breasr cancer report 2013
TRANSCRIPT
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BREAST CANCER
Breast cancer is a malignant tumor that starts
in the cells of the breast.
A malignant tumor is a group of cancer cells
that can grow into (invade) surrounding
tissues or spread (metastasize) to distantareas of the body.
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The disease occurs almost entirely in women,
but men can get it, too.
One of every 13 Filipino women are expected todevelop breast cancer in her lifetime. (Philippine
Star, 2013)
Breast cancer is the most common cancer in thePhilippines, taking at least 16 percent of the
50,000 cases diagnosed. (Department of Health
and Philippine Cancer Society, 2010)
In men , less than 1% of all breast cancers.(Dr.
Aldine Basa, 2010)
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The Normal
Breast
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The Lymphatic
System of the Breast
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Pathogenesis of Breast Cancer
Normal cells in the body communicate with
each other and regulate each other's
proliferation (division).Cells proliferate toreplace worn-out cells.
When cancer occurs, cells escape the normalcontrols on their growth and proliferation.
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How do cells escape their normal
growth and proliferation?
By acquiring damage (mutations) to genes
that normally regulate cell proliferation.
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What are the genes that are being
damaged?
Tumor Suppressor Genes
they control the processes of cell growth and cell
death (called apoptosis).
Proto-oncogenes
responsible for promoting cell growth.
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What happens to the genes when
mutated?
Tumor Suppressor Genes (acquired/inherited)
this can lead to tumor formation or growth
Proto-oncogenes (acquired)
they become oncogenes and then can promote
tumor formation or growth.
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Two Categories of Breast Cancer
Noninvasive Breast Cancer
Ductal Carcinoma in Situlocated within the ductand have not invaded the surrounding fatty breasttissue.
Lobular Carcinoma in Situabnormal cells growinside the lobules of the breast, but have not spreadto the nearby tissue or beyond.
Invasive Breast Cancer
Infiltrating Ductal Carcinomaoriginates in themammary glands and grows in the epithelial cells
lining these ducts.
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Possible Outcomes of Metastasis of
Breast Cancer
70% of breast cancer patients suffer from
bone metastases.
10% suffer from brain metastases. 20% suffer from lung and liver metastases.
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Manifestation of Metastases
Metastatic breast cancer to the lung or pleura
causes
chronic cough,
dyspnea
abnormal chest X-ray
chest pain
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Manifestation of Metastases
Metastatic disease to the bone causes
severe,
progressive pain
less commonly
pathological fracture
erythema over the affected bone
swelling
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Manifestation of Metastases
Metastatic breast cancer to the brain causes
the following symptoms:
persistent,
progressively worsening headache,
visual changes,
seizures, nausea or vomiting,
vertigo,
behavioral and personality changes,
increased intracranial pressure.
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Manifestation of Metastases
Metastatic disease to the liver causes
Jaundice
elevated liver enzymes
abdominal pain
loss of appetite
nausea
vomiting
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Gender
Simply being a woman is the main risk factor
for developing breast cancer.
Men can develop breast cancer, but thisdisease is about 100 times more common
among women than men.
This is likely because men have less of thefemale hormones estrogen and progesterone,
which can promote breast cancer cell growth
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Aging
Your risk of developing breast cancer
increases as you get older.
About 1 out of 8 invasive breast cancers arefound in women younger than 45, while
about 2 of 3 invasive breast cancers are
found in women age 55 or older.
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Race and Ethnicity
Overall, White women are slightly more likely todevelop breast cancer than are African-Americanwomen, but African-American women are more
likely to die of this cancer. However, in women under 45 years of age, breast
cancer is more common in African-American
women. Asian, Hispanic, and Native-American women
have a lower risk of developing and dying frombreast cancer.
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Dense Breast Tissue
Women with dense breasts is four to five
times more likely to get breast cancer than
women with less dense breasts.
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P lif i l i i h i I h
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Proliferative lesions with atypia: In these
conditions, there is an overgrowth of cells in
the ducts or lobules of the breast tissue, withsome of the cells no longer appearing normal.
They have a stronger effect on breast cancerrisk, raising it 3 1/2 to 5 times higher than
normal.
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Menstrual periods
Women who have had more menstrual cycles
because they started menstruating early
(before age 12) and/or went through
menopause later (after age 55) have a slightly
higher risk of breast cancer.
The increase in risk may be due to a longer
lifetime exposure to the hormones estrogen
and progesterone.
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Having children
Women who have had no children or who had
their first child after age 30 have a slightly
higher breast cancer risk.
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Hormone Therapy and Birth Control
Pills
Women using this therapeutic regimens can
increase the risk of developing breast cancer
due to the prolonged exposure of estrogen
and progesterone.
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Alcohol
Alcohol causes cancer cells' blood vessels to
grow which in turn fuels the growth of the
tumor, a process known as angiogenesis.
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Overweight and Obese
Most of a woman's estrogen comes from fat
tissue. Having more fat tissue especially after
menopause can increase your chance of
getting breast cancer by raising the estrogen
levels.
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Tobacco Smoking
For a long time, studies found no link between
cigarette smoking and breast cancer.
In 2009, the International Agency for Research on
Cancer concluded that there is limited evidence that
tobacco smoking causes breast cancer.
It is Suggestive but not Sufficient evidence
of a link at this point. (The 2006 US Surgeon
General's report, The Health Consequences of
Involuntary Exposure to Tobacco Smoke)
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Other possible signs and symptoms: Swelling of all or part of a breast (even if no distinct
lump is felt)
Skin irritation or dimpling Breast or nipple pain
Nipple retraction (turning inward)
Redness, scaliness, or thickening of the nipple or breastskin
Nipple discharge (other than breast milk)
Lymph nodes under the arm
.
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Early Cancer Detection Women age 40 and older should have a
mammogram every year and should continueto do so for as long as they are in good health.
Women in their 20s and 30s should have aclinical breast exam (CBE) as part of a periodic(regular) health exam by a health professionalpreferably every 3 years. Starting at age 40,women should have a CBE by a healthprofessional every year.
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Early Cancer Detection Breast self-examination (BSE) is an option for
women starting in their 20s. Women shouldbe told about the benefits and limitations ofBSE. Women should report any breast
changes to their health professional rightaway.
Women at high risk (greater than 20% lifetimerisk) should get an MRI and a mammogramevery year.
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Nursing Diagnosis
Deficient knowledge related to planned surgicaltreatments.
Anxiety related to the diagnosis of cancer
Fear related to specific treatments and bodyimage changes
Risk for ineffective coping related to the diagnosis
of breast cancer Decisional conflict related to treatment options.
Disturbed body image related to loss or alteration
of the breast
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Screening Procedures
Self-Breast Examination
Clinical Breast Examination
Mammogram
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Diagnostic exams in Breast CABiopsy
It is the examination of affected tissue in detectingpresence of cancer cells.
Nuclear Magnetic Resonance Imaging
This is viewing the structure of the breast using a high tech
radiation imaging in detecting presence of mass or tumors.
Ductogram
A type of X-ray that helps determine the cause of nipple
discharge. A ductogram can show if there is a mass inside
the duct at the nipple
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Treatment
Lumpectomy
Partial or segmental mastectomy
Simple mastectomy
Modified radical mastectomy Axillary lymph node dissection
Chemotherapy
Radiation Therapy
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Surgical Nursing Intervention
Pre-operative Obtain informed consent
Provide good care for a breast care
Be sure to know what kind of surgery to beperformed in order to prepare the patient
If mastectomy is scheduled:
Prevent pulmonary complications andthromboembolism
Place patient on the affected side
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Surgical Nursing Intervention
Post-operative Inspect dressing anteriorly and posteriorly
Check circulatory status
Encourage coughing exercises and turning scheduleevery two hours
Provide psychological and emotional support
Explain to the patient that she may experience phantom
breast syndrome
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Nursing Interventions Monitor for adverse effects of radiation therapy such as
fatigue, sore throat, dry cough, nausea, anorexia.
Monitor for adverse effects of chemotherapy; bonemarrow suppression, nausea and vomiting, alopecia,
weight gain or loss, fatigue, stomatitis, anxiety, anddepression.
Realize that a diagnosis of breast cancer is a devastating
emotional shock to the woman. Provide psychologicalsupport to the patient throughout the diagnostic andtreatment process.
Involve the patient in planning and treatment.
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Nursing Interventions Describe surgical procedures to alleviate fear.
Prepare the patient for the effects of chemotherapy, and planahead for alopecia, fatigue.
Administer antiemetics prophylactically, as directed, forpatients receiving chemotherapy.
Administer I.V. fluids and hyperalimentation as indicated.
Help patient identify and use support persons or family orcommunity.
Suggest to the patient the psychological interventions may benecessary for anxiety, depression, or sexual problems.
Teach all women the recommended cancer-screeningprocedures.
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Medications
Trastuzumab (Herceptin) Pertuzumab (Perjeta)
Ado-trastuzumab emtansine
(KadcylaLapatinib (Tykerb)
Bevacizumab (Avastin)
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