Breast Cancer- Level 2

Breast Cancer

By the end of the lecture, students will be able to:
- State the risk factors of breast cancer.
- Describe the various diagnostic methods and treatments for breast cancer.
- Explain the physical and emotional aspects of nursing care for a patient undergoing breast cancer surgery.

BReast CAncer gene 1 and 2
Everyone has BRCA genes.
In normal cells, BRCA1 and BRCA2 help suppress tumors by preventing uncontrolled cell growth.
Inheritance of BRCA1 and BRCA2 gene mutations has been linked to a greatly increased risk for breast, ovarian, and uterine cancers.

Breast cancer usually starts in milk ducts.
It can then either:
- Remain in-situ – stay within the duct
- Become invasive – break through the walls of the ducts and metastasize
80\% of breast cancer is invasive ductal

One of the best ways for a person to become self-aware of how their breasts normally look and feel, and to detect when something changes.
NOT a reliable way to screen for breast cancer

Benign	Malignant
Round and well-defined	Irregular shape, poorly delineated
Freely movable	Nonmobile (usually attached to chest wall)
Tenderness or pain with palpation	Nontender

Helps identify the lymph node(s) that drain first from the tumor site - sentinel lymph node(s) (SLNs)
Radioisotope and/or blue dye is injected into the affected breast and will travel the same route as the cancer.
If the radioisotope or dye is found in any SLNs, they are biopsied (about 1-4 of them) and sent for pathologic analysis.
If SNLs are negative – no further action needed
If SNLs are positive (or cannot be identified) – may have a complete axillary lymph node dissection (ALND) where 12-20 lymph nodes are typically removed.
SLNB is less invasive and has a lower mortality rate than ALND.

Lumpectomy – with radiation therapy
Mastectomy – with or without reconstruction
- Simple (total) mastectomy – removal of all breast tissue with SLNB
- Modified radical mastectomy – removal of all breast tissue with ALND; pectoralis muscle is spared

Positioning:
- Elevate affected arm on a pillow when lying down
Exercise:
- Flexing and extending fingers begins in PACU with progressive increase in activity at surgeon’s direction
- Don’t put stress on incision or involve shoulder until directed by HCP.
Massage:
- Decongestive therapy with lymphedema therapist
Compression:
- Use intermittent pneumatic compression sleeve or a fitted, elastic pressure sleeve during waking hours
No blood pressure readings, venipunctures, or injections on affected arm.
Avoid burns. Use cooking mitt.
Avoid cuts.
Avoid cutting cuticles. Push back cuticle.
Use electric razor for shaving axilla.

Used after surgery to:
- Prevent local breast cancer recurrence
- Prevent lymph node recurrence
- Relieve pain caused by spread of cancer
Primary lesions are radiated over several weeks.

Definition: Use of cytotoxic drugs to destroy cancer cells
Can be used pre-op (neoadjuvant) or post-op (adjuvant)
- Pre-op: Shrinks the size of the tumor, making surgery more likely to succeed and allowing for more breast conservation
- Post-op: Decreases the rate of recurrence and increases the length of survival
Combinations of drugs are more effective than the use of a single drug

Loss of part (or all) of breast can affect a patient’s:
- Sexual identity
- Body image
- Relationships
Provide a safe environment for expression of feeling.
Help identify sources of support and strength.

Breast reconstruction can be done with implant(s) or the patient’s own tissue.
Musculocutaneous flap, most often taken from abdomen or back, is used in reconstruction.
As part of the final stage of reconstruction, the nipple and areola are reconstructed.