auto recovery save of breast cancer

8/6/2019 Auto Recovery Save of Breast Cancer

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Introduction

“Women agonize... over cancer; we take as a personal threat the lump in

every friend's breast.” ~Martha Weinman Lear, Heartsounds

A group of abnormal cells that have abnormal growth patterns form in

tissues of the breast, usually the ducts (tubes that carry milk to the nipple)

and lobules (glands that make milk) is what we defined Breast Cancer. It

occurs in both men and women, although male breast cancer is rare.

Breast cancer is the leading killer of women ages 35 to 54 worldwide. It is

the second leading cause of cancer deaths in women today (after lung

cancer) and is the most common cancer among women. According to the

American Cancer Society, about 1.3 million women will be diagnosed with

breast cancer annually worldwide about 465,000 will die from the disease.

Breast cancer death rates have been dropping steadily since 1990, according

to the Society, because of earlier detection and better treatments. According

to the WHO, approximately 70 percent of breast cancers occur in women with none

of the known risk factors. Only about 5 percent of breast cancers are inherited. Inthe 1940s, the risk for breast cancer was 1 in 22. Today, it is 1 in 18.

http://www.emedicinehealth.com/script/main/art.asp?articlekey=22433

http://www.emedicinehealth.com/script/main/art.asp?articlekey=22433



Furthermore, In Asia, the Philippines has the highest incidence rate of

breast cancer and is considered to have the ninth highest incidence rate in the

world today.

In terms of breast cancer detection, a local study revealed that the used of

Breast Self Examination (BSE), and aspiration biopsy/open biopsy are the most

effective strategy used in Philippines setting, incurring savings for the government

by almost 3 million Philippine pesos or US $60, 000 (1989) value per year per

100,000 per woman. Mammography is neither readily available nor affordable

especially in the rural areas.

In line with the nursing profession focused on assisting individuals, families,

and communities in attaining, maintaining, and recovering optimal health and

functioning. We the students of San Pedro College BSN 3O group 3, subgroup 1

choose Patient X as our subject for case study.

This case study is about Patient X condition, she has breast cancer stage 3.

Risk factors are also present in the patient. Patient X was treated with sessions of

chemotherapy. Patient X case is an example of cancer metastasis. It was of this

reason that we look into her case as interesting. This will enable us to identify

problems and formulate interventions for our future clients that may have a similar

case. Not only will the members of this group be the beneficiary of this paper. We

would like to share the knowledge that we gained from this sort of disease.



Objectives

The group formulated these objectives for the purpose of directing us

towards the completion of this case study, and to make it an organized and a

methodological one, after our exposure in OR Ward.

General Objectives

That within our 1 week span of duty in OR Ward, San Pedro Hospital Davao

City. Our group will be able to gather pertinent data regarding our client through

interview, and thorough assessment regarding the subject and the patient’s current

condition that would aid us in knowing the disease process involve in the case and

so that the group will also be able to produce a comprehensible case study.

Specific Objectives:

A. Find a patient for our case study;

B. establish a wholesome and interpersonal relationship with the patient and his

family to elicit cooperation and trust from them;

C. formulate an introduction that would give an overview of our patient’s

condition;

D. establish objectives and goals that would help guide our group in making the

case study;

E. gather and present sufficient data and information regarding the total status

of the patient, including the family;

F. identify the health history of our patient, which would include the present

and past health history;



G. assess our patient in a cephalocaudal manner which would help us

understand the condition of the patient more and for our future use in the

study;

H. explain the complete diagnosis of our patient;

I. discuss the basic Anatomy and Physiology of the organs involved in the

patient’s illness and condition;

J. trace the pathophysiology of the patient’s illness through a diagram

presentation and integrate it with symptomatology and etiology;

K. discuss and present the diagnostic examinations undergone by the patient

including the result of such tests as a proof of the patient’s present condition;

L. discuss and present the medical-surgical management in line with the

present condition of our patient;

M. enumerate the drugs prescribed to our patient. Be familiar with the drugs’

actions, indications and contraindications as well as its side and adverse

effects. And knowing what to do in giving such drugs to our patient;

N. render health teachings and discharge planning of the patient that are

essential for her condition;

O. explain the prognosis with its measured calculation which could help in

determining the potential result and outcomes of the patient’s condition; and

P. list down all the books, references and resources used in the achievement of

this case study.



ETIOLOGY

Predisposing Factors

FACTORS RATIONALE

PRESEN

T/

ABSENT

JUSTIFIC

ATION

SEX Breast cancer is the most common

cancer among women because a

woman’s breast cells are constantly

exposed to the growth promoting effect

of female hormones estrogen and

progesterone .

http://www.cancer.org/Cancer/BreastCan

cer/OverviewGuide/breast-cancer-

overview-what-causes

Sa patient

basis ni

Sa patient

basis ni

AGE Breast cancer incidence and death rates

generally increase with age. About 2 out

of 3 women with invasive breast cancer

are 55 or older when the cancer is found.




http://www.cancer.org/Cancer/BreastCancer/OverviewGuide/breast-cancer-overview-what-causes














GENETIC RISK

FACTORS

About 5% to 10% of breast cancers are

thought to be linked to inherited

changes (mutations) in certain genes.

The most common gene changes are

those of the BRCA1 and BRCA2 genes.

Women with these gene changes have

up to an 80% chance of getting breast

cancer during their lifetimes.


cer/OverviewGuide/breast-cancer-overview-what-causes

RACE White women are slightly more likely to

get breast cancer than African-American

women. But African American women

are more likely to die of breast cancer.

Asian, Hispanic, and Native-American

women have a lower risk of getting and

dying from breast cancer.




EARLY

MENARCHE and

LATE

Women who began having periods early

(before age 12) or who went through

the change of life (menopause) after the

age of 55 have a slightly increased risk















MENOPAUSAL

AGE

of breast cancer. They have had more

menstrual periods and as a result have

been exposed to more of the hormones

estrogen and progesterone.




NULLIPARITY

AND NON-BREASTFEEDIN

G WOMEN

Women who have had not had children,

or who had their first child after age 30,

have a slightly higher risk of breast

cancer. Being pregnant many times and

at an early age reduces breast cancer

risk. Being pregnant lowers a woman's

total number of lifetime menstrual

cycles. Breast-feeding slightly lowers

breast cancer risk, especially if the

breast-feeding lasts 1½ to 2 years. This

could be because breast-feeding lowers

a woman's total number of menstrual

periods, as does pregnancy


















Breast Cancer Precipitating Factors

FACTORS RATIONALE

PRESENT

/ ABSENT JUSTIFICATION

HIGH FAT DIET Most studies found that breast

cancer is less common in

countries where the typical

diet is low in fat. On the other

hand, many studies of women

in the United States have not

found breast cancer risk to be

linked to how much fat they

ate. So the study of fat in the

diet have not clearly shown

that it is a breast cancer risk

factor

OBESITY

Being overweight or obese is

linked to a higher risk of

breast cancer, especially for

women after change of life or

if the weight gain took place

during adulthood. Also, the

risk seems to be higher if the

extra fat is around the waist.

But studies of fat in the diet as

it relates to breast cancer risk



have often given conflicting

results .

LONG TERM

ESTROGEN

THERAPY

Post-menopausal hormone

therapy (also known as

hormone replacement therapy

or HRT), has been used for

many years to help relieve

symptoms of menopause and

to help prevent thinning of the

bones (osteoporosis).

Its two types are:

Combined PHT- Use of

combined PHT increases the

risk of getting breast cancer. It

may also increase the chances

of dying from breast cancer.

Breast cancer may also be

found at a more advanced

stage. Five years after

stopping PHT, the breast

cancer risk seems to drop back

to normal.

ERT- he use of estrogen

alone does not seem to

increase the risk of developing

breast cancer very much, if at



all. But when used long-term

(for more than 10 years),

some studies have found that

ERT increases the risk of

ovarian and breast cancer.

ALCOHOL Alcohol used are associated

with increase levels of

circulating estrogen and this is

thought to be the primary

means through which they

confer an increased risk of

breast cancer, since estrogen

can fuel breast cancer growth.

Those who have 2 to 5 drinks

daily have about 1½ times the

risk of women who drink no

alcohol.

-Fred Hutchinson Cancer

Research Center

-www.sciencedaily.com

LACK OF

PHYSICIAL

MOBILITY

One study found that as little

as 1 hour and 15 minutes to

2½ hours of brisk walking per

week reduced the risk by 18%.

Walking 10 hours a week



reduced the risk a little more.

The American Cancer Society

suggests that you exercise for

45 to 60 minutes 5 or more

days a week. Physical activity

may prevent tumor

development by lowering

hormone levels, particularly in

premenopausal women;

lowering levels of insulin and

insulin-like growth factor (IGF-

I) improving the immune

response, and assisting with

weight maintenance to avoid a

high body mass and excess

body fat.

-McTiernan A., editor.

Cancer Prevention and

Management through Exercise

and Weight Control . Boca

Raton: Taylor anf Francis

Group, LLC, 2006

CIGARETTE

SMOKING

Carcinogens found in tobacco

smoke pass through the

alveolar membrane and into

the blood stream, by means of



which they may be transported

to the breast via plasma

lipoproteins. Due to the fact

that they are lipophilic,

tobacco-related carcinogens

can be stored in breast adipose

tissue and metabolize then

activated by human mammary

epithelial cells. Tobacco smoke

contains potential human

breast carcinogens including

PAHs, aromatic amines and N -

nitrosamines and the higher

smoking prevalence of

smoking specific DNA adducts

and P53 gene mutations found

in the breast tissue of smokers

compared with that in non-

smokers supports the

biological plausibility of a

positive association between

cigarette smoking and breast

cancer risk .

-Cigarette Smoking and the

Risk of Breast Cancer in Women.



Paul D. Terry and Thomas

E. Rohan

http://cebp.aacrjournals.org

RADIATION

THERAPY

Women who have had

radiation treatment to the

chest area (Hodgkin’s or non-

Hodgkin’s disease) earlier in

life have a greatly increased

risk of breast cancer. The risk

from chest radiation is highest

if the radiation were given

during the teens, when the

breasts were still developing.

Radiation treatment after age

40 does not seem to increase

breast cancer risk .

RECENT

CONTRACEPTIVE

USE

Women who are using birth

control pills have a slightly

greater risk of breast cancer

than women who have never

used them. This risk seems to

go back to normal over time

once the pills are stopped.

Women who stopped using the



pill more than 10 years ago do

not seem to have any

increased risk. It's a good idea

to talk to your doctor about

the risks and benefits of birth

control pills.

ANTIPERSPIRAN

T USE

Chemicals in underarm

antiperspirants are absorbed

through the skin, interfere

with lymph circulation, caused

toxins to build up in the

breast, and eventually lead to

breast cancer. One small study

has found trace levels of

parabens (used as

preservative in an

antiperspirant and other

products), which have weak

estrogen-like properties in a

small sample of breast cancer

tumor.



SYMPTOMATOLOGY

FACTORS RATIONALE PRESENT/ABSENT JUSTIFICATION

THICKENING or

LUMP IN or NEAR

the UNDERARM

AREA

A woman’s breast can feel lumpier

just before her menstrual periods.

At this time of the month she

experiences a surge in female

hormones- estrogen,

progesterone and prolactin. These

hormones stimulate dense fibrous

tissues to grow and retain fluid.

Breast cancer first announces

itself in a form of a lump.

http:/mothenature.com

Asymmetry Prior to each menstrual period,

the surge to estrogen and

progesterone stimulates fluid

retention and growth in breast

tissue.

Bleeding and Excess fluids seeps out into the

duct which causes discharge from



discharge from

the nipple

the nipples.

Skin dimpling,

orange peeling or

Pittng of the

breast

A dimpling on the breast skin or

nipple could be from the lost of

elasticity of the supporting

ligaments as you age but dimpling

may also be a sign that a tumor is

buried in the tissues is pulling on

the skin or nipples. In the case of

a tumor, dimpling may show up

long before a lump becomes large

enough to feel.

Warmth, Redness

and Swelling

Warmth, redness, and swelling

are due to inflammation process.

It is due to the invasion and

obstruction of the dermal

lymphatic by the tumor.

Medical-surgical Nursing

Black and Hawks, 2004



NARRATIVE PATHOPHYSIOLOGY

The etiology of breast cancer and even on any type of cancer is still

unknown. Predisposing factor s that are present on the case of our patient

are the following: sex, age, early menarche and her late pregnancy, while

her precipitating factor is her usage of antiperspirant for long period of time,

since she was in adolescent age. Under the predisposing factors, these leads

to an over expressed estrogen receptor and in an increase in the estrogen

level and with it the metabolism increases which leads to an increase in cell

proliferation. On the other hand, under the precipitating factor, there is now

absorption of chemicals particularly chemicals that contains a weak

estrogen-like substance that enters to the breast tissues and toxins also

interferes with the lymphatic circulation of the lymphatic system. Toxins

being impacted and stored in the breast builds up. When these two factors

meet, initiation phase begins. Wherein carcinogens binds to cells DNA

resulting to alteration of functions. Genotoxic waste in estrogen metabolism

takes place and there is already an error in cellular duplication, resulting into

a damage and interruption on the cell proliferation, the repair and

elimination process that supposed to be is going to happen in a certain cell,

is now inhibited.

Oncogenes ( any gene that is a causative factor in the initiation of cancerous

growth ) now make it possible fir cell transformations as diving excessively and

uncontrollably until it proceeds to the next phase which is the promotion phase



where a continues duplication of mutated DNA happens. A single cell begins to

divide abnormally and a formation of a new tissue or tumor follows. This is now the

Stage I of cancer. Wherein if not treated, Malignant Conversion happens, an

accumulation of cancer cells in the breast, center of the tumor necrotizes and

begins to chip of malignant cells to seek a new blood supply and cells and cells

eventually break out of the tumor and invade the surrounding nodes and bloods

vessels. Before preceding into the next stage the cancer cells spreads in two ways,

it is either the Lymphatic or Hematologic. When Stage II occurs, cells penetrate

the lymphatic vessels by invasion process and cells lodge in the lymph nodes and

grow. Surrounding lymph nodes and vessels around the breast become obstructed

and are malignant one. Cancer cells continue to stream in lymph fluids and may

undergo metastasis destroying epithelial wall until there is already impairment in

the lymph flow and accumulation of fluid in the chest cavity until new sites of tumor

develop. In stage III before it is going to be diagnosed in that stage, diagnostic

exams are being conducted first, like excisional biopsy, blood test, mammogramand chest x-ray. Once a patient has symptoms suggestive of a breast cancer or an

abnormal screening mammogram, the patient will usually be referred for a

diagnostic mammogram. A diagnostic mammogram is another set of x-rays with

additional angles and close-up views. Often, an ultrasound will be performed during

the same session. An ultrasound uses high-frequency sound waves to outline the

suspicious areas of the breast. It is painless and can often distinguish between

benign and malignant lesions. Depending on the results of the mammograms and

or of the ultrasound, the doctors may recommend to undergo for a biopsy. A biopsy

allows the doctor to get samples of the of tissue to be examined under a



microscope and is the only way to know for sure if it’s a cancer. There are different

types of biopsies; they differ on how much tissue is removed. Some biopsies use a

very fine needle, while others use thicker needle or even require a small surgical

procedure to remove more tissue. The team of doctors will decide which type of

biopsy is needed depending on the particular breast mass.

Once the tissue is removed, a doctor known as a pathologist will review the

specimen. The pathologist ca tell if the cells are cancerous or not, if the tumor does

represent cancer, the pathologist will characterize it by what type of tissue it arose

from, how abnormal it looks (known a grade), whether or not it is invading the

surrounding tissues, and whether or not the entire lump was removed during

surgery. The pathologist will also test the cancer cells for the presence of estrogen

and progesterone receptors can be treated with hormonal therapies. HER-2/neu

expressions may also help predict outcome. There are also some therapies directed

specifically at tumors dependent on the presence of HER-2/neu. On Stage III B if its

not treated, the patient will have a poor prognosis which means that the cancer

cells that are able to survive the environment and pressure still continue to the

venous blood flow and metastasize which lead to Stage IV wherein an impairment

in liver and lungs functioning happen that will results to organ failure and arrest

that may lead to death.



PATHOPHYSIOLOGY

PRECIPITATING FACTORS:

PREDISPOSING FACTORS:

Sex

Age

Early Menarche and latemenopausal

Nulliparity and Non-breastfeeding

OverExpressed

IncreasedEstrogen

Increasedestrogen

Increased

estrogenMetabolism

Increased cellProliferation

Initiation:

Carcinogen Binds top the cell

DNA results to alteration of function

auto recovery save of breast cancer

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