cancers

UNIT 6: IMMUNOLOGY AND CANCERS

BREAST DISORDERS

Overview of the Anatomy of the Breast

  • Structural Components:

    • Clavicle
    • Pectoralis major muscle
    • Intercostal muscles
    • Ribs
    • Lobules
    • Ductule
    • Milk duct
    • Inframammary fold
    • Fat
    • Nipple pore
    • Suspensory ligaments of Cooper

  • Quadrants of the Breast:

    • Upper inner
    • Upper outer
    • Lower inner
    • Lower outer
    • Tail of Spence

Cultural and Psychosocial Considerations

  • Breast cancer is a major health problem affecting various demographics and cultures.

Breast Cancer Statistics in the U.S.

  • More than 215,000 women and 1,450 men develop breast cancer annually.
  • More than 40,000 deaths occur due to breast cancer each year.

RISK FACTORS FOR BREAST CANCER

  • Female gender
  • Age
  • Personal and family history, including genetic mutations
  • Hormonal factors
  • Exposure to radiation
  • History of benign breast disease
  • Obesity
  • High-fat diet (controversial)
  • Alcohol intake

GUIDELINES FOR EARLY DETECTION OF BREAST CANCER

  • Clinical breast exam for women in their 20s and 30s at least every 3 years and preferably annually after age 40.
  • Annual mammography beginning at age 40.
  • Women at increased risk may require:
    • Earlier initial screening
    • Shorter screening intervals
    • Additional screening procedures like ultrasound or MRI
  • Instruction on breast self-examination (BSE) benefits and limitations should begin in their 20s.

BREAST SELF-EXAMINATION (BSE)

  • Instructions should be provided to women regarding BSE.
  • Men should also be informed if there’s a family history of breast cancer.
  • Encourage BSE without overemphasizing its necessity.
  • Instructional materials can be acquired from:
    • American Cancer Society (ACS)
    • National Cancer Institute

TEACHING BREAST SELF-EXAM

  • Best performed days 5–7 after the first day of menses or once monthly for postmenopausal women.
  • Emphasis on normal breast tissue and how to identify changes.
  • Routine BSE helps women recognize their natural breast abnormalities.
  • Demonstration of the examination technique is crucial.
  • Learners should perform a BSE demonstration on themselves or a breast model.

Technique Involves

  • Part of the examination can be done in the shower with soapy hands to glide over the breast, which helps focus on underlying tissue.
  • Include assessment of the area between the breast and underarm, as well as the underarm itself.
  • Discuss the importance of reporting any changes.
  • Outline goals, instructional methods, and evaluation methods for teaching BSE.
  • Provide lists of resources for information and materials.

BREAST DISORDERS

  • Benign Conditions:

    • Breast pain
    • Cysts
    • Fibroadenomas
    • Benign proliferative breast disease:
    • Atypical hyperplasia
    • Lobular carcinoma in situ

  • Malignant Conditions:

    • Breast cancer

DIAGNOSTIC TESTS

  • Mammography
  • Galactography
  • Ultrasonography
  • Magnetic resonance imaging (MRI)
  • Biopsies:
    • Percutaneous: fine-needle aspiration, core biopsies
    • Surgical biopsies: excision, incision, wire needle localization

SURGICAL MANAGEMENT OF BREAST CANCER

  • Breast conservation treatment
  • Total mastectomy
  • Modified radical mastectomy
  • Sentinel node biopsy and axillary lymph node dissection
  • Breast reconstruction surgery

NONSURGICAL MANAGEMENT OF BREAST CANCER

  • Radiation therapy:
    • External beam
    • Brachytherapy
  • Chemotherapy
  • Hormonal therapy:
    • Estrogen and progesterone receptor assay
    • Selective estrogen receptor modulators (SERMs) such as tamoxifen
    • Aromatase inhibitors: anastrazole, letrozole, exemestane
  • Targeted therapy

NURSING PROCESS – ASSESSMENT FOR SURGICAL PATIENT

  • Assess how the patient is responding to her diagnosis.
  • Evaluate coping mechanisms that are helpful to her.
  • Determine the psychological or emotional supports she utilizes (partner, family, friends).
  • Identify her educational needs.
  • Noting any discomfort.

NURSING PROCESS - PREOPERATIVE DIAGNOSIS

  • Possible diagnoses include:
    • Deficient knowledge
    • Anxiety
    • Fear
    • Risk for ineffective coping
    • Decisional conflict

NURSING PROCESS - POSTOPERATIVE DIAGNOSIS

  • Possible diagnoses include:
    • Pain
    • Disturbed sensory perception
    • Disturbed body image
    • Self-care deficit
    • Risk for sexual dysfunction
    • Deficient knowledge related to:
    • Drain management
    • Arm exercises
    • Hand and arm care

COLLABORATIVE PROBLEMS / POTENTIAL COMPLICATIONS

  • Lymphedema
  • Hematoma/seroma formation
  • Infection

NURSING PROCESS – PLANNING

  • Major goals may include:
    • Increase knowledge about the disease and its treatment
    • Reduce preoperative and postoperative fear, anxiety, and emotional stress
    • Improve decision-making ability and coping skills
    • Improve sexual function
    • Prevent complications

NURSING PROCESS – PREOPERATIVE INTERVENTIONS

  • Review and reinforce information regarding treatment options.
  • Prepare the patient for expectations before, during, and after surgery.
  • Educate about surgical drains, arm and shoulder mobility, and range-of-motion exercises.
  • Maintain open communication.
  • Provide realistic expectations.
  • Support coping and involve supportive services as needed.

NURSING PROCESS – POSTOPERATIVE INTERVENTIONS

  • Inform the patient about common postoperative sensations.
  • Ensure privacy is maintained.
  • Provide a bra with breast form post-surgery.
  • Offer counseling and referrals as necessary.
  • Monitor for potential complications.

HAND AND ARM CARE

  • Address the potential for lymphedema formation after axillary lymph node dissection (ALND).
  • Emphasize the importance of patient education and prevention guidelines.
  • Recommendations include:
    • No blood pressure measurements, injections, or blood draws in the affected arm.
    • Perform exercises three times a day for 20 minutes to enhance circulation and muscle strength.
    • Mild analgesics or warm showers can ease the exercise process.
    • Limit lifting to no more than 5–10 pounds temporarily.

CERVICAL CANCER

  • RISK FACTORS:
    • Sexual activity
    • Exposure to Human Papillomavirus (HPV)
    • Human Immunodeficiency Virus (HIV)
    • Smoking
    • Low socioeconomic status
    • Nutritional deficiencies
    • Chronic cervical infections

PREVENTION

  • Regular pelvic exams and PAP tests.
  • Education on risk factors and prevention strategies.
  • Smoking cessation programs.
  • HPV immunization vaccination.

CLINICAL MANIFESTATIONS

  • Rarely any symptoms in the early stage.
  • Symptoms may include:
    • Discharge
    • Irregular bleeding
    • Bleeding after intercourse
    • Leg pain
    • Dysuria
    • Rectal bleeding
    • Edema of extremities

ASSESSMENT & DIAGNOSTIC TESTING

  • Abnormal Pap smear findings require follow-up.
  • Biopsy may be indicated.
  • Staging of the cancer.
  • Diagnostic tests may include colposcopy, dilation and curettage (D&C), CT, MRI.

MEDICAL MANAGEMENT

  • Precursor or Preinvasive Lesions:

    • Cryotherapy
    • Loop electrocautery excision procedure (LEEP)
    • Conization

  • Invasive Cancer Treatments:

    • Brachytherapy
    • Surgery

OVARIAN CANCER

FACTS

  • Ovarian cancer carries a 3- to 4-fold increased risk for breast cancer.
  • Associated with BRCA-1 and BRCA-2 genes, which lead to increased risk for both breast and ovarian cancers.

RISK FACTORS

  • Nulliparity (having never given birth)
  • Infertility
  • Older age, particularly peaking in late 70s
  • High dietary fat intake
  • Talc in the perianal area
  • Family history of cancer
  • History of breast cancer

PROTECTIVE BARRIERS

  • Hysterectomy
  • Use of oral contraceptives
  • Breastfeeding
  • Pregnancy

CLINICAL MANIFESTATIONS

  • Symptoms include:
    • Increased abdominal girth
    • Pelvic pressure
    • Bloating
    • Back pain
    • Indigestion
    • Flatulence
    • Leg and pelvic pain

ASSESSMENT & DIAGNOSTICS

  • Any enlarged ovary should be thoroughly investigated.
  • Approximately 75% have metastasized by the time of diagnosis.
  • Roughly 60% have spread outside the pelvis.

MEDICAL MANAGEMENT

  • Surgical Options Include:

    • Staging
    • Exploration
    • Reductive surgery

  • Pharmacologic Management:

    • Chemotherapy as indicated.

NURSING MANAGEMENT

  • Provision of emotional support.
  • Implement comfort measures as needed.
  • Provide information and education to the patient.
  • Exhibit attentiveness and caring to the patient throughout the treatment process.