lemessa jira bearst cancer slide share
TRANSCRIPT
Seminar presentation By:- Lemessa jira
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Presentation outline • Breast anatomy • breast cancer• Epidemiology of breast cancer• Types of breast cancer• Stages of breast cancer • Cause of breast cancer • Risk factors • Diagnosis and treatment• Nursing interventions
Learning Objectives• At the end of this session, you will be able to:• Understand anatomy of breast• Define breast cancer• categorize types & stages of breast cancer• List the causes of breast cancer• Understand risk factors for breast cancer• Describe the diagnosis and treatment options
of breast cancer• Identify nursing interventions for breast
cancer4cribe
Female Breast Anatomy• Breasts consist mainly of
fatty tissue interspersed with connective tissue
• There are also less conspicuous parts
– lobes– ducts– lymph nodes
(American cancer society, 2016)
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Normal BreastBreast profile
A ducts
B lobules
C dilated section of duct to hold milk
D nipple
E fat
F pectoralis major muscle
G chest wall/rib cage
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EnlargementA normal duct cells
B basement membrane (duct wall)
C lumen (center of duct)
Illustration © Mary K. Bryson
Muscles
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Breast hasno
muscle tissue
Musclesunderneath the breasts
separating them from the ribs
Breast Gland
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• Each breast has 15 to 20 sections (lobes) arranged like the petals of daisy
• Inside each lobe are many smaller structures called lobules
• At the end of each lobule are tiny sacs (bulbs) that can produce milk
Ducts
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Areola
Lobes, lobules, and bulbs areLinked by a
network of thintubes (ducts)
Ducts carrymilk from bulbs
toward dark areaof skin in thecenter of the
breast (areola)
Ducts join togetherinto larger ducts ending
at the nipple, wheremilk is delivered
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Blood Vessels
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Oxygen, nutrients, and other life-sustaining nourishment are delivered to breast tissue by the blood in the arteries and capillaries.
Lymphatic System
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• Lymph ducts: Drain fluid that carries white blood cells (that fight disease) from the breast tissues into lymph nodes under the armpit and behind the breastbone
• Lymph nodes: Filter harmful bacteria and play a key role in fighting off infection
(Bahcall O, 2013)A network of vessels
Lymph ductLymph node
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• Breast cancer starts when cells in the breast begin to grow out of control. These cells usually form a tumor that can often be seen on an x-ray or felt as a lump
(American cancer society, 2016)
epidimiology
• In the US, around 1 in 8 women carry a lifetime risk of invasive breast cancer.
(American cancer society, 2016) 14
Breast cancer is the common cancer in women worldwide. It represents 16% of all cancers in women. This rate is twice that of colorectal cancer and cervical cancer and about three times that of lung cancer.
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Cont..Somewhere in the world… • A case of breast cancer is diagnosed every 19 seconds • A woman dies from breast cancer every 60 secondsOver the next 25 years… • Another 42 million new cases are expected worldwide • Another 13 million people worldwide will die from breast cancer (Globocan, 2012)
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Types of breast cancers • Ductal carcinoma in situ (DCIS)
- DCIS means that abnormal cells start in the cells lining the ducts without invading through the walls of the ducts into the tissue of the breast. Because the cells haven’t invaded, DCIS is also sometimes called a non-invasive breast cancer.
Ductal Carcinoma in situ (DCIS)
17Illustration © Mary K. Bryson
Ductal cancer cells
Normal ductal cellCarcinoma refers to
any cancer that begins in the skin or other tissues that cover internal organs
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Cont…
• Invasive (or infiltrating) ductal carcinoma (IDC)
- This is the most common breast cancer. It starts in the cells lining a duct, and then the abnormal cells break through the wall of the duct and grow into (invade) the tissue of the breast
Invasive Ductal Carcinoma (IDC – 80% of breast cancer)
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• The cancer has spread to the surrounding tissues
Illustration © Mary K. Bryson
Ductal cancer cells breaking through the wall
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• Invasive (infiltrating) lobular carcinoma (ILC)
- This cancer starts in the cells lining the milk glands (the lobules). The cells grow through the wall of the lobules and then can spread to nearby lymph nodes or other parts of the body.
Invasive Lobular Carcinoma (ILC)
21Illustration © Mary K. Bryson
Lobular cancer cells breaking
through the wall
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• Inflammatory breast cancer (IBC) - This is a rare type of invasive breast
cancer. Often, there is no single lump or tumor. Instead, IBC makes the skin of the breast look red and feel warm.
(American cancer society, 2016)
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Stages of breast cancer
• Stage 0—non-invasive carcinomas (LCIS or DCIS). Cancer cells have not invaded the surrounding breast tissue.
• Stage I—the tumor is no more than 2 cm in size and cancer cells have not spread beyond the breast.
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• Stage II—either the tumor has spread to the lymph nodes under the arms but the tumor is less than 2 cm in size, or the tumor has not spread to the lymph nodes under the arms but is greater than 5 cm in size, or the tumor is between 2 and 5 cm and may or may not have spread to the nodes
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Cont…• Stage III—the tumor is greater than 5 cm in
size and has spread to the lymph nodes under the arms.
• Stage IV—the cancer has spread to other parts of the body (metastatic cancer).
(American Joint Committee on Cancer, 2010)
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Causes of breast cancer • The exact causes of breast cancer are not
well understood• Breast cancer is usually caused by a
genetic abnormality. However, only 5-10% of cancers are due to an abnormality inherited from parents.
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• The National Institute of Environmental Health Sciences (NIEHS) added estrogen to its list of known cancer-causing agents.
(December 2015)
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Risk Factors• Non modifiable risk factors Gender: Breast cancer is much more common in
women than in men. Age: risk goes up with age.
80% of breast cancer occur in women older than age 50. in 30s, have one in 233 chance of developing breast cancer. By age 35, chance is one in eight.
(Anderson GL, et al, 2012)
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Cont…• Genetic risk factors: Inherited changes
(mutations) in certain genes like BRCA1 and BRCA2 can increase the risk
• Around 45 percent of women who inherit a harmful BRCA2 mutation will develop breast cancer by age 70 years.
(Burstein HJ, et al, 2011)
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Cont…Menstrual periodsBreast radiation early in lifeFamily history Personal history of breast cancer Dense breast tissueRaceEarly menopause is protective
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• Modifiable risk factorNot having children or having them later
in lifeUsing hormone therapy after menopauseBeing overweight or obeseNot breastfeedingAlcohol
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Compared to women who don't drink at all, women who have three alcoholic drinks per week have a 15% higher risk of breast cancer. Experts estimate that the risk of breast cancer goes up another 10% for each additional drink women regularly have each day
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Screening for breast cancer • The term screening refers to tests and
exams used to find a disease like cancer in people who do not have any symptoms. The earlier breast cancer is found, the better the chances that treatment will work. The goal is to find cancers before they start to cause symptoms
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Signs and symptoms of breast cancer
• The most common symptom of breast cancer is a new lump or mass. A lump that is painless, hard, and has uneven edges is more likely to be cancer.
• Swelling of all or part of the breast• Skin irritation or dimpling
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Cont…
• Breast pain• Nipple pain or the nipple turning inward • Redness, scaliness, or thickening of the
nipple or breast skin• A nipple discharge other than breast milk • Change in color or appearance of areola
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Diagnosis of breast cancer• Complete history• Physical exam (including a breast
exam)
Mammography• Use a low-dose x-ray system to
examine breasts• Digital mammography replaces
x-ray film by solid-state detectors that convert x-rays into electrical signals. These signals are used to produce images that can be displayed on a computer screen (similar to digital cameras)
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What Mammograms ShowTwo of the most important mammographic indicators of breat cancers
– Masses– Microcalcifications: Tiny flecks of calcium
– like grains of salt – in the soft tissue of the breast that can sometimes indicate an early cancer.
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Detection of Malignant Masses
Malignant masses have a more spiculated appearance
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malignant
benign
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Breast ultrasound
• An ultrasound uses sound waves to outline a part of the body. The sound wave echoes are picked up by a computer to create a picture on a computer screen. For most breast ultrasounds, a small, microphone-like instrument is placed on the skin of the breast after gel is applied.
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Cont…• This test is often used to look at an
area of concern found on a mammogram. It can tell if something is a cyst or a solid mass (tumor).
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MRI of the breast • MRI scans use magnets and radio waves
(instead of x-rays) to produce very detailed, cross-sectional images of the body. For a breast MRI, you have to lie face down on a special platform inside a narrow tube. The platform has openings for each breast that allow the image to be taken without pressing on the breast
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Biopsy• A biopsy is done when other tests
show that you might have breast cancer. The only way to know for sure is for you to have a biopsy. During this test, cells from the area of concern are removed so they can be studied in the lab.
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Types of treatment for breast cancer
• Surgery • Radiation • Chemotherapy • Hormone therapy • Targeted therapy • Ovarian ablation or suppression
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Surgery • Surgery is usually the first type of treatment for
breast cancer. The type of surgery you undergo will depend on the type of breast cancer you have.
There are two main types of breast cancer surgery:
• breast-conserving surgery – the cancerous lump (tumour) is removed
• mastectomy – surgery to remove the whole breast
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Chemotherapy • Chemotherapy involves using anti-cancer
(cytotoxic) medication to kill the cancer cells.
• It's usually used after surgery to destroy any cancer cells that haven't been removed. This is called adjuvant chemotherapy.
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Radiotherapy
• Radiotherapy uses controlled doses of radiation to kill cancer cells. It's usually given after surgery and chemotherapy to kill any remaining cancer cells.
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Hormone treatment
• Some breast cancers are stimulated to grow by the hormones estrogen or progesterone, which are found naturally in your body.
• These types of cancer are known as hormone receptor-positive cancers. Hormone therapy works by lowering the levels of hormones in your body or by stopping their effects
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Nursing process DIAGNOSES
• Risk for infection, related to surgical incision
• Acute pain, related to surgery
• Disturbed body image, related to loss of breast. Decisional conflict about treatment, related to
concerns about risks and benefits. Fear, related to disease process/prognosis
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Cont… EXPECTED OUTCOMES
• Remain free of infection. • Experience minimal pain or discomfort
during her recovery. • Maintain a positive body image, regardless
of her decision about reconstruction.
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Cont…
• Evaluate the treatment options in relation to personal values and decide on a course of action.
• Identify the sources of her fear and demonstrate behaviors that may reduce fears.
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IMPLEMENTATION• Teach her about hand washing and wound
care.• Discuss the postoperative drainage device
and its management after she goes home.• Assess her pain tolerance and administer
analgesics as prescribed
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Cont…• Encourage her to discuss her thoughts
and feelings about her body changes• Encourage her to verbalize her fears
about her own prognosis and about her daughters’ future risk of breast cancer; assess the need/interest for referral to psychological counseling.
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Cont…• Assess her interest in spiritual/religious
support and refer if appropriate.• Teach her about dietary and lifestyle
changes that can help reduce the risk of breast cancer for her daughters (low-fat, high-fiber diet; regular exercise; avoidance of obesity, alcohol, and oral contraceptives).
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References • American Joint Committee on Cancer. Breast. In: AJCC Cancer Staging Manual, 7th ed. New
York: Springer; 2010: 347–369.• American Cancer Society. Cancer Facts and Figures 2016. Atlanta, Ga: American Cancer
Society; 2016• Anderson GL, Clebowski RT, Aragaki AK, et al. Conjugated equine oestrogen and breast cancer
incidence and mortality in postmenopausal women with hysterectomy: extended follow-up of the Women’s Health Initiative randomised placebo-controlled trial. Lancet Oncol. 2012 May;13(5):476−486. Epub 2012 Mar 7.
• Bahcall O. Common variation and heritability estimates for breast, ovarian and prostate cancers. Nature Genetics. Accessed at www.nature.com/icogs/primer/common-variationand-heritability-estimates-for-breast-ovarian-and-prostate-cancers/ on May 30, 2013.
• Burstein HJ, Harris JR, Morrow M. Malignant tumors of the breast. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg's Cancer: Principles and Practice of Oncology. 9th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2011:1401–1456.
