin dimpling

Nipple retraction

Peau d’orange

ASSESSMENT FINDINGS

1. MASS- the most common location is the ________

2. Mass is ______. Fixed, hard with irregular borders

3. _______

4. _______

5._______

• Ductal Carcinoma in situ

• Invasive Ductal Carcinoma

• Invasive lobular carcinoma

3 types of breast cancer

Ductal Carcinoma In Situ

Invasive Ductal Carcinoma

The cancer has spread to the surrounding tissues

Carcinoma refers to any cancer that begins in the skin or other tissues that cover internal organs

80%

Invasive Lobular Carcinoma

Lobular cancer cells breaking through the wall

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Tumor size

Node

Metastasis

The American Joint Committee on Cancer (AJCC) has designated staging by

Stage 1

Tumor < 2.0 cm in greatest dimension

No nodal involvement (N0)

No metastases (M0)

Stage 2

Tumor > 2.0 < 5 cm

or

Ipsilateral axillary lymph node (N1)

No Metastasis (M0)

Stage 3

Tumor > 5 cm (T3)

or ipsilateral axillary lymph nodes fixed to each other or other structures (N2)

involvement of ipsilateral internal mammary nodes (N3)

Inflammatory carcinoma (T4d)

Stage 4

Any T

Any N

Metastasis (M1)

Breast Self-examination

Opportunity for woman to become familiar with her breasts

Monthly exam of the breasts and underarm area

May discover any changes early

Begin at age 20, continue monthly

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WHEN TO DO BSE

Menstruating women- 5 to 7 days after the beginning of their period

Menopausal women - same date each month

Pregnant women – same date each month

Takes about 20 minutes

Perform BSE at least once a month

Examine all breast tissue

Breast Exam

The doctor will check both of your breasts, feeling for any lumps or other abnormalities. Your doctor will likely check your breasts in varying positions, such as with your arms above your head and at your side.

Mammogram

is a X-ray of the breast that takes pictures of the fat, fibrous tissues, ducts, lobes, and blood vessels.

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When should a mammogram be performed?

• If a lump has been found during self-examination or by a physician

• Younger women who have a strong history of breast cancer in their family

• All women over forty

• Women who have had previous diagnosis of breast cancer.

Breast Ultrasound

Ultrasound uses sound waves to produce images of structures deep within the body. Your doctor may recommend an ultrasound to help determine whether a breast abnormality is likely to be a fluid-filled cyst or a solid mass, which may be either benign or cancerous.——— is helpful to guide radiologic biopsy to get a sample of breast tissue if a solid mass is found.

Breast Biopsy

Needle Biopsy

is necessary to confirm or rule out cancer. _______ can provide a core of tissue or a fluid aspirate, but ______ biopsy should be restricted to fluid-filled cysts and advanced malignant lesions.

Breast Biopsy

Lumpectomy

provides a complete tissue specimen, which can be sectioned to allow more accurate evaluation.

or _______

all part of lump is removed and tested for malignancy

• Vital Signs

• Ice packs

• Supportive bra

• Report bleeding

• Emotional support

Breast Biopsy: Nursing Interventions

Breast MRI

uses a magnet and radio waves to create pictures of the interior of your breast. Before a ______, you receive an injection of dye. This test may be ordered after a breast biopsy confirms cancer, but before surgery to give your doctor an idea of the extent of the cancer and to see if there's any evidence of cancer in the other breast.

• Chemotherapy

• Radiation Therapy

• Drugs

• Surgery

Treatment for Breast Cancer

Chemotherapy

• destroying cells that are dividing and multiplying all the time.

• used for treatment of breast cancer because there is a possibility of the cancer to spread to other parts of the body.

• works better for premenopausal women.

• prevent the spread of cancer.

• drugs are administered intravenously.

Radiation

at high energy levels, has the ability to destroy what is in its path, including normal and abnormal cells

Fortunately new technologies have found a way to battle cancer with __________.

________ usually destroys rapidly dividing cancerous cells.

Normal cells have the ability to repair themselves.

Drugs

Usually drugs used to battle cancer are taken while receiving some other type of treatment.

Most of the time as well, three or four drugs are used at the same time, so there is an overlapping effectiveness.

There are four drugs that are commonly used to battle breast cancer.

Alkylating Agents

Antimetabolites

Natural Products

Hormones

Types of Drugs used to treat Breast Cancer (4)

Alkylating Agents
Cytoxan

______

These types of drugs usually damage the programs that control the growth in tumor cells.

Antimetabolites

_______ and ______

This type of drug interferes with the making of nucleotides, which are the substances that make up DNA.

Natural Products

_______ (Oncovin and vinblastine (Velban) come from the periwinkle plant.

These drugs interfere with cell structure as well as cell division.

Hormones

_________

affect the growth of hormones and usually enhances the effects of other cytotoxic drugs.

Lumpectomy

Surgery to remove a tumor (lump) and a small amount of normal tissue around it.

Partial Mastectomy

Surgery to remove the part of the breast that has cancer and some normal tissue around it. This procedure is also called a segmental mastectomy.

Total Mastectomy

Surgery to remove the whole breast that has cancer. This procedure is also called a simple mastectomy. Some of the lymph nodes under the arm may be removed for biopsy at the same time as the breast surgery or after. This is done through a separate incision.

Modified radical mastectomy

Surgery to remove the whole breast that has cancer, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes, part of the chest wall muscles.

Radical Mastectomy

Surgery to remove the breast that has cancer, chest wall muscles under the breast, and all of the lymph nodes under the arm. This procedure is sometimes called a Halsted radical mastectomy.